401k Plan data: PRESBYTERIAN COMMUNITIES OF SOUTH CAROLINA WELFARE plan

PRESBYTERIAN COMMUNITIES OF SOUTH CAROLINA WELFARE 401k Plan overview

Plan Name	PRESBYTERIAN COMMUNITIES OF SOUTH CAROLINA WELFARE
Plan identification number	501

PRESBYTERIAN COMMUNITIES OF SOUTH CAROLINA WELFARE Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Long-term disability cover Other welfare benefit cover

401k Sponsoring company profile

PRESBYTERIAN COMMUNITIES OF SOUTH CAROLINA has sponsored the creation of one or more 401k plans.

Company Name: PRESBYTERIAN COMMUNITIES OF SOUTH CAROLINA

Employer identification number (EIN): 570373677

NAIC Classification: 623000
NAIC Description: Nursing and Residential Care Facilities

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PRESBYTERIAN COMMUNITIES OF SOUTH CAROLINA WELFARE

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-01-01 KEVIN JOHNSON 2023-10-12
501 2021-01-01 W. CHAD MELVEN 2022-10-17
501 2020-01-01 W. CHAD MELVEN 2021-10-13
501 2019-01-01 W. CHAD MELVEN 2020-10-14
501 2018-01-01 W. CHAD MELVEN 2019-10-14

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2022-01-01	KEVIN JOHNSON	2023-10-12
501	2021-01-01	W. CHAD MELVEN	2022-10-17
501	2020-01-01	W. CHAD MELVEN	2021-10-13
501	2019-01-01	W. CHAD MELVEN	2020-10-14
501	2018-01-01	W. CHAD MELVEN	2019-10-14

Plan Statistics for PRESBYTERIAN COMMUNITIES OF SOUTH CAROLINA WELFARE

401k plan membership statisitcs for PRESBYTERIAN COMMUNITIES OF SOUTH CAROLINA WELFARE

Measure Date Value
2022: PRESBYTERIAN COMMUNITIES OF SOUTH CAROLINA WELFARE 2022 401k membership
Total participants, beginning-of-year 2022-01-01 577
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 634
Total of all active and inactive participants 2022-01-01 634
2021: PRESBYTERIAN COMMUNITIES OF SOUTH CAROLINA WELFARE 2021 401k membership
Total participants, beginning-of-year 2021-01-01 621
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 577
Total of all active and inactive participants 2021-01-01 577
2020: PRESBYTERIAN COMMUNITIES OF SOUTH CAROLINA WELFARE 2020 401k membership
Total participants, beginning-of-year 2020-01-01 674
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 621
Total of all active and inactive participants 2020-01-01 621
2019: PRESBYTERIAN COMMUNITIES OF SOUTH CAROLINA WELFARE 2019 401k membership
Total participants, beginning-of-year 2019-01-01 637
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 674
Total of all active and inactive participants 2019-01-01 674
2018: PRESBYTERIAN COMMUNITIES OF SOUTH CAROLINA WELFARE 2018 401k membership
Total participants, beginning-of-year 2018-01-01 0
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 637
Total of all active and inactive participants 2018-01-01 637

Measure	Date	Value
2022: PRESBYTERIAN COMMUNITIES OF SOUTH CAROLINA WELFARE 2022 401k membership
Total participants, beginning-of-year	2022-01-01	577
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	634
Total of all active and inactive participants	2022-01-01	634
2021: PRESBYTERIAN COMMUNITIES OF SOUTH CAROLINA WELFARE 2021 401k membership
Total participants, beginning-of-year	2021-01-01	621
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	577
Total of all active and inactive participants	2021-01-01	577
2020: PRESBYTERIAN COMMUNITIES OF SOUTH CAROLINA WELFARE 2020 401k membership
Total participants, beginning-of-year	2020-01-01	674
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	621
Total of all active and inactive participants	2020-01-01	621
2019: PRESBYTERIAN COMMUNITIES OF SOUTH CAROLINA WELFARE 2019 401k membership
Total participants, beginning-of-year	2019-01-01	637
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	674
Total of all active and inactive participants	2019-01-01	674
2018: PRESBYTERIAN COMMUNITIES OF SOUTH CAROLINA WELFARE 2018 401k membership
Total participants, beginning-of-year	2018-01-01	0
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	637
Total of all active and inactive participants	2018-01-01	637

