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DUKE UNIVERSITY WELFARE AND FRINGE BENEFITS PLAN 401k Plan overview

Plan NameDUKE UNIVERSITY WELFARE AND FRINGE BENEFITS PLAN
Plan identification number 524

DUKE UNIVERSITY WELFARE AND FRINGE BENEFITS PLAN Benefits

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

401k Sponsoring company profile

DUKE UNIVERSITY has sponsored the creation of one or more 401k plans.

Company Name:DUKE UNIVERSITY
Employer identification number (EIN):560532129
NAIC Classification:611000

Additional information about DUKE UNIVERSITY

Jurisdiction of Incorporation: North Carolina Secretary of State
Incorporation Date:
Company Identification Number: 0044012

More information about DUKE UNIVERSITY

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DUKE UNIVERSITY WELFARE AND FRINGE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5242022-01-01
5242021-01-01
5242020-01-01
5242019-01-01
5242018-01-01
5242017-01-01JOYCE WILLIAMS
5242016-01-01JOYCE WILLIAMS
5242015-01-01JOYCE WILLIAMS
5242014-01-01JOYCE WILLIAMS
5242013-01-01JOYCE WILLIAMS
5242012-01-01JOYCE WILLIAMS
5242011-01-01LOIS ANN GREEN
5242009-01-01LOIS ANN GREEN

Plan Statistics for DUKE UNIVERSITY WELFARE AND FRINGE BENEFITS PLAN

401k plan membership statisitcs for DUKE UNIVERSITY WELFARE AND FRINGE BENEFITS PLAN

Measure Date Value
2022: DUKE UNIVERSITY WELFARE AND FRINGE BENEFITS PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-0138,809
Total number of active participants reported on line 7a of the Form 55002022-01-0139,494
Number of retired or separated participants receiving benefits2022-01-01212
Total of all active and inactive participants2022-01-0139,706
Total participants2022-01-0139,706
2021: DUKE UNIVERSITY WELFARE AND FRINGE BENEFITS PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-0137,950
Total number of active participants reported on line 7a of the Form 55002021-01-0138,615
Number of retired or separated participants receiving benefits2021-01-01194
Total of all active and inactive participants2021-01-0138,809
Total participants2021-01-0138,809
2020: DUKE UNIVERSITY WELFARE AND FRINGE BENEFITS PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-0136,783
Total number of active participants reported on line 7a of the Form 55002020-01-0137,725
Number of retired or separated participants receiving benefits2020-01-01225
Total of all active and inactive participants2020-01-0137,950
Total participants2020-01-0137,950
2019: DUKE UNIVERSITY WELFARE AND FRINGE BENEFITS PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-0135,762
Total number of active participants reported on line 7a of the Form 55002019-01-0136,572
Number of retired or separated participants receiving benefits2019-01-01211
Total of all active and inactive participants2019-01-0136,783
Total participants2019-01-0136,783
2018: DUKE UNIVERSITY WELFARE AND FRINGE BENEFITS PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-0133,883
Total number of active participants reported on line 7a of the Form 55002018-01-0135,571
Number of retired or separated participants receiving benefits2018-01-01191
Total of all active and inactive participants2018-01-0135,762
Total participants2018-01-0135,762
2017: DUKE UNIVERSITY WELFARE AND FRINGE BENEFITS PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-0134,053
Total number of active participants reported on line 7a of the Form 55002017-01-0133,667
Number of retired or separated participants receiving benefits2017-01-01216
Total of all active and inactive participants2017-01-0133,883
Total participants2017-01-0133,883
2016: DUKE UNIVERSITY WELFARE AND FRINGE BENEFITS PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-0132,566
Total number of active participants reported on line 7a of the Form 55002016-01-0133,909
Number of retired or separated participants receiving benefits2016-01-01144
Total of all active and inactive participants2016-01-0134,053
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-0139
Total participants2016-01-0134,092
2015: DUKE UNIVERSITY WELFARE AND FRINGE BENEFITS PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-0132,017
Total number of active participants reported on line 7a of the Form 55002015-01-0132,357
Number of retired or separated participants receiving benefits2015-01-01169
Number of other retired or separated participants entitled to future benefits2015-01-0140
Total of all active and inactive participants2015-01-0132,566
Total participants2015-01-010
2014: DUKE UNIVERSITY WELFARE AND FRINGE BENEFITS PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-0132,436
Total number of active participants reported on line 7a of the Form 55002014-01-0131,807
Number of retired or separated participants receiving benefits2014-01-01166
Number of other retired or separated participants entitled to future benefits2014-01-0144
Total of all active and inactive participants2014-01-0132,017
Total participants2014-01-010
2013: DUKE UNIVERSITY WELFARE AND FRINGE BENEFITS PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-0130,760
Total number of active participants reported on line 7a of the Form 55002013-01-0132,130
Number of retired or separated participants receiving benefits2013-01-01254
Number of other retired or separated participants entitled to future benefits2013-01-0152
Total of all active and inactive participants2013-01-0132,436
Total participants2013-01-010
2012: DUKE UNIVERSITY WELFARE AND FRINGE BENEFITS PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-0129,370
Total number of active participants reported on line 7a of the Form 55002012-01-0130,545
Number of retired or separated participants receiving benefits2012-01-01215
Total of all active and inactive participants2012-01-0130,760
Total participants2012-01-010
2011: DUKE UNIVERSITY WELFARE AND FRINGE BENEFITS PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-0128,377
Total number of active participants reported on line 7a of the Form 55002011-01-0129,286
Total of all active and inactive participants2011-01-0129,286
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-0184
Total participants2011-01-0129,370
2009: DUKE UNIVERSITY WELFARE AND FRINGE BENEFITS PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-0131,877
Total number of active participants reported on line 7a of the Form 55002009-01-0130,207
Number of retired or separated participants receiving benefits2009-01-014,381
Total of all active and inactive participants2009-01-0134,588
Total participants2009-01-0134,588

Form 5500 Responses for DUKE UNIVERSITY WELFARE AND FRINGE BENEFITS PLAN

2022: DUKE UNIVERSITY WELFARE AND FRINGE BENEFITS PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: DUKE UNIVERSITY WELFARE AND FRINGE BENEFITS PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: DUKE UNIVERSITY WELFARE AND FRINGE BENEFITS PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: DUKE UNIVERSITY WELFARE AND FRINGE BENEFITS PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
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: DUKE UNIVERSITY WELFARE AND FRINGE BENEFITS PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
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: DUKE UNIVERSITY WELFARE AND FRINGE BENEFITS PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
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: DUKE UNIVERSITY WELFARE AND FRINGE BENEFITS PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
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: DUKE UNIVERSITY WELFARE AND FRINGE BENEFITS PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
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: DUKE UNIVERSITY WELFARE AND FRINGE BENEFITS PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
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: DUKE UNIVERSITY WELFARE AND FRINGE BENEFITS PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
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: DUKE UNIVERSITY WELFARE AND FRINGE BENEFITS PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
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: DUKE UNIVERSITY WELFARE AND FRINGE BENEFITS PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
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: DUKE UNIVERSITY WELFARE AND FRINGE BENEFITS PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
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

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number010-350003
Policy instance 5
Insurance contract or identification number010-350003
Number of Individuals Covered72890
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $289,570
Total amount of fees paid to insurance companyUSD $2,500
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $23,219,832
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $289,570
Amount paid for insurance broker fees2500
Insurance broker organization code?3
BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )
Policy contract number14163438
Policy instance 1
Insurance contract or identification number14163438
Number of Individuals Covered13218
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Health Insurance Welfare BenefitYes
Were dividends or retroactive rate refunds paid as a credit?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00350170
Policy instance 2
Insurance contract or identification number00350170
Number of Individuals Covered1141
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $19,133
Total amount of fees paid to insurance companyUSD $8,946
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $127,552
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,133
Amount paid for insurance broker fees8946
Insurance broker organization code?3
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number1094472
Policy instance 3
Insurance contract or identification number1094472
Number of Individuals Covered1319
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $12,053
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $80,353
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,053
Insurance broker organization code?3
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number85006
Policy instance 4
Insurance contract or identification number85006
Number of Individuals Covered3
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $21
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $638
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $21
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract numberSA381025983501
Policy instance 16
Insurance contract or identification numberSA381025983501
Number of Individuals Covered27722
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $393,719
Total amount of fees paid to insurance companyUSD $452,242
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $7,940,971
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees452242
Commission paid to Insurance BrokerUSD $393,719
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number043211-GLT
Policy instance 6
Insurance contract or identification number043211-GLT
Number of Individuals Covered495
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $34,378
Total amount of fees paid to insurance companyUSD $20,191
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $229,184
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $34,378
Insurance broker organization code?3
Amount paid for insurance broker fees20191
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number043211-GRH
Policy instance 7
Insurance contract or identification number043211-GRH
Number of Individuals Covered4200
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $90,254
Total amount of fees paid to insurance companyUSD $78,666
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $902,538
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $90,254
Insurance broker organization code?3
Amount paid for insurance broker fees78666
ACE AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 22667 )
Policy contract numberADD N00944324
Policy instance 8
Insurance contract or identification numberADD N00944324
Number of Individuals Covered38400
Insurance policy start date2021-10-25
Insurance policy end date2022-10-25
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $90,682
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 numberG000BDL6
Policy instance 9
Insurance contract or identification numberG000BDL6
Number of Individuals Covered12026
Insurance policy start date2022-01-01
Insurance policy end date2023-01-01
Total amount of commissions paid to insurance brokerUSD $47,754
Other welfare benefits providedACCIDENTAL DEATH OR DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $477,537
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $47,754
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract numberSA381025983501
Policy instance 15
Insurance contract or identification numberSA381025983501
Number of Individuals Covered38552
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $26,222
Total amount of fees paid to insurance companyUSD $30,120
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $528,879
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees30120
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $26,222
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract number80961
Policy instance 14
Insurance contract or identification number80961
Number of Individuals Covered7
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $54
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $6,367
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $31
Insurance broker organization code?3
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number05449B
Policy instance 13
Insurance contract or identification number05449B
Number of Individuals Covered66936
Insurance policy start date2021-05-01
Insurance policy end date2022-04-30
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $18,716
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract number80960
Policy instance 12
Insurance contract or identification number80960
Number of Individuals Covered1
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $715
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number45317-LTC
Policy instance 11
Insurance contract or identification number45317-LTC
Number of Individuals Covered1351
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $194,016
Other welfare benefits providedLONG TERM CARE
Welfare Benefit Premiums Paid to CarrierUSD $3,233,594
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $194,016
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number0754368
Policy instance 10
Insurance contract or identification number0754368
Number of Individuals Covered40593
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $190,331
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,813,869
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $190,331
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number043211-GRH
Policy instance 7
Insurance contract or identification number043211-GRH
Number of Individuals Covered4426
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $101,818
Total amount of fees paid to insurance companyUSD $78,376
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $977,470
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $101,818
Insurance broker organization code?3
Amount paid for insurance broker fees78376
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number043211-GLT
Policy instance 6
Insurance contract or identification number043211-GLT
Number of Individuals Covered615
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $42,016
Total amount of fees paid to insurance companyUSD $22,669
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $280,109
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $42,016
Insurance broker organization code?3
Amount paid for insurance broker fees22669
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number010-350003
Policy instance 5
Insurance contract or identification number010-350003
Number of Individuals Covered72175
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $347,410
Total amount of fees paid to insurance companyUSD $2,500
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $23,160,643
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $347,410
Amount paid for insurance broker fees2500
Insurance broker organization code?3
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number85006
Policy instance 4
Insurance contract or identification number85006
Number of Individuals Covered4
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $42
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $862
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $42
Insurance broker organization code?3
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number1094472
Policy instance 3
Insurance contract or identification number1094472
Number of Individuals Covered1289
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $14,288
Total amount of fees paid to insurance companyUSD $939
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $95,256
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,288
Amount paid for insurance broker fees939
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00350170
Policy instance 2
Insurance contract or identification number00350170
Number of Individuals Covered1175
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $22,496
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $149,970
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $22,496
Insurance broker organization code?3
BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )
Policy contract number14163438
Policy instance 1
Insurance contract or identification number14163438
Number of Individuals Covered12863
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Health Insurance Welfare BenefitYes
Were dividends or retroactive rate refunds paid as a credit?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ACE AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 22667 )
Policy contract numberADD N00944324
Policy instance 8
Insurance contract or identification numberADD N00944324
Number of Individuals Covered38060
Insurance policy start date2020-10-25
Insurance policy end date2021-10-25
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $87,171
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 numberG000BDL6
Policy instance 9
Insurance contract or identification numberG000BDL6
Number of Individuals Covered11374
Insurance policy start date2021-01-01
Insurance policy end date2022-01-01
Total amount of commissions paid to insurance brokerUSD $43,337
Other welfare benefits providedACCIDENTAL DEATH OR DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $433,373
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $43,337
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number0754368
Policy instance 10
Insurance contract or identification number0754368
Number of Individuals Covered39472
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $188,206
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,771,786
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $188,206
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract numberSA381025983501
Policy instance 16
Insurance contract or identification numberSA381025983501
Number of Individuals Covered39139
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $306,299
Total amount of fees paid to insurance companyUSD $429,292
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $8,644,124
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees429292
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $306,299
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract numberSA381025983501
Policy instance 15
Insurance contract or identification numberSA381025983501
Number of Individuals Covered39139
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $18,169
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $441,009
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $18,169
Insurance broker organization code?3
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract number80961
Policy instance 14
Insurance contract or identification number80961
Number of Individuals Covered10
