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VANGUARD FURNITURE COMPANY EMPLOYEE LIFE, DISABILITY AND DENTAL PLAN 401k Plan overview

Plan NameVANGUARD FURNITURE COMPANY EMPLOYEE LIFE, DISABILITY AND DENTAL PLAN
Plan identification number 502

VANGUARD FURNITURE COMPANY EMPLOYEE LIFE, DISABILITY AND DENTAL PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Other welfare benefit cover

401k Sponsoring company profile

VANGUARD FURNITURE COMPANY has sponsored the creation of one or more 401k plans.

Company Name:VANGUARD FURNITURE COMPANY
Employer identification number (EIN):560928040
NAIC Classification:337000

Form 5500 Filing Information

Submission information for form 5500 for 401k plan VANGUARD FURNITURE COMPANY EMPLOYEE LIFE, DISABILITY AND DENTAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022022-01-01TAMMY SMITH2023-07-25
5022021-01-01TAMMY SMITH2022-07-25
5022020-01-01TAMMY SMITH2021-07-28
5022019-01-01TAMMY SMITH2020-07-30
5022018-01-01TAMMY SMITH2019-07-29
5022017-01-01
5022016-01-01
5022015-01-01
5022014-01-01
5022013-01-01
5022012-01-01JOE ROYALL
5022011-01-01JOE ROYALL
5022010-01-01
5022009-01-01
5022008-01-01
5022007-01-01

Plan Statistics for VANGUARD FURNITURE COMPANY EMPLOYEE LIFE, DISABILITY AND DENTAL PLAN

401k plan membership statisitcs for VANGUARD FURNITURE COMPANY EMPLOYEE LIFE, DISABILITY AND DENTAL PLAN

Measure Date Value
2022: VANGUARD FURNITURE COMPANY EMPLOYEE LIFE, DISABILITY AND DENTAL PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01562
Total number of active participants reported on line 7a of the Form 55002022-01-01730
Total of all active and inactive participants2022-01-01730
2021: VANGUARD FURNITURE COMPANY EMPLOYEE LIFE, DISABILITY AND DENTAL PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01538
Total number of active participants reported on line 7a of the Form 55002021-01-01562
Total of all active and inactive participants2021-01-01562
2020: VANGUARD FURNITURE COMPANY EMPLOYEE LIFE, DISABILITY AND DENTAL PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01538
Total number of active participants reported on line 7a of the Form 55002020-01-01538
Total of all active and inactive participants2020-01-01538
2019: VANGUARD FURNITURE COMPANY EMPLOYEE LIFE, DISABILITY AND DENTAL PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01568
Total number of active participants reported on line 7a of the Form 55002019-01-01538
Number of retired or separated participants receiving benefits2019-01-010
Total of all active and inactive participants2019-01-01538
2018: VANGUARD FURNITURE COMPANY EMPLOYEE LIFE, DISABILITY AND DENTAL PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01556
Total number of active participants reported on line 7a of the Form 55002018-01-01567
Number of retired or separated participants receiving benefits2018-01-011
Total of all active and inactive participants2018-01-01568
2017: VANGUARD FURNITURE COMPANY EMPLOYEE LIFE, DISABILITY AND DENTAL PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01535
Total number of active participants reported on line 7a of the Form 55002017-01-01556
Total of all active and inactive participants2017-01-01556
2016: VANGUARD FURNITURE COMPANY EMPLOYEE LIFE, DISABILITY AND DENTAL PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01522
Total number of active participants reported on line 7a of the Form 55002016-01-01535
Total of all active and inactive participants2016-01-01535
2015: VANGUARD FURNITURE COMPANY EMPLOYEE LIFE, DISABILITY AND DENTAL PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01474
Total number of active participants reported on line 7a of the Form 55002015-01-01522
Total of all active and inactive participants2015-01-01522
2014: VANGUARD FURNITURE COMPANY EMPLOYEE LIFE, DISABILITY AND DENTAL PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01410
Total number of active participants reported on line 7a of the Form 55002014-01-01474
Total of all active and inactive participants2014-01-01474
2013: VANGUARD FURNITURE COMPANY EMPLOYEE LIFE, DISABILITY AND DENTAL PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01338
Total number of active participants reported on line 7a of the Form 55002013-01-01410
Total of all active and inactive participants2013-01-01410
2012: VANGUARD FURNITURE COMPANY EMPLOYEE LIFE, DISABILITY AND DENTAL PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01311
Total number of active participants reported on line 7a of the Form 55002012-01-01338
Total of all active and inactive participants2012-01-01338
2011: VANGUARD FURNITURE COMPANY EMPLOYEE LIFE, DISABILITY AND DENTAL PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01304
Total number of active participants reported on line 7a of the Form 55002011-01-01311
Total of all active and inactive participants2011-01-01311
2010: VANGUARD FURNITURE COMPANY EMPLOYEE LIFE, DISABILITY AND DENTAL PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-01370
Total number of active participants reported on line 7a of the Form 55002010-01-01304
Total of all active and inactive participants2010-01-01304
2009: VANGUARD FURNITURE COMPANY EMPLOYEE LIFE, DISABILITY AND DENTAL PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01452
Total number of active participants reported on line 7a of the Form 55002009-01-01370
Total of all active and inactive participants2009-01-01370
2008: VANGUARD FURNITURE COMPANY EMPLOYEE LIFE, DISABILITY AND DENTAL PLAN 2008 401k membership
Total participants, beginning-of-year2008-01-01461
Total number of active participants reported on line 7a of the Form 55002008-01-01452
Total of all active and inactive participants2008-01-01452
2007: VANGUARD FURNITURE COMPANY EMPLOYEE LIFE, DISABILITY AND DENTAL PLAN 2007 401k membership
Total participants, beginning-of-year2007-01-01468
Total number of active participants reported on line 7a of the Form 55002007-01-01461
Total of all active and inactive participants2007-01-01461

