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ALLIANCE ONE INTERNATIONAL HEALTH CARE & BENEFIT PLAN FOR SALARIED EMPLOYEES 401k Plan overview

Plan NameALLIANCE ONE INTERNATIONAL HEALTH CARE & BENEFIT PLAN FOR SALARIED EMPLOYEES
Plan identification number 501

ALLIANCE ONE INTERNATIONAL HEALTH CARE & BENEFIT PLAN FOR SALARIED EMPLOYEES Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)
  • Other welfare benefit cover

401k Sponsoring company profile

ALLIANCE ONE INTERNATIONAL, INC. has sponsored the creation of one or more 401k plans.

Company Name:ALLIANCE ONE INTERNATIONAL, INC.
Employer identification number (EIN):541746567
NAIC Classification:312200
NAIC Description: Tobacco Manufacturing

Additional information about ALLIANCE ONE INTERNATIONAL, INC.

Jurisdiction of Incorporation: Virginia Secretary of State
Incorporation Date: 1994-10-19
Company Identification Number: 0435445
Legal Registered Office Address: Bank of America Center, 16th Floor
1111 East Main Street
RICHMOND
United States of America (USA)
23219

More information about ALLIANCE ONE INTERNATIONAL, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ALLIANCE ONE INTERNATIONAL HEALTH CARE & BENEFIT PLAN FOR SALARIED EMPLOYEES

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012019-01-01LAURA D JONES2020-10-02 LAURA D JONES2020-10-02
5012018-01-01LAURA D JONES2019-10-15 LAURA D JONES2019-10-15
5012017-01-01
5012016-01-01
5012015-01-01
5012014-01-01
5012014-01-01
5012013-01-01
5012012-01-01LAURA D. JONES LAURA D. JONES2013-07-29
5012011-01-01LAURA D. JONES LAURA D. JONES2012-08-13
5012009-01-01MITCHELL C. PULLEY MITCHELL C. PULLEY2010-09-20

Plan Statistics for ALLIANCE ONE INTERNATIONAL HEALTH CARE & BENEFIT PLAN FOR SALARIED EMPLOYEES

401k plan membership statisitcs for ALLIANCE ONE INTERNATIONAL HEALTH CARE & BENEFIT PLAN FOR SALARIED EMPLOYEES