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $231
Total amount of fees paid to insurance companyUSD $8
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $9,175
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $91
Insurance broker organization code?3
Amount paid for insurance broker fees8
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number05449B
Policy instance 13
Insurance contract or identification number05449B
Number of Individuals Covered67596
Insurance policy start date2020-05-01
Insurance policy end date2021-04-30
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $26,655
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract number80960
Policy instance 12
Insurance contract or identification number80960
Number of Individuals Covered1
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $780
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number45317-LTC
Policy instance 11
Insurance contract or identification number45317-LTC
Number of Individuals Covered1403
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $196,032
Other welfare benefits providedLONG TERM CARE
Welfare Benefit Premiums Paid to CarrierUSD $3,267,192
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $196,032
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number043211-GLT
Policy instance 7
Insurance contract or identification number043211-GLT
Number of Individuals Covered788
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $49,886
Total amount of fees paid to insurance companyUSD $27,405
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $360,120
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $49,886
Amount paid for insurance broker fees366
Additional information about fees paid to insurance brokerBONUS PAID
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number043211-GRH
Policy instance 8
Insurance contract or identification number043211-GRH
Number of Individuals Covered4747
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $150,627
Total amount of fees paid to insurance companyUSD $82,143
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,084,401
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $150,627
Amount paid for insurance broker fees1012
Additional information about fees paid to insurance brokerBONUS PAID
Insurance broker organization code?3
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number010-350003
Policy instance 6
Insurance contract or identification number010-350003
Number of Individuals Covered71456
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $342,331
Total amount of fees paid to insurance companyUSD $2,500
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $22,822,074
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $342,331
Amount paid for insurance broker fees2500
Insurance broker organization code?3
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number85006
Policy instance 5
Insurance contract or identification number85006
Number of Individuals Covered6
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $56
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,296
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $56
Insurance broker organization code?3
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number1094472
Policy instance 4
Insurance contract or identification number1094472
Number of Individuals Covered1231
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $13,752
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,752
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0028939
Policy instance 2
Insurance contract or identification number0028939
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $3,681
Total amount of fees paid to insurance companyUSD $670
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH OR DISMEMBERMENT
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,681
Amount paid for insurance broker fees670
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )
Policy contract numberDUNV
Policy instance 1
Insurance contract or identification numberDUNV
Number of Individuals Covered13160
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Health Insurance Welfare BenefitYes
Were dividends or retroactive rate refunds paid as a credit?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ACE AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 22667 )
Policy contract numberADD N00944324
Policy instance 9
Insurance contract or identification numberADD N00944324
Number of Individuals Covered37146
Insurance policy start date2019-10-25
Insurance policy end date2020-10-25
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $107,968
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 numberGMDC0BDL6
Policy instance 10
Insurance contract or identification numberGMDC0BDL6
Number of Individuals Covered10846
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $48,769
Other welfare benefits providedACCIDENTAL DEATH OR DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $487,694
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $48,769
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00350170
Policy instance 3
Insurance contract or identification number00350170
Number of Individuals Covered1061
Insurance policy start date2019-06-30
Insurance policy end date2020-07-01
Total amount of commissions paid to insurance brokerUSD $17,991
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $119,942
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,991
Insurance broker organization code?3
LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )
Policy contract numberSA381025983501
Policy instance 17
Insurance contract or identification numberSA381025983501
Number of Individuals Covered38321
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $284,631
Total amount of fees paid to insurance companyUSD $392,243
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $7,485,268
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees367243
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $284,631
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )
Policy contract numberSA381025983501
Policy instance 16
Insurance contract or identification numberSA381025983501
Number of Individuals Covered38321
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $18,200
Total amount of fees paid to insurance companyUSD $23,947
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $441,749
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $18,200
Amount paid for insurance broker fees23947
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract number80960
Policy instance 15
Insurance contract or identification number80960
Number of Individuals Covered4
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,046
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number05449B
Policy instance 14
Insurance contract or identification number05449B
Number of Individuals Covered68579
Insurance policy start date2019-05-01
Insurance policy end date2020-04-30
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $59,189
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract number80961
Policy instance 13
Insurance contract or identification number80961
Number of Individuals Covered11
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $480
Total amount of fees paid to insurance companyUSD $316
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $14,572
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees238
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $216
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number45317-LTC
Policy instance 12
Insurance contract or identification number45317-LTC
Number of Individuals Covered1436
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $167,015
Other welfare benefits providedLONG TERM CARE
Welfare Benefit Premiums Paid to CarrierUSD $2,783,585
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $167,015
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number0754368
Policy instance 11
Insurance contract or identification number0754368
Number of Individuals Covered36934
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $135,068
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,764,595
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $135,068
Insurance broker organization code?3
ACE AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 22667 )
Policy contract numberADD N00944324
Policy instance 10
Insurance contract or identification numberADD N00944324
Number of Individuals Covered36413
Insurance policy start date2018-10-25
Insurance policy end date2019-10-25
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $104,240
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 numberT66BA-P-050819
Policy instance 11
Insurance contract or identification numberT66BA-P-050819
Number of Individuals Covered5081
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $44,496
Other welfare benefits providedACCIDENTAL DEATH OR DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $444,962
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $44,496
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number0754368
Policy instance 12
Insurance contract or identification number0754368
Number of Individuals Covered34951
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $167,229
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,355,053
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $167,229
Insurance broker organization code?3
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number45317-LTC
Policy instance 13
Insurance contract or identification number45317-LTC
Number of Individuals Covered1482
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $148,431
Other welfare benefits providedLONG TERM CARE
Welfare Benefit Premiums Paid to CarrierUSD $2,473,845
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $148,431
Insurance broker organization code?3
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract number8027018
Policy instance 14
Insurance contract or identification number8027018
Number of Individuals Covered15
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $326
Total amount of fees paid to insurance companyUSD $80
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $18,710
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $198
Insurance broker organization code?3
Amount paid for insurance broker fees43
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number05449B
Policy instance 15
Insurance contract or identification number05449B
Number of Individuals Covered66996
Insurance policy start date2018-05-01
Insurance policy end date2019-04-30
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $67,304
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number043211-GRH
Policy instance 9
Insurance contract or identification number043211-GRH
Number of Individuals Covered4883
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $145,045
Total amount of fees paid to insurance companyUSD $75,621
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $874,041
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $145,045
Insurance broker organization code?3
Amount paid for insurance broker fees75621
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number010-350003
Policy instance 7
Insurance contract or identification number010-350003
Number of Individuals Covered68514
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $326,524
Total amount of fees paid to insurance companyUSD $2,500
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $21,768,261
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $326,524
Amount paid for insurance broker fees2500
Insurance broker organization code?3
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number85006
Policy instance 6
Insurance contract or identification number85006
Number of Individuals Covered11
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $78
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,995
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $78
Insurance broker organization code?3
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract numberH37512
Policy instance 5
Insurance contract or identification numberH37512
Number of Individuals Covered1051
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $13,584
Total amount of fees paid to insurance companyUSD $5,022
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $90,559
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,584
Amount paid for insurance broker fees4588
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00350170
Policy instance 4
Insurance contract or identification number00350170
Number of Individuals Covered1068
Insurance policy start date2018-06-30
Insurance policy end date2019-07-01
Total amount of commissions paid to insurance brokerUSD $19,615
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $130,768
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,615
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0028939
Policy instance 3
Insurance contract or identification number0028939
Number of Individuals Covered37723
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $23,605
Total amount of fees paid to insurance companyUSD $4,459
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH OR DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $532,581
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $23,605
Amount paid for insurance broker fees4459
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0033836
Policy instance 2
Insurance contract or identification number0033836
Number of Individuals Covered17419
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $443,869
Total amount of fees paid to insurance companyUSD $103,233
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $8,066,373
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $443,869
Insurance broker organization code?5
Amount paid for insurance broker fees103233
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )
Policy contract number000029
Policy instance 1
Insurance contract or identification number000029
Number of Individuals Covered13254
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Health Insurance Welfare BenefitYes
Were dividends or retroactive rate refunds paid as a credit?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract number8028766
Policy instance 16
Insurance contract or identification number8028766
Number of Individuals Covered4
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $3
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,832
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number043211-GLT
Policy instance 8
Insurance contract or identification number043211-GLT
Number of Individuals Covered878
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $51,697
Total amount of fees paid to insurance companyUSD $27,356
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $315,940
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $51,697
Insurance broker organization code?3
Amount paid for insurance broker fees27356
BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )
Policy contract number000029
Policy instance 1
Insurance contract or identification number000029
Number of Individuals Covered13626
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Health Insurance Welfare BenefitYes
Were dividends or retroactive rate refunds paid as a credit?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract number8028766
Policy instance 16
Insurance contract or identification number8028766
Number of Individuals Covered4
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $3
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,832
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3
Insurance broker organization code?3
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number05449B
Policy instance 15
Insurance contract or identification number05449B
Number of Individuals Covered65495
Insurance policy start date2017-05-01
Insurance policy end date2018-04-30
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $67,304
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract number8027018
Policy instance 14
Insurance contract or identification number8027018
Number of Individuals Covered19
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $355
Total amount of fees paid to insurance companyUSD $73
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $21,024
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $183
Insurance broker organization code?3
Amount paid for insurance broker fees72
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number45317-LTC
Policy instance 13
Insurance contract or identification number45317-LTC
Number of Individuals Covered1529
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $151,218
Other welfare benefits providedLONG TERM CARE
Welfare Benefit Premiums Paid to CarrierUSD $2,520,294
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $151,218
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number0754368
Policy instance 12
Insurance contract or identification number0754368
Number of Individuals Covered33451
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $159,916
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,085,750
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $159,916
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 )
Policy contract numberT66BA-P-050819
Policy instance 11
Insurance contract or identification numberT66BA-P-050819
Number of Individuals Covered4674
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $39,440
Other welfare benefits providedACCIDENTAL DEATH OR DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $394,398
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $39,440
Insurance broker organization code?3
ACE AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 22667 )
Policy contract numberADD N00944324
Policy instance 10
Insurance contract or identification numberADD N00944324
Number of Individuals Covered35045
Insurance policy start date2017-10-25
Insurance policy end date2018-10-25
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $104,022
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00350170
Policy instance 4
Insurance contract or identification number00350170
Number of Individuals Covered1071
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $19,633
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $130,889
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,633
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number043211-GRH
Policy instance 9
Insurance contract or identification number043211-GRH
Number of Individuals Covered4791
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $138,740
Total amount of fees paid to insurance companyUSD $73,809
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $924,933
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $138,740
Insurance broker organization code?3
Amount paid for insurance broker fees73809
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0033836
Policy instance 2
Insurance contract or identification number0033836
Number of Individuals Covered17725
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $448,529
Total amount of fees paid to insurance companyUSD $124,694
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $7,889,373
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $448,529
Insurance broker organization code?5
Amount paid for insurance broker fees124694
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0028939
Policy instance 3
Insurance contract or identification number0028939
Number of Individuals Covered36415
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $20,637
Total amount of fees paid to insurance companyUSD $3,308
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH OR DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $507,771
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $20,637
Amount paid for insurance broker fees3308
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract numberH37512
Policy instance 5
Insurance contract or identification numberH37512
Number of Individuals Covered1034
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $7,814
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $44,653
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,814
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number85006
Policy instance 6
Insurance contract or identification number85006
Number of Individuals Covered12
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $92
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,541
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $92
Insurance broker organization code?3
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number010-350003
Policy instance 7
Insurance contract or identification number010-350003
Number of Individuals Covered65755
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $340,848
Total amount of fees paid to insurance companyUSD $2,500
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $22,723,183
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $340,848
Amount paid for insurance broker fees2500
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number043211-GLT
Policy instance 8
Insurance contract or identification number043211-GLT
Number of Individuals Covered833
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $53,181
Total amount of fees paid to insurance companyUSD $28,499
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $354,542
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $53,181
Insurance broker organization code?3
Amount paid for insurance broker fees28499
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number85006
Policy instance 6
Insurance contract or identification number85006
Number of Individuals Covered12
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $92
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,541
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $92
Insurance broker organization code?3
Insurance broker nameHOLROYD AGENCY
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number010-350003
Policy instance 7
Insurance contract or identification number010-350003
Number of Individuals Covered62849
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $278,331
Total amount of fees paid to insurance companyUSD $2,500
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $18,555,399
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $278,331
Amount paid for insurance broker fees2500
Insurance broker organization code?3
Insurance broker nameMARK III BROKERAGE INC
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number043211-GLT
Policy instance 8
Insurance contract or identification number043211-GLT
Number of Individuals Covered951
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $60,183
Total amount of fees paid to insurance companyUSD $32,002
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $391,755
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $60,183
Insurance broker organization code?3
Amount paid for insurance broker fees32002
Insurance broker nameMGIS
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number043211-GRH
Policy instance 9
Insurance contract or identification number043211-GRH
Number of Individuals Covered4856
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $136,622
Total amount of fees paid to insurance companyUSD $72,056
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $896,104
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $136,622
Insurance broker organization code?3
Amount paid for insurance broker fees72056
Insurance broker nameMGIS, INC
ACE AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 22667 )
Policy contract numberADD N00944324
Policy instance 10
Insurance contract or identification numberADD N00944324
Number of Individuals Covered33667
Insurance policy start date2016-10-25
Insurance policy end date2017-10-25
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $85,730
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 numberT66BA-P-050819
Policy instance 11
Insurance contract or identification numberT66BA-P-050819
Number of Individuals Covered3657
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $35,151
Other welfare benefits providedACCIDENTAL DEATH OR DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $351,511
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $35,151
Insurance broker organization code?3
Insurance broker nameMARK III BROKERAGE INC
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number0754368
Policy instance 12
Insurance contract or identification number0754368
Number of Individuals Covered31502
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $154,834
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,112,544
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $154,834
Insurance broker organization code?3
Insurance broker nameMARK III BROKERAGE, INC.
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number45317-LTC
Policy instance 13
Insurance contract or identification number45317-LTC
Number of Individuals Covered1562
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $142,312
Other welfare benefits providedLONG TERM CARE
Welfare Benefit Premiums Paid to CarrierUSD $2,371,860
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $142,312
Insurance broker organization code?3
Insurance broker nameBENEFITS ADVISOR
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract number8027018
Policy instance 14
Insurance contract or identification number8027018
Number of Individuals Covered24
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $435
Total amount of fees paid to insurance companyUSD $71
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $21,765
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $156
Insurance broker organization code?3
Amount paid for insurance broker fees7
Insurance broker nameGAVALAS NICHOLAS B
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number05449A
Policy instance 15
Insurance contract or identification number05449A
Number of Individuals Covered3
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $1,210
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $15,121
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,210
Insurance broker organization code?3
Insurance broker nameARTHUR J GALLAGHER
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number05449B
Policy instance 16
Insurance contract or identification number05449B
Number of Individuals Covered58671
Insurance policy start date2016-05-01
Insurance policy end date2017-04-30
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $116,054
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract number8027189
Policy instance 17
Insurance contract or identification number8027189
Number of Individuals Covered5
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $3
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,089
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3
Insurance broker organization code?3
Insurance broker nameGAVALAS NICHOLAS
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract numberH37512
Policy instance 5
Insurance contract or identification numberH37512
Number of Individuals Covered1038
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $15,249
Total amount of fees paid to insurance companyUSD $1,697
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $87,136
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,249
Amount paid for insurance broker fees1697
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
Insurance broker nameMARSH & MCLENNAN LLC
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00350170
Policy instance 4
Insurance contract or identification number00350170
Number of Individuals Covered1041
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $18,876
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $125,839
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $18,876
Insurance broker organization code?3
Insurance broker nameMARSH & MCLENNAN AGENCY LLC
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0028939
Policy instance 3
Insurance contract or identification number0028939
Number of Individuals Covered34518
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $18,100
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH OR DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $480,228
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $18,100
Insurance broker organization code?3
Insurance broker nameMARK III BROKERAGE
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0033836
Policy instance 2
Insurance contract or identification number0033836
Number of Individuals Covered17881
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $451,713
Total amount of fees paid to insurance companyUSD $149,404
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $7,942,116
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $451,713
Insurance broker organization code?5
Amount paid for insurance broker fees149404
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker nameMERCER HEALTH & BENEFITS LLC
BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )
Policy contract number000029
Policy instance 1
Insurance contract or identification number000029
Number of Individuals Covered13911
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Health Insurance Welfare BenefitYes
Were dividends or retroactive rate refunds paid as a credit?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ACE AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 22667 )
Policy contract numberADD N00944324R
Policy instance 10
Insurance contract or identification numberADD N00944324R
Number of Individuals Covered32357
Insurance policy start date2014-10-25
Insurance policy end date2015-10-25
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $23,733
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 numberT66BA-P 50819
Policy instance 11
Insurance contract or identification numberT66BA-P 50819
Number of Individuals Covered3054
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $26,340
Other welfare benefits providedACCIDENTAL DEATH OR DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $263,404
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $26,340
Insurance broker organization code?3
Insurance broker nameBENEFIT ADVISORS INC.
BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )
Policy contract number000029
Policy instance 1
Insurance contract or identification number000029
Number of Individuals Covered14321
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Health Insurance Welfare BenefitYes
Were dividends or retroactive rate refunds paid as a credit?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number0754368
Policy instance 12
Insurance contract or identification number0754368
Number of Individuals Covered15561
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $137,604
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,880,658
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $137,604
Insurance broker organization code?3
Insurance broker nameMARK III BROKERAGE, INC.
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract number8027189
Policy instance 17
Insurance contract or identification number8027189
Number of Individuals Covered8
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $37
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,252
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $18
Insurance broker organization code?3
Insurance broker nameGAVALAS NICHOLAS
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number45317-LTC
Policy instance 13
Insurance contract or identification number45317-LTC
Number of Individuals Covered1636
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $132,678
Other welfare benefits providedLONG TERM CARE
Welfare Benefit Premiums Paid to CarrierUSD $2,211,297
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $132,678
Insurance broker organization code?3
Insurance broker nameBENEFITS ADVISOR
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract number8027018
Policy instance 14
Insurance contract or identification number8027018
Number of Individuals Covered26
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $600
Total amount of fees paid to insurance companyUSD $126
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $26,301
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $360
Amount paid for insurance broker fees33
Insurance broker organization code?3
Insurance broker nameTIMOTHY EBERT
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number05449A
Policy instance 15
Insurance contract or identification number05449A
Number of Individuals Covered1
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $406
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,076
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $406
Insurance broker organization code?3
Insurance broker nameARTHUR J GALLAGHER
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number05449B
Policy instance 16
Insurance contract or identification number05449B
Number of Individuals Covered29361
Insurance policy start date2014-05-01
Insurance policy end date2015-04-30
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $35,540
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number043211-GRH
Policy instance 9
Insurance contract or identification number043211-GRH
Number of Individuals Covered4910
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $121,328
Total amount of fees paid to insurance companyUSD $64,672
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $873,981
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $121,328
Insurance broker organization code?3
Amount paid for insurance broker fees64672
Insurance broker nameMGIS, INC
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number043211-GLT
Policy instance 8
Insurance contract or identification number043211-GLT
Number of Individuals Covered1115
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $56,128
Total amount of fees paid to insurance companyUSD $29,755
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $402,114
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $56,128
Insurance broker organization code?3
Amount paid for insurance broker fees29755
Insurance broker nameMGIS
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number010-350003
Policy instance 7
Insurance contract or identification number010-350003
Number of Individuals Covered56834
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $269,141
Total amount of fees paid to insurance companyUSD $2,500
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $17,942,725
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $269,141
Amount paid for insurance broker fees2500
Insurance broker organization code?3
Insurance broker nameMARK III BROKERAGE INC
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number85006
Policy instance 6
Insurance contract or identification number85006
Number of Individuals Covered18
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $150
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $6,159
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $150
Insurance broker organization code?3
Insurance broker nameHOLROYD AGENCY
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract numberH37512
Policy instance 5
Insurance contract or identification numberH37512
Number of Individuals Covered1004
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $14,827
Total amount of fees paid to insurance companyUSD $415
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $84,728