Form 5500 Responses for VANGUARD FURNITURE COMPANY EMPLOYEE LIFE, DISABILITY AND DENTAL PLAN

2022: VANGUARD FURNITURE COMPANY EMPLOYEE LIFE, DISABILITY AND DENTAL 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: VANGUARD FURNITURE COMPANY EMPLOYEE LIFE, DISABILITY AND DENTAL 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: VANGUARD FURNITURE COMPANY EMPLOYEE LIFE, DISABILITY AND DENTAL 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: VANGUARD FURNITURE COMPANY EMPLOYEE LIFE, DISABILITY AND DENTAL 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: VANGUARD FURNITURE COMPANY EMPLOYEE LIFE, DISABILITY AND DENTAL 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: VANGUARD FURNITURE COMPANY EMPLOYEE LIFE, DISABILITY AND DENTAL 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: VANGUARD FURNITURE COMPANY EMPLOYEE LIFE, DISABILITY AND DENTAL 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: VANGUARD FURNITURE COMPANY EMPLOYEE LIFE, DISABILITY AND DENTAL 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: VANGUARD FURNITURE COMPANY EMPLOYEE LIFE, DISABILITY AND DENTAL 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: VANGUARD FURNITURE COMPANY EMPLOYEE LIFE, DISABILITY AND DENTAL 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: VANGUARD FURNITURE COMPANY EMPLOYEE LIFE, DISABILITY AND DENTAL 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: VANGUARD FURNITURE COMPANY EMPLOYEE LIFE, DISABILITY AND DENTAL 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
2010: VANGUARD FURNITURE COMPANY EMPLOYEE LIFE, DISABILITY AND DENTAL PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan benefit arrangement – InsuranceYes
2009: VANGUARD FURNITURE COMPANY EMPLOYEE LIFE, DISABILITY AND DENTAL PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – InsuranceYes
2008: VANGUARD FURNITURE COMPANY EMPLOYEE LIFE, DISABILITY AND DENTAL PLAN 2008 form 5500 responses
2008-01-01Type of plan entitySingle employer plan
2008-01-01Plan funding arrangement – InsuranceYes
2008-01-01Plan benefit arrangement – InsuranceYes
2007: VANGUARD FURNITURE COMPANY EMPLOYEE LIFE, DISABILITY AND DENTAL PLAN 2007 form 5500 responses
2007-01-01Type of plan entitySingle employer plan
2007-01-01Plan funding arrangement – InsuranceYes
2007-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30046842
Policy instance 3
Insurance contract or identification number30046842
Number of Individuals Covered435
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $1,844
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $49,604
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,844
Insurance broker organization code?3
AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )
Policy contract numberG 00610865
Policy instance 2
Insurance contract or identification numberG 00610865
Number of Individuals Covered895
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $71,199
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $474,658
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $71,199
Insurance broker organization code?3
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
Policy contract number739453
Policy instance 1
Insurance contract or identification number739453
Number of Individuals Covered481
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $18,854
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $251,546
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $18,854
Insurance broker organization code?3
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
Policy contract number739453
Policy instance 1
Insurance contract or identification number739453
Number of Individuals Covered410
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $31,854
Total amount of fees paid to insurance companyUSD $4,055
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $246,964
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,502
Amount paid for insurance broker fees4055
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )
Policy contract numberG 00610865
Policy instance 2
Insurance contract or identification numberG 00610865
Number of Individuals Covered698
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $59,295
Total amount of fees paid to insurance companyUSD $110
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $395,302
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $59,295
Insurance broker organization code?3
Amount paid for insurance broker fees110
Additional information about fees paid to insurance brokerOTHER COMPENSATION
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30046842
Policy instance 3
Insurance contract or identification number30046842
Number of Individuals Covered386
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $1,656
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $44,521
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,656
Insurance broker organization code?3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30046842
Policy instance 3
Insurance contract or identification number30046842
Number of Individuals Covered388
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $1,739
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $44,490
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $945
Insurance broker organization code?3
AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )
Policy contract numberG 00610865
Policy instance 2
Insurance contract or identification numberG 00610865
Number of Individuals Covered653
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $59,286
Total amount of fees paid to insurance companyUSD $556
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $395,242
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $54,807
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerOTHER COMPENSATION
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
Policy contract number739453
Policy instance 1
Insurance contract or identification number739453
Number of Individuals Covered401
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $33,784
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $207,330
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $18,722
Insurance broker organization code?3
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
Policy contract number739453
Policy instance 1
Insurance contract or identification number739453
Number of Individuals Covered420
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $31,138
Total amount of fees paid to insurance companyUSD $6,745
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $228,254
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $20,759
Amount paid for insurance broker fees6745
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )
Policy contract numberG 00610865
Policy instance 2
Insurance contract or identification numberG 00610865