Financial Data on PRESBYTERIAN COMMUNITIES OF SOUTH CAROLINA WELFARE

Measure	Date	Value
2018 : PRESBYTERIAN COMMUNITIES OF SOUTH CAROLINA WELFARE 2018 401k financial data
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Was this plan covered by a fidelity bond	2018-12-31	No
If this is an individual account plan, was there a blackout period	2018-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-12-31	No
Were any leases to which the plan was party in default or uncollectible	2018-12-31	No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-12-31	No
Was there a failure to transmit to the plan any participant contributions	2018-12-31	No
Has the plan failed to provide any benefit when due under the plan	2018-12-31	No
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2018-12-31	No
Did the plan have assets held for investment	2018-12-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-12-31	No

Form 5500 Responses for PRESBYTERIAN COMMUNITIES OF SOUTH CAROLINA WELFARE

2022: PRESBYTERIAN COMMUNITIES OF SOUTH CAROLINA WELFARE 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2021: PRESBYTERIAN COMMUNITIES OF SOUTH CAROLINA WELFARE 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2020: PRESBYTERIAN COMMUNITIES OF SOUTH CAROLINA WELFARE 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2019: PRESBYTERIAN COMMUNITIES OF SOUTH CAROLINA WELFARE 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2018: PRESBYTERIAN COMMUNITIES OF SOUTH CAROLINA WELFARE 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	First time form 5500 has been submitted	Yes
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G000C25Z

Policy instance

Insurance contract or identification number	G000C25Z
Number of Individuals Covered	634
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $39,805
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D, VOL ST DIS, VOL LIFE & AD&D
Welfare Benefit Premiums Paid to Carrier	USD $331,706
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $39,805
Insurance broker organization code?	3

PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )

Policy contract number

0010361930

Policy instance

Insurance contract or identification number	0010361930
Number of Individuals Covered	79
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $1,227
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $24,470
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $858
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

R0563080

Policy instance

Insurance contract or identification number	R0563080
Number of Individuals Covered	3
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $28
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	GCIEE , GRPACCVO
Welfare Benefit Premiums Paid to Carrier	USD $854
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $21
Insurance broker organization code?	3

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00580366

Policy instance

Insurance contract or identification number	00580366
Number of Individuals Covered	396
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $39,467
Total amount of fees paid to insurance company	USD $1,816
Dental Insurance Welfare Benefit	Yes
Other welfare benefits provided	CRITICAL ILLNESS AND ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $255,614
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $39,035
Amount paid for insurance broker fees	1816
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

PHYSICIANS EYECARE PLAN (National Association of Insurance Commissioners NAIC id number: 15447 )

Policy contract number

00587

Policy instance

Insurance contract or identification number	00587
Number of Individuals Covered	316
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $2,882
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $28,824
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,882
Insurance broker organization code?	3

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

53039

Policy instance

Insurance contract or identification number	53039
Number of Individuals Covered	577
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $34,916
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $349,156
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $34,916
Insurance broker organization code?	3

PHYSICIANS EYECARE PLAN (National Association of Insurance Commissioners NAIC id number: 15447 )

Policy contract number

00587

Policy instance

Insurance contract or identification number	00587
Number of Individuals Covered	310
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $3,203
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $32,029
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,203
Insurance broker organization code?	3

BLUECHOICE HEALTHPLAN (National Association of Insurance Commissioners NAIC id number: 95741 )

Policy contract number

03-07684

Policy instance

Insurance contract or identification number	03-07684
Number of Individuals Covered	365
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00580366

Policy instance

Insurance contract or identification number	00580366
Number of Individuals Covered	186
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $21,555
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Other welfare benefits provided	CRITICAL ILLNESS AND ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $45,410
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $20,146
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

R0563080

Policy instance

Insurance contract or identification number	R0563080
Number of Individuals Covered	277
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $1,994
Total amount of fees paid to insurance company	USD $188
Other welfare benefits provided	GCIEE , GRPACCVO
Welfare Benefit Premiums Paid to Carrier	USD $10,978
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,381
Amount paid for insurance broker fees	188
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )

Policy contract number

0010361930

Policy instance

Insurance contract or identification number	0010361930
Number of Individuals Covered	93
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $1,864
Total amount of fees paid to insurance company	USD $61
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $27,979
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,304
Amount paid for insurance broker fees	56
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

BLUECHOICE HEALTHPLAN (National Association of Insurance Commissioners NAIC id number: 95741 )