Measure Date Value
2019: ALLIANCE ONE INTERNATIONAL HEALTH CARE & BENEFIT PLAN FOR SALARIED EMPLOYEES 2019 401k membership
Total participants, beginning-of-year2019-01-01758
Total number of active participants reported on line 7a of the Form 55002019-01-01335
Number of retired or separated participants receiving benefits2019-01-01410
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-01745
2018: ALLIANCE ONE INTERNATIONAL HEALTH CARE & BENEFIT PLAN FOR SALARIED EMPLOYEES 2018 401k membership
Total participants, beginning-of-year2018-01-01781
Total number of active participants reported on line 7a of the Form 55002018-01-01363
Number of retired or separated participants receiving benefits2018-01-01395
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-01758
2017: ALLIANCE ONE INTERNATIONAL HEALTH CARE & BENEFIT PLAN FOR SALARIED EMPLOYEES 2017 401k membership
Total participants, beginning-of-year2017-01-01797
Total number of active participants reported on line 7a of the Form 55002017-01-01365
Number of retired or separated participants receiving benefits2017-01-01416
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-01781
2016: ALLIANCE ONE INTERNATIONAL HEALTH CARE & BENEFIT PLAN FOR SALARIED EMPLOYEES 2016 401k membership
Total participants, beginning-of-year2016-01-01815
Total number of active participants reported on line 7a of the Form 55002016-01-01363
Number of retired or separated participants receiving benefits2016-01-01434
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-01797
2015: ALLIANCE ONE INTERNATIONAL HEALTH CARE & BENEFIT PLAN FOR SALARIED EMPLOYEES 2015 401k membership
Total participants, beginning-of-year2015-01-01827
Total number of active participants reported on line 7a of the Form 55002015-01-01371
Number of retired or separated participants receiving benefits2015-01-01444
Number of other retired or separated participants entitled to future benefits2015-01-010
Total of all active and inactive participants2015-01-01815
2014: ALLIANCE ONE INTERNATIONAL HEALTH CARE & BENEFIT PLAN FOR SALARIED EMPLOYEES 2014 401k membership
Total participants, beginning-of-year2014-01-01855
Total number of active participants reported on line 7a of the Form 55002014-01-01377
Number of retired or separated participants receiving benefits2014-01-01450
Total of all active and inactive participants2014-01-01827
2013: ALLIANCE ONE INTERNATIONAL HEALTH CARE & BENEFIT PLAN FOR SALARIED EMPLOYEES 2013 401k membership
Total participants, beginning-of-year2013-01-01877
Total number of active participants reported on line 7a of the Form 55002013-01-01390
Number of retired or separated participants receiving benefits2013-01-01465
Total of all active and inactive participants2013-01-01855
2012: ALLIANCE ONE INTERNATIONAL HEALTH CARE & BENEFIT PLAN FOR SALARIED EMPLOYEES 2012 401k membership
Total participants, beginning-of-year2012-01-01874
Total number of active participants reported on line 7a of the Form 55002012-01-01390
Number of retired or separated participants receiving benefits2012-01-01487
Total of all active and inactive participants2012-01-01877
2011: ALLIANCE ONE INTERNATIONAL HEALTH CARE & BENEFIT PLAN FOR SALARIED EMPLOYEES 2011 401k membership
Total participants, beginning-of-year2011-01-01904
Total number of active participants reported on line 7a of the Form 55002011-01-01380
Number of retired or separated participants receiving benefits2011-01-01494
Total of all active and inactive participants2011-01-01874
2009: ALLIANCE ONE INTERNATIONAL HEALTH CARE & BENEFIT PLAN FOR SALARIED EMPLOYEES 2009 401k membership
Total participants, beginning-of-year2009-01-01887
Total number of active participants reported on line 7a of the Form 55002009-01-01391
Number of retired or separated participants receiving benefits2009-01-01412
Total of all active and inactive participants2009-01-01803
Total participants2009-01-010