Number of Individuals Covered667
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $53,887
Total amount of fees paid to insurance companyUSD $7,920
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $359,246
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $53,887
Amount paid for insurance broker fees7920
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30046842
Policy instance 3
Insurance contract or identification number30046842
Number of Individuals Covered393
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $1,643
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $43,957
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,643
Insurance broker organization code?3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30046842
Policy instance 3
Insurance contract or identification number30046842
Number of Individuals Covered389
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $1,740
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $44,440
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,740
Insurance broker organization code?3
Insurance broker nameWELLS FARGO INS. SERVICES USA, INC.
AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )
Policy contract numberG 00610865
Policy instance 2
Insurance contract or identification numberG 00610865
Number of Individuals Covered697
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $50,682
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $337,875
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $50,682
Insurance broker organization code?3
Insurance broker nameUSI INS SERVICES NATIONAL INC.
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
Policy contract number739453
Policy instance 1
Insurance contract or identification number739453
Number of Individuals Covered415
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $29,833
Total amount of fees paid to insurance companyUSD $5,464
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $219,243
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,889
Amount paid for insurance broker fees5464
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
Insurance broker nameIBSI HOLDINGS, INC.
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30046842
Policy instance 3
Insurance contract or identification number30046842
Number of Individuals Covered346
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $1,679
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $40,699
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,679
Insurance broker organization code?3
Insurance broker nameWELLS FARGO INS. SERVICES USA, INC.
AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )
Policy contract numberG 00610865
Policy instance 2
Insurance contract or identification numberG 00610865
Number of Individuals Covered647
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $40,616
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $270,773
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $40,616
Insurance broker organization code?3
Insurance broker nameWELLS FARGO INSURANCE SERVICES
HUMANA (National Association of Insurance Commissioners NAIC id number: 70580 )
Policy contract number739453
Policy instance 1
Insurance contract or identification number739453
Number of Individuals Covered384
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $24,683
Total amount of fees paid to insurance companyUSD $1,848
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $165,609
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,455
Amount paid for insurance broker fees1848
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
Insurance broker nameIBSI HOLDINGS, INC
AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )
Policy contract numberG 00610865
Policy instance 2
Insurance contract or identification numberG 00610865
Number of Individuals Covered474
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $35,428
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
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $236,186
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $35,428
Insurance broker organization code?3
Insurance broker nameWELLS FARGO INSURANCE SERVICES
AMERICAN GENERAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60488 )
Policy contract number566Q25
Policy instance 1
Insurance contract or identification number566Q25
Number of Individuals Covered112
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $21,577
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 $143,849
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,385
Insurance broker organization code?3
Insurance broker nameIBSI HOLDINGS, INC
AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )
Policy contract numberG 00610865
Policy instance 2
Insurance contract or identification numberG 00610865
Number of Individuals Covered410
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $27,822
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
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $185,479
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $27,822
Insurance broker organization code?3
Insurance broker nameWELLS FARGO INSURANCE SERVICES
AMERICAN GENERAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60488 )
Policy contract number566Q25
Policy instance 1
Insurance contract or identification number566Q25
Number of Individuals Covered155
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $18,385
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 $114,909
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,491
Insurance broker organization code?3
Insurance broker nameIBSI HOLDINGS, INC
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract number4083U0
Policy instance 1
Insurance contract or identification number4083U0
Number of Individuals Covered447
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $10,925
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 $117,546
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,925
Insurance broker organization code?3
Insurance broker nameWELLS FARGO INSURANCE SERVICES
AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )
Policy contract numberG 00610865
Policy instance 2
Insurance contract or identification numberG 00610865
Number of Individuals Covered338
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $24,430
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
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $162,868
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $24,430
Insurance broker organization code?3
Insurance broker nameWELLS FARGO INSURANCE SERVICES
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract number4083U0
Policy instance 1
Insurance contract or identification number4083U0
Number of Individuals Covered411
