SPAN-AMERICA MEDICAL SYSTEMS, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan SPAN-AMERICA MEDICAL SYSTEMS, INC. EMPLOYEE BENEFIT PLAN
401k plan membership statisitcs for SPAN-AMERICA MEDICAL SYSTEMS, INC. EMPLOYEE BENEFIT PLAN
Measure | Date | Value |
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2022: SPAN-AMERICA MEDICAL SYSTEMS, INC. EMPLOYEE BENEFIT PLAN 2022 401k membership |
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Total participants, beginning-of-year | 2022-04-01 | 254 |
Total number of active participants reported on line 7a of the Form 5500 | 2022-04-01 | 231 |
Number of retired or separated participants receiving benefits | 2022-04-01 | 1 |
Number of other retired or separated participants entitled to future benefits | 2022-04-01 | 9 |
Total of all active and inactive participants | 2022-04-01 | 241 |
2021: SPAN-AMERICA MEDICAL SYSTEMS, INC. EMPLOYEE BENEFIT PLAN 2021 401k membership |
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Total participants, beginning-of-year | 2021-04-01 | 245 |
Total number of active participants reported on line 7a of the Form 5500 | 2021-04-01 | 238 |
Number of retired or separated participants receiving benefits | 2021-04-01 | 1 |
Number of other retired or separated participants entitled to future benefits | 2021-04-01 | 15 |
Total of all active and inactive participants | 2021-04-01 | 254 |
2020: SPAN-AMERICA MEDICAL SYSTEMS, INC. EMPLOYEE BENEFIT PLAN 2020 401k membership |
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Total participants, beginning-of-year | 2020-04-01 | 139 |
Total number of active participants reported on line 7a of the Form 5500 | 2020-04-01 | 240 |
Number of retired or separated participants receiving benefits | 2020-04-01 | 5 |
Number of other retired or separated participants entitled to future benefits | 2020-04-01 | 0 |
Total of all active and inactive participants | 2020-04-01 | 245 |
2019: SPAN-AMERICA MEDICAL SYSTEMS, INC. EMPLOYEE BENEFIT PLAN 2019 401k membership |
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Total participants, beginning-of-year | 2019-04-01 | 176 |
Total number of active participants reported on line 7a of the Form 5500 | 2019-04-01 | 133 |
Number of retired or separated participants receiving benefits | 2019-04-01 | 3 |
Number of other retired or separated participants entitled to future benefits | 2019-04-01 | 3 |
Total of all active and inactive participants | 2019-04-01 | 139 |
2018: SPAN-AMERICA MEDICAL SYSTEMS, INC. EMPLOYEE BENEFIT PLAN 2018 401k membership |
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Total participants, beginning-of-year | 2018-04-01 | 179 |
Total number of active participants reported on line 7a of the Form 5500 | 2018-04-01 | 174 |
Number of retired or separated participants receiving benefits | 2018-04-01 | 1 |
Number of other retired or separated participants entitled to future benefits | 2018-04-01 | 1 |
Total of all active and inactive participants | 2018-04-01 | 176 |
2017: SPAN-AMERICA MEDICAL SYSTEMS, INC. EMPLOYEE BENEFIT PLAN 2017 401k membership |
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Total participants, beginning-of-year | 2017-04-01 | 159 |
Total number of active participants reported on line 7a of the Form 5500 | 2017-04-01 | 177 |
Number of retired or separated participants receiving benefits | 2017-04-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2017-04-01 | 2 |
Total of all active and inactive participants | 2017-04-01 | 179 |
2016: SPAN-AMERICA MEDICAL SYSTEMS, INC. EMPLOYEE BENEFIT PLAN 2016 401k membership |
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Total participants, beginning-of-year | 2016-04-01 | 153 |
Total number of active participants reported on line 7a of the Form 5500 | 2016-04-01 | 159 |
Number of retired or separated participants receiving benefits | 2016-04-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2016-04-01 | 0 |
Total of all active and inactive participants | 2016-04-01 | 159 |
2015: SPAN-AMERICA MEDICAL SYSTEMS, INC. EMPLOYEE BENEFIT PLAN 2015 401k membership |
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Total participants, beginning-of-year | 2015-04-01 | 161 |
Total number of active participants reported on line 7a of the Form 5500 | 2015-04-01 | 148 |
Number of retired or separated participants receiving benefits | 2015-04-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2015-04-01 | 5 |