Policy contract number

06388

Policy instance

Insurance contract or identification number	06388
Number of Individuals Covered	418
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUECHOICE HEALTHPLAN (National Association of Insurance Commissioners NAIC id number: 95741 )

Policy contract number

06388

Policy instance

Insurance contract or identification number	06388
Number of Individuals Covered	375
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PHYSICIANS EYECARE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

00587

Policy instance

Insurance contract or identification number	00587
Number of Individuals Covered	378
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $3,653
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $36,535
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,892
Insurance broker organization code?	3

PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )

Policy contract number

0010361930

Policy instance

Insurance contract or identification number	0010361930
Number of Individuals Covered	126
Insurance policy start date	2020-01-01
Insurance policy end date	2021-01-01
Total amount of commissions paid to insurance broker	USD $4,214
Total amount of fees paid to insurance company	USD $305
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $31,892
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,949
Amount paid for insurance broker fees	279
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

53039

Policy instance

Insurance contract or identification number	53039
Number of Individuals Covered	621
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $33,973
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $339,730
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $33,973
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

R0563080

Policy instance

Insurance contract or identification number	R0563080
Number of Individuals Covered	86
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $13,222
Total amount of fees paid to insurance company	USD $1,256
Other welfare benefits provided	CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $65,830
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,040
Amount paid for insurance broker fees	1256
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

3341335

Policy instance

Insurance contract or identification number	3341335
Number of Individuals Covered	481
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $83,252
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $850,531
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $83,252
Insurance broker organization code?	3

DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 )

Policy contract number

21510000

Policy instance

Insurance contract or identification number	21510000
Number of Individuals Covered	674
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $15,935
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $172,747
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $15,935
Insurance broker organization code?	3

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

53039

Policy instance

Insurance contract or identification number	53039
Number of Individuals Covered	663
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $40,739
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $311,578
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $40,739
Insurance broker organization code?	3

PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )

Policy contract number

0010361930

Policy instance

Insurance contract or identification number	0010361930
Number of Individuals Covered	138
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $1,176
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $38,087
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $818
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

R0563080

Policy instance

Insurance contract or identification number	R0563080
Number of Individuals Covered	294
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $3,395
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	401K
Welfare Benefit Premiums Paid to Carrier	USD $73,201
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,764
Insurance broker organization code?	3

ADVANTICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 12278 )

Policy contract number

18010501

Policy instance

Insurance contract or identification number	18010501
Number of Individuals Covered	541
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $3,427
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $31,488
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,427
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

R0563080

Policy instance

Insurance contract or identification number	R0563080
Number of Individuals Covered	215
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $1,787
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	401K
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,743
Insurance broker organization code?	3

PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )

Policy contract number

0010361930

Policy instance

Insurance contract or identification number	0010361930
Number of Individuals Covered	294
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $10,033
Total amount of fees paid to insurance company	USD $1,371
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $49,322
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,022
Amount paid for insurance broker fees	665
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

R0563080

Policy instance

Insurance contract or identification number	R0563080
Number of Individuals Covered	386
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $9,614
Total amount of fees paid to insurance company	USD $732
Other welfare benefits provided	401K
Welfare Benefit Premiums Paid to Carrier	USD $89,207
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,678
Amount paid for insurance broker fees	652
Additional information about fees paid to insurance broker	ADDITIONAL COMP
Insurance broker organization code?	3

ADVANTICA REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

18010501

Policy instance

Insurance contract or identification number	18010501
Number of Individuals Covered	536
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $3,048
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $33,264
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,048
Insurance broker organization code?	3

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

3341335

Policy instance

Insurance contract or identification number	3341335
Number of Individuals Covered	499
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $71,271
Total amount of fees paid to insurance company	USD $15,960
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $801,841
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $71,271
Amount paid for insurance broker fees	15960
Additional information about fees paid to insurance broker	AGENT FEES
Insurance broker organization code?	3

DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 )

Policy contract number

21510000

Policy instance

Insurance contract or identification number	21510000
Number of Individuals Covered	667
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $16,303
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $177,887
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16,303
Insurance broker organization code?	3

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

53039

Policy instance

Insurance contract or identification number	53039
Number of Individuals Covered	589
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $31,415
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $313,762
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $31,415
Additional information about fees paid to insurance broker	SALES AND SERVICE COMPENSATION
Insurance broker organization code?	3

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Company Name:	PRESBYTERIAN COMMUNITIES OF SOUTH CAROLINA
Employer identification number (EIN):	570373677
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities