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BROOKS PIERCE MCLENDON HUMPHREY & LEONARD LLP CAFETERIA PLAN 401k Plan overview

Plan NameBROOKS PIERCE MCLENDON HUMPHREY & LEONARD LLP CAFETERIA PLAN
Plan identification number 501

BROOKS PIERCE MCLENDON HUMPHREY & LEONARD LLP CAFETERIA 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

401k Sponsoring company profile

BROOKS PIERCE MCLENDON HUMPHREY & LEONARD, LLP has sponsored the creation of one or more 401k plans.

Company Name:BROOKS PIERCE MCLENDON HUMPHREY & LEONARD, LLP
Employer identification number (EIN):560561489
NAIC Classification:541110
NAIC Description:Offices of Lawyers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BROOKS PIERCE MCLENDON HUMPHREY & LEONARD LLP CAFETERIA PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01HOWARD WILLIAMS2023-07-20 HOWARD WILLIAMS2023-07-20
5012021-01-01HOWARD WILLIAMS2022-10-17 HOWARD WILLIAMS2022-10-17
5012020-01-01HOWARD WILLIAMS2021-10-12 HOWARD WILLIAMS2021-10-12
5012019-01-01HOWARD WILLIAMS2020-10-15 HOWARD WILLIAMS2020-10-15
5012018-01-01HOWARD WILLIAMS2019-07-31
5012017-01-01
5012016-01-01
5012015-01-01
5012014-01-01
5012013-01-01
5012012-01-01HOWARD WILLIAMS
5012011-01-01HOWARD WILLIAMS
5012009-01-01HOWARD WILLIAMS

Plan Statistics for BROOKS PIERCE MCLENDON HUMPHREY & LEONARD LLP CAFETERIA PLAN

401k plan membership statisitcs for BROOKS PIERCE MCLENDON HUMPHREY & LEONARD LLP CAFETERIA PLAN

Measure Date Value
2022: BROOKS PIERCE MCLENDON HUMPHREY & LEONARD LLP CAFETERIA PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01161
Total number of active participants reported on line 7a of the Form 55002022-01-01182
Total of all active and inactive participants2022-01-01182
2021: BROOKS PIERCE MCLENDON HUMPHREY & LEONARD LLP CAFETERIA PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01294
Total number of active participants reported on line 7a of the Form 55002021-01-01295
Total of all active and inactive participants2021-01-01295
2020: BROOKS PIERCE MCLENDON HUMPHREY & LEONARD LLP CAFETERIA PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01306
Total number of active participants reported on line 7a of the Form 55002020-01-01294
Total of all active and inactive participants2020-01-01294
2019: BROOKS PIERCE MCLENDON HUMPHREY & LEONARD LLP CAFETERIA PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01304
Total number of active participants reported on line 7a of the Form 55002019-01-01306
Total of all active and inactive participants2019-01-01306
2018: BROOKS PIERCE MCLENDON HUMPHREY & LEONARD LLP CAFETERIA PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01276
Total number of active participants reported on line 7a of the Form 55002018-01-01304
Total of all active and inactive participants2018-01-01304
2017: BROOKS PIERCE MCLENDON HUMPHREY & LEONARD LLP CAFETERIA PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01269
Total number of active participants reported on line 7a of the Form 55002017-01-01276
Total of all active and inactive participants2017-01-01276
2016: BROOKS PIERCE MCLENDON HUMPHREY & LEONARD LLP CAFETERIA PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01267
Total number of active participants reported on line 7a of the Form 55002016-01-01269
Total of all active and inactive participants2016-01-01269
2015: BROOKS PIERCE MCLENDON HUMPHREY & LEONARD LLP CAFETERIA PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01285
Total number of active participants reported on line 7a of the Form 55002015-01-01267
Total of all active and inactive participants2015-01-01267
2014: BROOKS PIERCE MCLENDON HUMPHREY & LEONARD LLP CAFETERIA PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01287
Total number of active participants reported on line 7a of the Form 55002014-01-01285
Total of all active and inactive participants2014-01-01285
2013: BROOKS PIERCE MCLENDON HUMPHREY & LEONARD LLP CAFETERIA PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01329
Total number of active participants reported on line 7a of the Form 55002013-01-01287
Total of all active and inactive participants2013-01-01287
2012: BROOKS PIERCE MCLENDON HUMPHREY & LEONARD LLP CAFETERIA PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01317
Total number of active participants reported on line 7a of the Form 55002012-01-01329
Total of all active and inactive participants2012-01-01329
2011: BROOKS PIERCE MCLENDON HUMPHREY & LEONARD LLP CAFETERIA PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01311
Total number of active participants reported on line 7a of the Form 55002011-01-01317
Total of all active and inactive participants2011-01-01317
2009: BROOKS PIERCE MCLENDON HUMPHREY & LEONARD LLP CAFETERIA PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01280
Total number of active participants reported on line 7a of the Form 55002009-01-01276
Total of all active and inactive participants2009-01-01276

Form 5500 Responses for BROOKS PIERCE MCLENDON HUMPHREY & LEONARD LLP CAFETERIA PLAN

2022: BROOKS PIERCE MCLENDON HUMPHREY & LEONARD LLP CAFETERIA PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – InsuranceYes
2021: BROOKS PIERCE MCLENDON HUMPHREY & LEONARD LLP CAFETERIA PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – InsuranceYes
2020: BROOKS PIERCE MCLENDON HUMPHREY & LEONARD LLP CAFETERIA PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – InsuranceYes
2019: BROOKS PIERCE MCLENDON HUMPHREY & LEONARD LLP CAFETERIA PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – InsuranceYes
2018: BROOKS PIERCE MCLENDON HUMPHREY & LEONARD LLP CAFETERIA PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – InsuranceYes
2017: BROOKS PIERCE MCLENDON HUMPHREY & LEONARD LLP CAFETERIA PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – InsuranceYes
2016: BROOKS PIERCE MCLENDON HUMPHREY & LEONARD LLP CAFETERIA PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – InsuranceYes
2015: BROOKS PIERCE MCLENDON HUMPHREY & LEONARD LLP CAFETERIA PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: BROOKS PIERCE MCLENDON HUMPHREY & LEONARD LLP CAFETERIA PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: BROOKS PIERCE MCLENDON HUMPHREY & LEONARD LLP CAFETERIA PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: BROOKS PIERCE MCLENDON HUMPHREY & LEONARD LLP CAFETERIA PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: BROOKS PIERCE MCLENDON HUMPHREY & LEONARD LLP CAFETERIA PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – InsuranceYes
2009: BROOKS PIERCE MCLENDON HUMPHREY & LEONARD LLP CAFETERIA PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01This submission is the final filingNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number010-057204
Policy instance 4
Insurance contract or identification number010-057204
Number of Individuals Covered139
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $12,141
Total amount of fees paid to insurance companyUSD $5,512
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $121,405
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,141
Insurance broker organization code?3
Amount paid for insurance broker fees5512
PACIFIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67466 )
Policy contract numberM360010000
Policy instance 3
Insurance contract or identification numberM360010000
Number of Individuals Covered72
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $20,774
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $224,261
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $20,774
Insurance broker organization code?3
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number60720
Policy instance 2
Insurance contract or identification number60720
Number of Individuals Covered182
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $50,076
Total amount of fees paid to insurance companyUSD $34
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedVOL LIFE VOL DEP LIFE
Welfare Benefit Premiums Paid to CarrierUSD $249,162
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $33,120
Insurance broker organization code?3
Amount paid for insurance broker fees34
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30042596
Policy instance 1
Insurance contract or identification number30042596
Number of Individuals Covered110
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $1,252
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $24,902
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,252
Insurance broker organization code?3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30042596
Policy instance 1
Insurance contract or identification number30042596
Number of Individuals Covered96
Insurance policy start date2020-10-01
Insurance policy end date2021-09-30
Total amount of commissions paid to insurance brokerUSD $1,173
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $22,406
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,173
Insurance broker organization code?3
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number60720
Policy instance 2
Insurance contract or identification number60720
Number of Individuals Covered161
Insurance policy start date2020-10-01
Insurance policy end date2021-09-30
Total amount of commissions paid to insurance brokerUSD $36,948
Total amount of fees paid to insurance companyUSD $32
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedVOL LIFE VOL DEP LIFE
Welfare Benefit Premiums Paid to CarrierUSD $224,985
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $29,979
Insurance broker organization code?3
Amount paid for insurance broker fees32
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number1098004
Policy instance 3
Insurance contract or identification number1098004
Number of Individuals Covered295
Insurance policy start date2021-01-01
Insurance policy end date2021-09-30
Total amount of commissions paid to insurance brokerUSD $960
Total amount of fees paid to insurance companyUSD $1,968