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,793
Insurance broker organization code?3
Amount paid for insurance broker fees415
Additional information about fees paid to insurance brokerBONUS
Insurance broker nameNFP INSURANCE SERVICES INC
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0028939
Policy instance 3
Insurance contract or identification number0028939
Number of Individuals Covered31123
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $17,707
Total amount of fees paid to insurance companyUSD $3,761
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH OR DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $467,840
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,707
Amount paid for insurance broker fees3761
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
Insurance broker nameMARK III BROKERAGE
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0033836
Policy instance 2
Insurance contract or identification number0033836
Number of Individuals Covered18435
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $468,241
Total amount of fees paid to insurance companyUSD $150,600
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $6,659,563
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $468,241
Insurance broker organization code?5
Amount paid for insurance broker fees150600
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker nameMERCER HEALTH & BENEFITS LLC
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00350170
Policy instance 4
Insurance contract or identification number00350170
Number of Individuals Covered1005
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $16,839
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $112,261
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,839
Insurance broker nameMARSH & MCLENNAN AGENCY LLC
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number0754368
Policy instance 12
Insurance contract or identification number0754368
Number of Individuals Covered26574
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $130,461
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,612,707
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $130,461
Insurance broker organization code?3
Insurance broker nameMARK III BROKERAGE, INC.
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number45317-LTC
Policy instance 13
Insurance contract or identification number45317-LTC
Number of Individuals Covered1675
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $132,923
Other welfare benefits providedLONG TERM CARE
Welfare Benefit Premiums Paid to CarrierUSD $2,215,385
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $132,923
Insurance broker organization code?3
Insurance broker nameBENEFITS ADVISOR
BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )
Policy contract number000029
Policy instance 1
Insurance contract or identification number000029
Number of Individuals Covered14769
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Health Insurance Welfare BenefitYes
Were dividends or retroactive rate refunds paid as a credit?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number05449A
Policy instance 15
Insurance contract or identification number05449A
Number of Individuals Covered2
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $5,693
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $71,159
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,693
Insurance broker organization code?3
Insurance broker nameARTHUR J GALLAGHER
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number05449B
Policy instance 16
Insurance contract or identification number05449B
Number of Individuals Covered28287
Insurance policy start date2013-05-01
Insurance policy end date2014-04-30
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $71,080
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract number8027189
Policy instance 17
Insurance contract or identification number8027189
Number of Individuals Covered8
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $40
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $6,230
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $20
Insurance broker organization code?3
Insurance broker nameGAVALAS NICHOLAS
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract number8027002
Policy instance 14
Insurance contract or identification number8027002
Number of Individuals Covered27
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $253
Total amount of fees paid to insurance companyUSD $2
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $28,878
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $120
Insurance broker organization code?3
Amount paid for insurance broker fees2
Insurance broker nameBRADLEY ATKINS
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 )
Policy contract numberT66BA-P 50819
Policy instance 11
Insurance contract or identification numberT66BA-P 50819
Number of Individuals Covered2735
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $25,425
Other welfare benefits providedACCIDENTAL DEATH OR DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $254,247
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $25,425
Insurance broker organization code?3
Insurance broker nameBENEFIT ADVISORS INC.
ACE AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 22667 )
Policy contract numberADD N00944324R
Policy instance 10
Insurance contract or identification numberADD N00944324R
Number of Individuals Covered29004
Insurance policy start date2013-10-25
Insurance policy end date2014-10-25
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $23,733
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 number0033836
Policy instance 2
Insurance contract or identification number0033836
Number of Individuals Covered18718
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $476,326
Total amount of fees paid to insurance companyUSD $79,167
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $6,030,789
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $476,326
Insurance broker organization code?3
Amount paid for insurance broker fees79167
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker nameSEABURY & SMITH INC
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0028939
Policy instance 3
Insurance contract or identification number0028939
Number of Individuals Covered30921
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $20,861
Total amount of fees paid to insurance companyUSD $4,431
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH OR DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $469,264
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $20,861
Amount paid for insurance broker fees4431
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
Insurance broker nameMARK III BROKERAGE
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00350170
Policy instance 4
Insurance contract or identification number00350170
Number of Individuals Covered990
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $18,183
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $121,222
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $18,183
Insurance broker organization code?3
Insurance broker nameTHE BENEFIT PLANNING GROUP, INC.
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract numberH37512
Policy instance 5
Insurance contract or identification numberH37512
Number of Individuals Covered987
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $14,688
Total amount of fees paid to insurance companyUSD $83
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $83,930
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,688
Insurance broker organization code?3
Amount paid for insurance broker fees83
Additional information about fees paid to insurance brokerBONUS
Insurance broker nameNFP INSURANCE SERVICES INC
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number85006
Policy instance 6
Insurance contract or identification number85006
Number of Individuals Covered19
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $166
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $6,841
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $166
Insurance broker organization code?3
Insurance broker nameHOLROYD AGENCY
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number010-350003
Policy instance 7
Insurance contract or identification number010-350003
Number of Individuals Covered55433
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $363,764
Total amount of fees paid to insurance companyUSD $2,500
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $18,562,084
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $363,764
Amount paid for insurance broker fees2500
Insurance broker organization code?3
Insurance broker nameMARK III BROKERAGE INC
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number043211-GRH
Policy instance 9
Insurance contract or identification number043211-GRH
Number of Individuals Covered4921
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $118,398
Total amount of fees paid to insurance companyUSD $68,972
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $724,190
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $118,398
Insurance broker organization code?3
Amount paid for insurance broker fees68972
Additional information about fees paid to insurance brokerADMINISTRATIVE SERVICES
Insurance broker nameMGIS, INC
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number043211-GLT
Policy instance 8
Insurance contract or identification number043211-GLT
Number of Individuals Covered1233
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $53,603
Total amount of fees paid to insurance companyUSD $31,375
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $329,428
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $53,603
Insurance broker organization code?3
Amount paid for insurance broker fees31375
Additional information about fees paid to insurance brokerADMINISTRATIVE SERVICES
Insurance broker nameMGIS
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0028939
Policy instance 3
Insurance contract or identification number0028939
Number of Individuals Covered30648
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $21,474
Total amount of fees paid to insurance companyUSD $4,391
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH OR DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $500,990
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $21,474
Amount paid for insurance broker fees4391
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
Insurance broker nameMARK III BROKERAGE
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00350170
Policy instance 4
Insurance contract or identification number00350170
Number of Individuals Covered987
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $19,645
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $130,969
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,645
Insurance broker organization code?3
Insurance broker nameTHE BENEFIT PLANNING GROUP, INC.
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number010-350003
Policy instance 7
Insurance contract or identification number010-350003
Number of Individuals Covered54654
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $335,643
Total amount of fees paid to insurance companyUSD $2,500
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $16,782,125
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $335,643
Amount paid for insurance broker fees2500
Insurance broker organization code?3
Insurance broker nameMARK III BROKERAGE INC
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number043211GLT
Policy instance 8
Insurance contract or identification number043211GLT
Number of Individuals Covered1228
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $62,134
Total amount of fees paid to insurance companyUSD $30,337