Form 5500 Responses for ALLIANCE ONE INTERNATIONAL HEALTH CARE & BENEFIT PLAN FOR SALARIED EMPLOYEES

2019: ALLIANCE ONE INTERNATIONAL HEALTH CARE & BENEFIT PLAN FOR SALARIED EMPLOYEES 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – General assets of the sponsorYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – General assets of the sponsorYes
2018: ALLIANCE ONE INTERNATIONAL HEALTH CARE & BENEFIT PLAN FOR SALARIED EMPLOYEES 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: ALLIANCE ONE INTERNATIONAL HEALTH CARE & BENEFIT PLAN FOR SALARIED EMPLOYEES 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: ALLIANCE ONE INTERNATIONAL HEALTH CARE & BENEFIT PLAN FOR SALARIED EMPLOYEES 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – General assets of the sponsorYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – General assets of the sponsorYes
2015: ALLIANCE ONE INTERNATIONAL HEALTH CARE & BENEFIT PLAN FOR SALARIED EMPLOYEES 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – General assets of the sponsorYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – General assets of the sponsorYes
2014: ALLIANCE ONE INTERNATIONAL HEALTH CARE & BENEFIT PLAN FOR SALARIED EMPLOYEES 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedYes
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – General assets of the sponsorYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – General assets of the sponsorYes
2013: ALLIANCE ONE INTERNATIONAL HEALTH CARE & BENEFIT PLAN FOR SALARIED EMPLOYEES 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – General assets of the sponsorYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – General assets of the sponsorYes
2012: ALLIANCE ONE INTERNATIONAL HEALTH CARE & BENEFIT PLAN FOR SALARIED EMPLOYEES 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – General assets of the sponsorYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – General assets of the sponsorYes
2011: ALLIANCE ONE INTERNATIONAL HEALTH CARE & BENEFIT PLAN FOR SALARIED EMPLOYEES 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – General assets of the sponsorYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – General assets of the sponsorYes
2009: ALLIANCE ONE INTERNATIONAL HEALTH CARE & BENEFIT PLAN FOR SALARIED EMPLOYEES 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – General assets of the sponsorYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract numberN14406177
Policy instance 3
Insurance contract or identification numberN14406177
Number of Individuals Covered335
Insurance policy start date2018-08-01
Insurance policy end date2019-07-31
Total amount of commissions paid to insurance brokerUSD $23,972
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $68,490
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $23,972
Insurance broker organization code?3
DELTA DENTAL OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54658 )
Policy contract number8112
Policy instance 2
Insurance contract or identification number8112
Number of Individuals Covered721
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number69158-5
Policy instance 1
Insurance contract or identification number69158-5
Number of Individuals Covered1544
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $59,008
Total amount of fees paid to insurance companyUSD $22,586
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $451,713
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $30,004
Insurance broker organization code?3
Amount paid for insurance broker fees22586
Additional information about fees paid to insurance brokerOVERWRITE FEE
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract numberN14406177
Policy instance 3
Insurance contract or identification numberN14406177
Number of Individuals Covered363
Insurance policy start date2017-08-01
Insurance policy end date2018-07-31
Total amount of commissions paid to insurance brokerUSD $23,741
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $67,830
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $23,741
Amount paid for insurance broker fees0
Insurance broker organization code?3
DELTA DENTAL OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54658 )
Policy contract number8112
Policy instance 2
Insurance contract or identification number8112
Number of Individuals Covered750
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number69158-5
Policy instance 1
Insurance contract or identification number69158-5
Number of Individuals Covered1797
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $69,723
Total amount of fees paid to insurance companyUSD $25,828
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $516,549
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $51,655
Insurance broker organization code?3
Amount paid for insurance broker fees25828
Additional information about fees paid to insurance brokerOVERWRITE FEE
ACE AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 22667 )
Policy contract numberADD N14406177
Policy instance 2
Insurance contract or identification numberADD N14406177
Number of Individuals Covered16635
Insurance policy start date2016-08-01
Insurance policy end date2017-07-31
Total amount of commissions paid to insurance brokerUSD $10,750
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $30,715
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,750
Insurance broker organization code?3
Insurance broker nameGLOBAL UNDERWRITERS AGENCY INC.
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number69158-5
Policy instance 1
Insurance contract or identification number69158-5
Number of Individuals Covered1884
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $68,862
Total amount of fees paid to insurance companyUSD $25,614
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $512,272
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $51,228
Insurance broker organization code?3
Amount paid for insurance broker fees25614
Insurance broker nameMOSAIC GROUP SERVICES, LLC
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010134322
Policy instance 1
Insurance contract or identification number000010134322
Number of Individuals Covered369
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $9,235
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $92,351
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,235
Insurance broker organization code?3
Insurance broker nameGREGORY SCOT GROOMS
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0146227
Policy instance 2
Insurance contract or identification number0146227
Number of Individuals Covered1909
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $43,626
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $435,674
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $43,626
Insurance broker organization code?3
Insurance broker nameSCOT GROOMS
DELTA DENTAL OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54658 )
Policy contract number8112
Policy instance 3
Insurance contract or identification number8112
Number of Individuals Covered765
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
Insurance broker nameGREGORY SCOT GROOMS
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 )
Policy contract numberT5MP-P-050942
Policy instance 4
Insurance contract or identification numberT5MP-P-050942
Number of Individuals Covered1114
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $17,888
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedBUSINESS TRAVEL ACCIDENT INSURANCE
Welfare Benefit Premiums Paid to CarrierUSD $119,250
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,888