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $95,691
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $960
Amount paid for insurance broker fees1968
Insurance broker organization code?3
PACIFIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67466 )
Policy contract numberM360010000
Policy instance 4
Insurance contract or identification numberM360010000
Number of Individuals Covered74
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $18,621
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $200,756
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $18,621
Insurance broker organization code?3
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number1098004
Policy instance 3
Insurance contract or identification number1098004
Number of Individuals Covered294
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $1,330
Total amount of fees paid to insurance companyUSD $342
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $127,729
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,330
Amount paid for insurance broker fees342
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number60720
Policy instance 2
Insurance contract or identification number60720
Number of Individuals Covered162
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $39,860
Total amount of fees paid to insurance companyUSD $35
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedVOL LIFE VOL DEP LIFE
Welfare Benefit Premiums Paid to CarrierUSD $230,032
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $30,715
Insurance broker organization code?3
Amount paid for insurance broker fees30
Additional information about fees paid to insurance brokerTHIRD PARTY ADMINISTRATION FEES
PACIFIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67466 )
Policy contract numberM360010000
Policy instance 4
Insurance contract or identification numberM360010000
Number of Individuals Covered79
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $14,562
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $151,258
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,562
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number149174 0001
Policy instance 5
Insurance contract or identification number149174 0001
Number of Individuals Covered6
Insurance policy start date2020-01-01
Insurance policy end date2021-01-01
Total amount of commissions paid to insurance brokerUSD $1,836
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedGROUP LONG TERM CARE
Welfare Benefit Premiums Paid to CarrierUSD $12,242
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,836
Insurance broker organization code?4
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number149174 0800
Policy instance 6
Insurance contract or identification number149174 0800
Number of Individuals Covered6
Insurance policy start date2020-01-01
Insurance policy end date2021-01-01
Total amount of commissions paid to insurance brokerUSD $425
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedGROUP LONG TERM CARE
Welfare Benefit Premiums Paid to CarrierUSD $2,530
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $425
Insurance broker organization code?4
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30042596
Policy instance 1
Insurance contract or identification number30042596
Number of Individuals Covered88
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $1,206
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $23,307
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,206
Insurance broker organization code?3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30042596
Policy instance 1
Insurance contract or identification number30042596
Number of Individuals Covered96
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $655
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $23,163
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $655
Insurance broker organization code?3
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number1098004
Policy instance 3
Insurance contract or identification number1098004
Number of Individuals Covered306
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $1,372
Total amount of fees paid to insurance companyUSD $13,746
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $136,833
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,372
Amount paid for insurance broker fees13746
Insurance broker organization code?3
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number60720
Policy instance 2
Insurance contract or identification number60720
Number of Individuals Covered171
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $43,742
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedVOL LIFE VOL DEP LIFE
Welfare Benefit Premiums Paid to CarrierUSD $217,898
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees43682
Insurance broker organization code?3
PACIFIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67466 )
Policy contract numberM360010000