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $9,339
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 $85,083
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )
Policy contract numberG 00610865
Policy instance 2
Insurance contract or identification numberG 00610865
Number of Individuals Covered311
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $21,910
Total amount of fees paid to insurance companyUSD $2,355
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
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $146,067
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RENAISSANCE LIFE & HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 52414 )
Policy contract number0007414
Policy instance 3
Insurance contract or identification number0007414
Number of Individuals Covered53
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $641
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $427
Insurance broker organization code?3
Insurance broker nameIBSI HOLDINGS, INC
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberF010418
Policy instance 1
Insurance contract or identification numberF010418
Number of Individuals Covered304
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $20,698
Total amount of fees paid to insurance companyUSD $4,870
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $121,751
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $20,698
Insurance broker organization code?3
Amount paid for insurance broker fees4870
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker nameIBSI HOLDINGS, INC
RENAISSANCE LIFE & HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 52414 )
Policy contract number0007415
Policy instance 2
Insurance contract or identification number0007415
Number of Individuals Covered360
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $13,942
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,295
Insurance broker organization code?3
Insurance broker nameIBSI HOLDINGS, INC
RENAISSANCE LIFE & HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 52414 )
Policy contract number0007414
Policy instance 3
Insurance contract or identification number0007414
Number of Individuals Covered34
Insurance policy start date2009-01-01
Insurance policy end date2009-12-31
Total amount of commissions paid to insurance brokerUSD $634
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $423
Insurance broker organization code?3
Insurance broker nameIBSI HOLDINGS, INC
RENAISSANCE LIFE & HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 52414 )
Policy contract number0007415
Policy instance 2
Insurance contract or identification number0007415
Number of Individuals Covered412
Insurance policy start date2009-01-01
Insurance policy end date2009-12-31
Total amount of commissions paid to insurance brokerUSD $13,171
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,781
Insurance broker organization code?3
Insurance broker nameIBSI HOLDINGS, INC
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberF010418
Policy instance 1
Insurance contract or identification numberF010418
Number of Individuals Covered938
Insurance policy start date2009-01-01
Insurance policy end date2009-12-31
Total amount of commissions paid to insurance brokerUSD $19,131
Total amount of fees paid to insurance companyUSD $6,002
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
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $137,370
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,131
Amount paid for insurance broker fees1501
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
Insurance broker nameIBSI HOLDINGS, INC
RENAISSANCE LIFE & HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 52414 )
Policy contract number0007415
Policy instance 2
Insurance contract or identification number0007415
Number of Individuals Covered509
Insurance policy start date2008-01-01
Insurance policy end date2008-12-31
Total amount of commissions paid to insurance brokerUSD $17,903
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,935
Insurance broker organization code?3
Insurance broker nameIBSI HOLDINGS, INC
RENAISSANCE LIFE & HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 52414 )
Policy contract number0007414
Policy instance 3
Insurance contract or identification number0007414
Number of Individuals Covered60
Insurance policy start date2008-01-01
Insurance policy end date2008-12-31
Total amount of commissions paid to insurance brokerUSD $766
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $511
Insurance broker organization code?3
Insurance broker nameIBSI HOLDINGS, INC
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberF010418
Policy instance 1
Insurance contract or identification numberF010418
Number of Individuals Covered452
Insurance policy start date2008-01-01
Insurance policy end date2008-12-31
Total amount of commissions paid to insurance brokerUSD $23,024
Total amount of fees paid to insurance companyUSD $5,417
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
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $170,380
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $23,024
Insurance broker organization code?3
Amount paid for insurance broker fees5417
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker nameIBSI HOLDINGS, INC
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000400003002
Policy instance 3
Insurance contract or identification number000400003002
Number of Individuals Covered203
Insurance policy start date2007-01-01
Insurance policy end date2007-12-31
Total amount of commissions paid to insurance brokerUSD $1,694
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
Welfare Benefit Premiums Paid to CarrierUSD $33,878
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,541
Insurance broker organization code?3
Insurance broker nameWACHOVIA INSURANCE SERVICES
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010024610
Policy instance 2
Insurance contract or identification number000010024610
Number of Individuals Covered461
Insurance policy start date2007-01-01
Insurance policy end date2007-12-31
Total amount of commissions paid to insurance brokerUSD $5,514
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
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $98,280
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,219
Insurance broker organization code?3
Insurance broker nameWACHOVIA INSURANCE SERVICES
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number00001D002581
Policy instance 1
Insurance contract or identification number00001D002581
Number of Individuals Covered310
Insurance policy start date2007-01-01
Insurance policy end date2007-12-31
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 $118,809
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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