Insurance broker organization code?3
Insurance broker nameGROOMS FINANCIAL GROUP
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 )
Policy contract numberT5MP-P-50942
Policy instance 3
Insurance contract or identification numberT5MP-P-50942
Number of Individuals Covered1132
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $17,888
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedBUSINESS TRAVEL ACCIDENT INSURANCE
Welfare Benefit Premiums Paid to CarrierUSD $119,250
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,888
Insurance broker organization code?3
Insurance broker nameGROOMS FINANCIAL GROUP
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010134322
Policy instance 1
Insurance contract or identification number000010134322
Number of Individuals Covered376
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $9,561
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $95,605
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,561
Insurance broker organization code?3
Insurance broker nameGREGORY SCOT GROOMS
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0146227
Policy instance 2
Insurance contract or identification number0146227
Number of Individuals Covered1918
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $40,242
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $404,389
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $40,242
Insurance broker organization code?3
Insurance broker nameSCOT GROOMS
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010134322
Policy instance 1
Insurance contract or identification number000010134322
Number of Individuals Covered390
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $9,546
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $95,460
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,546
Insurance broker organization code?3
Insurance broker nameGREGORY SCOT GROOMS
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 )
Policy contract numberT5MP-050942
Policy instance 3
Insurance contract or identification numberT5MP-050942
Number of Individuals Covered1137
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $17,888
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedBUSINESS TRAVEL ACCIDENT INSURANCE
Welfare Benefit Premiums Paid to CarrierUSD $119,250
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $17,888
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameGROOMS FINANCIAL GROUP
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0146227
Policy instance 2
Insurance contract or identification number0146227
Number of Individuals Covered1224
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $41,496
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $436,575
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $41,496
Insurance broker organization code?3
Insurance broker nameSCOT GROOMS
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0146227
Policy instance 2
Insurance contract or identification number0146227
Number of Individuals Covered1252
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $41,408
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $435,857
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $41,408
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameSCOT GROOMS
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 )
Policy contract numberT5MP-050942
Policy instance 3
Insurance contract or identification numberT5MP-050942
Number of Individuals Covered1224
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $17,888
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedBUSINESS TRAVEL ACCIDENT INSURANCE
Welfare Benefit Premiums Paid to CarrierUSD $119,250
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $17,888
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameGROOMS FINANCIAL GROUP
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number10134322
Policy instance 1
Insurance contract or identification number10134322
Number of Individuals Covered390
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $9,177
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $91,771
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,177
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameGREGORY SCOT GROOMS
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 )
Policy contract numberT5MP-50942
Policy instance 5
Insurance contract or identification numberT5MP-50942
Number of Individuals Covered1344
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $17,888
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedBUSINESS TRAVEL ACCIDENT INSURANCE
Welfare Benefit Premiums Paid to CarrierUSD $119,250
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
DELTA DENTAL OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54658 )
Policy contract numberNC00811201
Policy instance 4
Insurance contract or identification numberNC00811201
Number of Individuals Covered385
Insurance policy start date2011-01-01
Insurance policy end date2011-09-30
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0146227
Policy instance 3
Insurance contract or identification number0146227
Number of Individuals Covered884
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $39,604
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $453,928
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54658 )
Policy contract number8112
Policy instance 2
Insurance contract or identification number8112
Number of Individuals Covered817
Insurance policy start date2011-10-01
Insurance policy end date2011-12-31
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number10134322
Policy instance 1
Insurance contract or identification number10134322
Number of Individuals Covered388
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $9,809
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $98,089
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )
Policy contract number060143
Policy instance 4
Insurance contract or identification number060143
Number of Individuals Covered485
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 )
Policy contract numberT5MP-50942
Policy instance 1
Insurance contract or identification numberT5MP-50942
Number of Individuals Covered0
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $17,888
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $119,250
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,888
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameGROOMS FINANCIAL GROUP
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number008320
Policy instance 2
Insurance contract or identification number008320
Number of Individuals Covered1488
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $50,530
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $504,862
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $50,530
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameGROOMS FINANCIAL GROUP
DELTA DENTAL OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54658 )
Policy contract number008112
Policy instance 5
Insurance contract or identification number008112
Number of Individuals Covered387
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number008320
Policy instance 3
Insurance contract or identification number008320
Number of Individuals Covered820
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $11,506
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $114,882
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,506
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameGROOM FINANCIAL GROUP

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