Policy instance 4
Insurance contract or identification numberM360010000
Number of Individuals Covered80
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $14,443
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $169,551
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,443
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number245837
Policy instance 6
Insurance contract or identification number245837
Number of Individuals Covered170
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $9,591
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedVOL LIFE VOL DEP LIFE
Welfare Benefit Premiums Paid to CarrierUSD $64,091
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,591
Insurance broker organization code?3
Insurance broker nameMORGAN JAMES
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number010-042387
Policy instance 5
Insurance contract or identification number010-042387
Number of Individuals Covered141
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $5,158
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $143,094
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,727
Insurance broker organization code?3
Insurance broker nameBB&T INSURANCE SERVICES INC
NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 )
Policy contract number658545
Policy instance 2
Insurance contract or identification number658545
Number of Individuals Covered100
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $2,746
Total amount of fees paid to insurance companyUSD $642
Temporary Disability 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 $2,088
Amount paid for insurance broker fees533
Insurance broker organization code?3
Insurance broker nameCAROLINA CONDREY GROUP
BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )
Policy contract number009105
Policy instance 3
Insurance contract or identification number009105
Number of Individuals Covered276
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $39,000
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $39,000
Insurance broker organization code?3
Insurance broker nameBB&T INSURANCE SERVICES INC
NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 )
Policy contract number658545
Policy instance 1
Insurance contract or identification number658545
Number of Individuals Covered169
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $6,232
Total amount of fees paid to insurance companyUSD $1,458
Long Term Disability 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 $4,742
Amount paid for insurance broker fees1209
Insurance broker organization code?3
Insurance broker nameCAROLINA CONDREY GROUP
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30042596
Policy instance 4
Insurance contract or identification number30042596
Number of Individuals Covered101
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $1,171
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $21,362
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,171
Insurance broker organization code?3
Insurance broker nameBB&T INSURANCE SERVICES INC
SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )
Policy contract number454-4257-00
Policy instance 3
Insurance contract or identification number454-4257-00
Number of Individuals Covered166
Insurance policy start date2015-01-01
Insurance policy end date2016-01-01
Total amount of commissions paid to insurance brokerUSD $8,398
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedVOL LIFE VOL DEP LIFE
Welfare Benefit Premiums Paid to CarrierUSD $60,797
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,398
Insurance broker organization code?3
Insurance broker nameJAMES M. MORGAN III
BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )
Policy contract number009105
Policy instance 4
Insurance contract or identification number009105
Number of Individuals Covered267
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $39,000
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees39000
Insurance broker organization code?3
Insurance broker nameBB&T INSURANCE SERVICES INC
NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 )
Policy contract number658545
Policy instance 2
Insurance contract or identification number658545
Number of Individuals Covered166
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $2,333
Total amount of fees paid to insurance companyUSD $545
Temporary Disability 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 $1,774
Amount paid for insurance broker fees452
Insurance broker organization code?3
Insurance broker nameCAROLINA CONDREY GROUP
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30042596
Policy instance 6
Insurance contract or identification number30042596
Number of Individuals Covered85
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $1,070
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $18,513
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,070
Insurance broker organization code?3
Insurance broker nameBB&T INSURANCE SERVICES, INC.