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $414,029
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $62,134
Insurance broker organization code?3
Amount paid for insurance broker fees30337
Additional information about fees paid to insurance brokerADMINISTRATIVE SERVICES
Insurance broker nameMGIS
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract numberH37512
Policy instance 5
Insurance contract or identification numberH37512
Number of Individuals Covered984
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $15,752
Total amount of fees paid to insurance companyUSD $200
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $90,013
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,752
Insurance broker organization code?3
Amount paid for insurance broker fees200
Additional information about fees paid to insurance brokerBONUS
Insurance broker nameNFP INSURANCE SERVICES INC
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number85006
Policy instance 6
Insurance contract or identification number85006
Number of Individuals Covered20
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $189
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $7,560
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $189
Insurance broker organization code?3
Insurance broker nameHOLROYD AGENCY
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number043211GRH
Policy instance 9
Insurance contract or identification number043211GRH
Number of Individuals Covered4744
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $128,438
Total amount of fees paid to insurance companyUSD $62,711
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $855,854
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $128,438
Insurance broker organization code?3
Amount paid for insurance broker fees62711
Additional information about fees paid to insurance brokerADMINISTRATIVE SERVICES
Insurance broker nameMGIS, INC
ACE AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 22667 )
Policy contract numberADD N00944324R
Policy instance 10
Insurance contract or identification numberADD N00944324R
Number of Individuals Covered29267
Insurance policy start date2012-10-25
Insurance policy end date2013-10-25
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $23,733
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 numberT66BA-P 50819
Policy instance 11
Insurance contract or identification numberT66BA-P 50819
Number of Individuals Covered2793
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $22,930
Other welfare benefits providedACCIDENTAL DEATH OR DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $229,302
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $22,930
Insurance broker organization code?3
Insurance broker nameBENEFIT ADVISORS INC.
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number45317-LTC
Policy instance 13
Insurance contract or identification number45317-LTC
Number of Individuals Covered1725
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $117,279
Other welfare benefits providedLONG TERM CARE
Welfare Benefit Premiums Paid to CarrierUSD $1,954,650
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $117,279
Insurance broker organization code?3
Insurance broker nameBENEFITS ADVISOR
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract number8026259
Policy instance 14
Insurance contract or identification number8026259
Number of Individuals Covered28
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $274
Total amount of fees paid to insurance companyUSD $3
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $26,728
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $138
Insurance broker organization code?3
Amount paid for insurance broker fees3
Insurance broker nameBRADLEY ATKINS
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number05449A
Policy instance 15
Insurance contract or identification number05449A
Number of Individuals Covered3
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $2,052
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $25,650
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,052
Insurance broker organization code?3
Insurance broker nameARTHUR J GALLAGHER
BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )
Policy contract number000029
Policy instance 1
Insurance contract or identification number000029
Number of Individuals Covered15390
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Health Insurance Welfare BenefitYes
Were dividends or retroactive rate refunds paid as a credit?Yes
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 number0033836
Policy instance 2
Insurance contract or identification number0033836
Number of Individuals Covered17524
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $474,795
Total amount of fees paid to insurance companyUSD $104,712
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $6,874,660
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $474,795
Insurance broker organization code?5
Amount paid for insurance broker fees104712
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker nameSEABURY & SMITH INC
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number0754368
Policy instance 12
Insurance contract or identification number0754368
Number of Individuals Covered14569
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $127,418
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,657,646
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $127,418
Insurance broker organization code?3
Insurance broker nameMARK III BROKERAGE, INC.
BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )
Policy contract number000029
Policy instance 14
Insurance contract or identification number000029
Number of Individuals Covered15738
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Health Insurance Welfare BenefitYes
Were dividends or retroactive rate refunds paid as a credit?Yes
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 number33836
Policy instance 13
Insurance contract or identification number33836
Number of Individuals Covered17766
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $515,528
Total amount of fees paid to insurance companyUSD $88,677
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $6,561,375
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees88677
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $515,528
Insurance broker nameMARSH US CONSUMER
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0028939
Policy instance 12
Insurance contract or identification number0028939
Number of Individuals Covered30343
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $20,150
Total amount of fees paid to insurance companyUSD $3,006
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH OR DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $536,845
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $20,150
Amount paid for insurance broker fees3006
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
Insurance broker nameMARK III BROKERAGE
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00350170
Policy instance 11
Insurance contract or identification number00350170
Number of Individuals Covered990
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $16,115
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $107,433
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,115
Insurance broker organization code?3
Insurance broker nameTHE BENEFIT PLANNING GROUP, INC.
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract numberH37512
Policy instance 10
Insurance contract or identification numberH37512
Number of Individuals Covered987
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $11,852
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $67,725
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,852
Insurance broker organization code?3
Insurance broker nameTHE BENEFIT PLANNING GROUP, INC.
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract number8026259
Policy instance 1
Insurance contract or identification number8026259
Number of Individuals Covered44
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $417
Total amount of fees paid to insurance companyUSD $2
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $40,860
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees2
Additional information about fees paid to insurance brokerADMINISTRATIVE SERVICES
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $9
Insurance broker nameD.L. DAVIS & CO
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number043211GRH
Policy instance 6
Insurance contract or identification number043211GRH
Number of Individuals Covered3224
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $100,609
Total amount of fees paid to insurance companyUSD $58,690
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $733,891
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees58690
Additional information about fees paid to insurance brokerADMINISTRATIVE SERVICES
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $100,609
Insurance broker nameBENEFIT ADVISORS, INC
ACE AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 22667 )
Policy contract numberADD N00944324R
Policy instance 5
Insurance contract or identification numberADD N00944324R
Number of Individuals Covered28901
Insurance policy start date2011-10-25
Insurance policy end date2012-10-25
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $18,991
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 numberT66BA-P 50819
Policy instance 4
Insurance contract or identification numberT66BA-P 50819
Number of Individuals Covered2782
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $24,717
Other welfare benefits providedACCIDENTAL DEATH OR DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $247,172
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $24,717
Insurance broker organization code?3
Insurance broker nameBENEFIT ADVISORS INC.
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract numberMULTIPLE
Policy instance 3
Insurance contract or identification numberMULTIPLE
Number of Individuals Covered13751
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $119,044
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,380,893
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $119,044
Insurance broker nameMARK III BROKERAGE, INC.
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number45317-LTC
Policy instance 2
Insurance contract or identification number45317-LTC
Number of Individuals Covered1727
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $119,768
Other welfare benefits providedLONG TERM CARE
Welfare Benefit Premiums Paid to CarrierUSD $1,996,127
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $119,768
Insurance broker organization code?3
Insurance broker nameBENEFITS ADVISOR
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number010-350003
Policy instance 8
Insurance contract or identification number010-350003
Number of Individuals Covered53064
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $319,404
Total amount of fees paid to insurance companyUSD $2,500
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $15,970,191
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $319,404
Amount paid for insurance broker fees2500
Insurance broker organization code?3
Insurance broker nameMARK III BROKERAGE INC
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number85006
Policy instance 9
Insurance contract or identification number85006
Number of Individuals Covered22
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $217
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $8,409
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $217
Insurance broker organization code?3
Insurance broker nameW. CASPER HOLROYD, JR.
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number043211GLT
Policy instance 7
Insurance contract or identification number043211GLT
Number of Individuals Covered873
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $47,532
Total amount of fees paid to insurance companyUSD $27,610
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $345,257
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees27610
Additional information about fees paid to insurance brokerADMINISTRATIVE SERVICES
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $47,532
Insurance broker nameBENEFIT ADVISORS, INC.
ACE AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 22667 )
Policy contract numberADD N00944324R
Policy instance 4
Insurance contract or identification numberADD N00944324R
Insurance policy start date2010-10-25
Insurance policy end date2011-10-25
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $18,991
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 numberT66BA-P 50819
Policy instance 3
Insurance contract or identification numberT66BA-P 50819
Number of Individuals Covered2228
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $24,256
Other welfare benefits providedACCIDENTAL DEATH OR DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $242,562
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 number000029
Policy instance 13
Insurance contract or identification number000029
Number of Individuals Covered7105
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Health Insurance Welfare BenefitYes
Were dividends or retroactive rate refunds paid as a credit?Yes
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 number33836
Policy instance 12
Insurance contract or identification number33836
Number of Individuals Covered15719
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $437,437
Total amount of fees paid to insurance companyUSD $119,109
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,697,832
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 number0028939
Policy instance 11
Insurance contract or identification number0028939
Number of Individuals Covered29435
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $21,597
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH OR DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $526,088
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number45317-LTC
Policy instance 1
Insurance contract or identification number45317-LTC
Number of Individuals Covered1799
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $110,896
Other welfare benefits providedLONG TERM CARE
Welfare Benefit Premiums Paid to CarrierUSD $1,848,272
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract numberMULTIPLE
Policy instance 2
Insurance contract or identification numberMULTIPLE
Number of Individuals Covered12900
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $111,290
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,225,803
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00350170
Policy instance 10
Insurance contract or identification number00350170
Number of Individuals Covered971
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $19,360
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $129,064
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number85006
Policy instance 8
Insurance contract or identification number85006
Number of Individuals Covered22
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $206
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $8,236
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number010-350003
Policy instance 7
Insurance contract or identification number010-350003
Number of Individuals Covered23307
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $293,663
Total amount of fees paid to insurance companyUSD $2,500
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $14,683,139
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number043211GLT
Policy instance 6
Insurance contract or identification number043211GLT
Number of Individuals Covered1023
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $54,756
Total amount of fees paid to insurance companyUSD $37,847
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $368,777
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number043211GRH
Policy instance 5
Insurance contract or identification number043211GRH
Number of Individuals Covered4009
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $109,323
Total amount of fees paid to insurance companyUSD $74,212
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $723,126
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract numberH37512
Policy instance 9
Insurance contract or identification numberH37512
Number of Individuals Covered968
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $16,819
Total amount of fees paid to insurance companyUSD $661
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $96,110
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number45317-LTC
Policy instance 2
Insurance contract or identification number45317-LTC
Number of Individuals Covered1726
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $97,103
Other welfare benefits providedLONG TERM CARE
Welfare Benefit Premiums Paid to CarrierUSD $1,618,382
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $97,103
Insurance broker organization code?3
Insurance broker nameBENEFIT ADVISORS, INC
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract numberMULTIPLE
Policy instance 3
Insurance contract or identification numberMULTIPLE
Number of Individuals Covered12317
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $97,864
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,957,291
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $97,864
Insurance broker organization code?3
Insurance broker nameMARK III BROKERAGE, INC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 )
Policy contract numberT66BA-P 50819
Policy instance 4
Insurance contract or identification numberT66BA-P 50819
Number of Individuals Covered2214
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $24,024
Other welfare benefits providedACCIDENTAL DEATH OR DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $240,239
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $24,024
Insurance broker organization code?3
Insurance broker nameBENEFIT ADVISORS INC.
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract number8025861
Policy instance 6
Insurance contract or identification number8025861
Number of Individuals Covered37
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $434
Total amount of fees paid to insurance companyUSD $1
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $41,871
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
Amount paid for insurance broker fees1
Commission paid to Insurance BrokerUSD $3
Insurance broker nameNEWMAN TOWNSEND
ACE AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 22667 )
Policy contract numberADD N00944324R
Policy instance 5
Insurance contract or identification numberADD N00944324R
Number of Individuals Covered27093
Insurance policy start date2009-10-25
Insurance policy end date2010-10-25
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $18,991
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number043211GRH
Policy instance 7
Insurance contract or identification number043211GRH
Number of Individuals Covered3677
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $110,428
Total amount of fees paid to insurance companyUSD $54,364
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $678,483
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees54364
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $110,428
Insurance broker nameBENEFIT ADVISORS, INC.
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number043211GLT
Policy instance 8
Insurance contract or identification number043211GLT
Number of Individuals Covered1089
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $68,364
Total amount of fees paid to insurance companyUSD $33,316
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $423,541
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees33316
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $68,364
Insurance broker nameBENEFIT ADVISORS
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number010-350003
Policy instance 9
Insurance contract or identification number010-350003
Number of Individuals Covered22660
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $248,299
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $12,289,916
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $248,299
Insurance broker organization code?3
Insurance broker nameMARK III BROKERAGE INC
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number85006
Policy instance 10
Insurance contract or identification number85006
Number of Individuals Covered23
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $244
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $8,754
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $244
Insurance broker organization code?3
Insurance broker nameW. CASPER HOLROYD, JR.
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract numberH37512
Policy instance 11
Insurance contract or identification numberH37512
Number of Individuals Covered962
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $14,140
Total amount of fees paid to insurance companyUSD $2,068
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $80,801
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees907
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $14,140
Insurance broker nameTHE BENEFIT PLANNING GROUP, INC.
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00350170
Policy instance 12
Insurance contract or identification number00350170
Number of Individuals Covered962
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $17,453
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $116,353
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,453
Insurance broker organization code?3
Insurance broker nameTHE BENEFIT PLANNING GROUP, INC.
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0028939
Policy instance 13
Insurance contract or identification number0028939
Number of Individuals Covered28913
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $21,783
Total amount of fees paid to insurance companyUSD $2,029
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH OR DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $513,787
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $21,783
Amount paid for insurance broker fees2029
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
Insurance broker nameMARK III BROKERAGE
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number33836
Policy instance 14
Insurance contract or identification number33836
Number of Individuals Covered14819
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $502,516
Total amount of fees paid to insurance companyUSD $162,133
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $6,318,534
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees162133
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $502,516
Insurance broker nameMARSH US CONSUMER
BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )
Policy contract number000029
Policy instance 15
Insurance contract or identification number000029
Number of Individuals Covered7006
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Health Insurance Welfare BenefitYes
Were dividends or retroactive rate refunds paid as a credit?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract number8026082
Policy instance 1
Insurance contract or identification number8026082
Number of Individuals Covered11
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $67
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $8,557
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9
Insurance broker organization code?3
Insurance broker nameDL DAVIS & CO INC

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