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number010-042387
Policy instance 7
Insurance contract or identification number010-042387
Number of Individuals Covered142
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $296
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $29,588
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $296
Insurance broker organization code?3
Insurance broker nameBB & T INSURANCE SERVICES
NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 )
Policy contract number658545
Policy instance 1
Insurance contract or identification number658545
Number of Individuals Covered166
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $6,065
Total amount of fees paid to insurance companyUSD $1,417
Long Term Disability 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 $4,593
Amount paid for insurance broker fees1171
Insurance broker organization code?3
Insurance broker nameCAROLINA CONDREY GROUP
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5468736
Policy instance 5
Insurance contract or identification number5468736
Number of Individuals Covered139
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $855
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $85,500
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $855
Insurance broker organization code?3
Insurance broker nameBB&T - PBM
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30042596
Policy instance 7
Insurance contract or identification number30042596
Number of Individuals Covered81
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $1,006
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $16,574
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,006
Insurance broker organization code?3
Insurance broker nameBB&T INSURANCE SERVICES INC
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number149174
Policy instance 6
Insurance contract or identification number149174
Number of Individuals Covered69
Insurance policy start date2014-01-01
Insurance policy end date2015-01-01
Total amount of commissions paid to insurance brokerUSD $1,621
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedLONG-TERM CARE
Welfare Benefit Premiums Paid to CarrierUSD $10,825
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,621
Insurance broker organization code?3
Insurance broker nameTHOMAS L DELEOT
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5468736
Policy instance 5
Insurance contract or identification number5468736
Number of Individuals Covered139
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $297
Total amount of fees paid to insurance companyUSD $190
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $113,402
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $297
Amount paid for insurance broker fees190
Insurance broker organization code?3
Insurance broker nameBB&T PBM
BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )
Policy contract number009105
Policy instance 4
Insurance contract or identification number009105
Number of Individuals Covered285
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $39,750
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health 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 $39,750
Insurance broker organization code?3
Insurance broker nameBB&T INSURANCE SERVICES INC
SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )
Policy contract number454-4257-00
Policy instance 3
Insurance contract or identification number454-4257-00
Number of Individuals Covered161
Insurance policy start date2014-01-01
Insurance policy end date2015-01-01
Total amount of commissions paid to insurance brokerUSD $7,629
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $55,529
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,722
Insurance broker organization code?3
Insurance broker nameJAMES M. MORGAN III
NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 )
Policy contract number658545
Policy instance 2
Insurance contract or identification number658545
Number of Individuals Covered161
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $2,398
Total amount of fees paid to insurance companyUSD $466
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Temporary Disability 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 $1,823
Amount paid for insurance broker fees379
Insurance broker organization code?3
Insurance broker nameCAROLINA CONDREY GROUP
NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 )
Policy contract number658545
Policy instance 1
Insurance contract or identification number658545
Number of Individuals Covered161
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $6,126
Total amount of fees paid to insurance companyUSD $1,191
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Long Term Disability 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 $4,660
Amount paid for insurance broker fees969
Insurance broker organization code?3
Insurance broker nameCAROLINA CONDREY GROUP
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number149174
Policy instance 7
Insurance contract or identification number149174
Number of Individuals Covered66
Insurance policy start date2013-01-01
Insurance policy end date2014-01-01
Total amount of commissions paid to insurance brokerUSD $1,687
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedLONG-TERM CARE
Welfare Benefit Premiums Paid to CarrierUSD $10,422
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,687
Insurance broker organization code?3
Insurance broker nameTHOMAS L DELEOT
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract number413A49
Policy instance 5
Insurance contract or identification number413A49
Number of Individuals Covered338
Insurance policy start date2013-01-01
Insurance policy end date2013-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $85,129
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 number009105
Policy instance 4
Insurance contract or identification number009105
Number of Individuals Covered287
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $40,000
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health 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 $40,000
Insurance broker organization code?3
Insurance broker nameBB&T INSURANCE SERVICES INC
SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )
Policy contract number454-4257-00
Policy instance 3
Insurance contract or identification number454-4257-00
Number of Individuals Covered165
Insurance policy start date2013-01-01
Insurance policy end date2014-01-01
Total amount of commissions paid to insurance brokerUSD $7,421
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $54,429
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,566
Insurance broker organization code?3
Insurance broker nameJAMES M. MORGAN III
NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 )
Policy contract number658545
Policy instance 1
Insurance contract or identification number658545
Number of Individuals Covered164
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $6,151
Total amount of fees paid to insurance companyUSD $1,196
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Long Term Disability 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 $2,385
Amount paid for insurance broker fees496
Insurance broker organization code?3
Insurance broker nameCAROLINA CONDREY GROUP
NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 )
Policy contract number658545
Policy instance 2
Insurance contract or identification number658545
Number of Individuals Covered164
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $2,526
Total amount of fees paid to insurance companyUSD $492
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Temporary Disability 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 $1,009
Amount paid for insurance broker fees210
Insurance broker organization code?3
Insurance broker nameCAROLINA CONDREY GROUP
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5468736
Policy instance 6
Insurance contract or identification number5468736
Number of Individuals Covered143
Insurance policy start date2013-10-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $52
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $28,551
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees52
Insurance broker organization code?3
Insurance broker nameBB&T PBM
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number149174
Policy instance 7
Insurance contract or identification number149174
Number of Individuals Covered63
Insurance policy start date2012-01-01
Insurance policy end date2013-01-01
Total amount of commissions paid to insurance brokerUSD $1,422
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedLONG-TERM CARE
Welfare Benefit Premiums Paid to CarrierUSD $10,302
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,422
Insurance broker organization code?3
Insurance broker nameTHOMAS DELEOT
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract number413A49
Policy instance 6
Insurance contract or identification number413A49
Number of Individuals Covered329
Insurance policy start date2012-07-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $55,085
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract number413A49
Policy instance 5
Insurance contract or identification number413A49
Number of Individuals Covered318
Insurance policy start date2012-01-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $55,124
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 number009105
Policy instance 4
Insurance contract or identification number009105
Number of Individuals Covered287
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )
Policy contract number454-4257-00
Policy instance 3
Insurance contract or identification number454-4257-00
Number of Individuals Covered167
Insurance policy start date2012-01-01
Insurance policy end date2013-01-01
Total amount of commissions paid to insurance brokerUSD $6,643
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $48,950
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,261
Insurance broker organization code?3
Insurance broker nameCAROLINA CONSULTING
NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 )
Policy contract number658545
Policy instance 2
Insurance contract or identification number658545
Number of Individuals Covered97
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $2,422
Total amount of fees paid to insurance companyUSD $471
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Temporary Disability 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 $921
Amount paid for insurance broker fees192
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
Insurance broker nameCAROLINA CONDREY GROUP
NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 )
Policy contract number658545
Policy instance 1
Insurance contract or identification number658545
Number of Individuals Covered154
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $6,063
Total amount of fees paid to insurance companyUSD $1,180
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Long Term Disability 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 $2,306
Amount paid for insurance broker fees480
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
Insurance broker nameCAROLINA CONDREY GROUP
BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )
Policy contract number009105
Policy instance 5
Insurance contract or identification number009105
Number of Individuals Covered284
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26921 )
Policy contract number889486-000/099
Policy instance 4
Insurance contract or identification number889486-000/099
Number of Individuals Covered299
Insurance policy start date2011-01-01
Insurance policy end date2011-09-30
Total amount of commissions paid to insurance brokerUSD $15,318
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $81,106
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )
Policy contract number454-4257-00
Policy instance 3
Insurance contract or identification number454-4257-00
Number of Individuals Covered158
Insurance policy start date2011-01-01
Insurance policy end date2012-01-01
Total amount of commissions paid to insurance brokerUSD $6,202
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $45,611
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 )
Policy contract number658545
Policy instance 2
Insurance contract or identification number658545
Number of Individuals Covered97
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $1,822
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Temporary Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 )
Policy contract number658545
Policy instance 1
Insurance contract or identification number658545
Number of Individuals Covered154
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $4,532
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract number413A49
Policy instance 6
Insurance contract or identification number413A49
Number of Individuals Covered317
Insurance policy start date2011-10-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $18,367
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 number009105
Policy instance 5
Insurance contract or identification number009105
Number of Individuals Covered260
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )
Policy contract number454-4257-00
Policy instance 3
Insurance contract or identification number454-4257-00
Number of Individuals Covered153
Insurance policy start date2010-01-01
Insurance policy end date2011-01-01
Total amount of commissions paid to insurance brokerUSD $5,844
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $43,133
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 )
Policy contract number658545
Policy instance 2
Insurance contract or identification number658545
Number of Individuals Covered93
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $1,792
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Temporary Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 )
Policy contract number658545
Policy instance 1
Insurance contract or identification number658545
Number of Individuals Covered148
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $4,524
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26921 )
Policy contract number889486-000/099
Policy instance 4
Insurance contract or identification number889486-000/099
Number of Individuals Covered311
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $15,780
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $105,394
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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