Total of all active and inactive participants | 2015-04-01 | 153 |
2014: SPAN-AMERICA MEDICAL SYSTEMS, INC. EMPLOYEE BENEFIT PLAN 2014 401k membership |
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Total participants, beginning-of-year | 2014-04-01 | 150 |
Total number of active participants reported on line 7a of the Form 5500 | 2014-04-01 | 160 |
Number of retired or separated participants receiving benefits | 2014-04-01 | 1 |
Number of other retired or separated participants entitled to future benefits | 2014-04-01 | 0 |
Total of all active and inactive participants | 2014-04-01 | 161 |
2013: SPAN-AMERICA MEDICAL SYSTEMS, INC. EMPLOYEE BENEFIT PLAN 2013 401k membership |
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Total participants, beginning-of-year | 2013-04-01 | 171 |
Total number of active participants reported on line 7a of the Form 5500 | 2013-04-01 | 148 |
Number of retired or separated participants receiving benefits | 2013-04-01 | 2 |
Number of other retired or separated participants entitled to future benefits | 2013-04-01 | 0 |
Total of all active and inactive participants | 2013-04-01 | 150 |
2012: SPAN-AMERICA MEDICAL SYSTEMS, INC. EMPLOYEE BENEFIT PLAN 2012 401k membership |
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Total participants, beginning-of-year | 2012-04-01 | 190 |
Total number of active participants reported on line 7a of the Form 5500 | 2012-04-01 | 153 |
Number of retired or separated participants receiving benefits | 2012-04-01 | 4 |
Number of other retired or separated participants entitled to future benefits | 2012-04-01 | 14 |
Total of all active and inactive participants | 2012-04-01 | 171 |
2011: SPAN-AMERICA MEDICAL SYSTEMS, INC. EMPLOYEE BENEFIT PLAN 2011 401k membership |
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Total participants, beginning-of-year | 2011-04-01 | 193 |
Total number of active participants reported on line 7a of the Form 5500 | 2011-04-01 | 190 |
Number of retired or separated participants receiving benefits | 2011-04-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2011-04-01 | 0 |
Total of all active and inactive participants | 2011-04-01 | 190 |
2010: SPAN-AMERICA MEDICAL SYSTEMS, INC. EMPLOYEE BENEFIT PLAN 2010 401k membership |
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Total participants, beginning-of-year | 2010-04-01 | 184 |
Total number of active participants reported on line 7a of the Form 5500 | 2010-04-01 | 178 |
Number of retired or separated participants receiving benefits | 2010-04-01 | 3 |
Number of other retired or separated participants entitled to future benefits | 2010-04-01 | 4 |
Total of all active and inactive participants | 2010-04-01 | 185 |
2009: SPAN-AMERICA MEDICAL SYSTEMS, INC. EMPLOYEE BENEFIT PLAN 2009 401k membership |
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Total participants, beginning-of-year | 2009-04-01 | 179 |
Total number of active participants reported on line 7a of the Form 5500 | 2009-04-01 | 179 |
Number of retired or separated participants receiving benefits | 2009-04-01 | 4 |
Number of other retired or separated participants entitled to future benefits | 2009-04-01 | 1 |
Total of all active and inactive participants | 2009-04-01 | 184 |
2022: SPAN-AMERICA MEDICAL SYSTEMS, INC. EMPLOYEE BENEFIT PLAN 2022 form 5500 responses |
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2022-04-01 | Type of plan entity | Single employer plan |
2022-04-01 | Submission has been amended | No |
2022-04-01 | This submission is the final filing | No |
2022-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2022-04-01 | Plan is a collectively bargained plan | No |
2022-04-01 | Plan funding arrangement – Insurance | Yes |
2022-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2022-04-01 | Plan benefit arrangement – Insurance | Yes |
2022-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2021: SPAN-AMERICA MEDICAL SYSTEMS, INC. EMPLOYEE BENEFIT PLAN 2021 form 5500 responses |
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2021-04-01 | Type of plan entity | Single employer plan |
2021-04-01 | Submission has been amended | No |
2021-04-01 | This submission is the final filing | No |
2021-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2021-04-01 | Plan is a collectively bargained plan | No |
2021-04-01 | Plan funding arrangement – Insurance | Yes |
2021-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2021-04-01 | Plan benefit arrangement – Insurance | Yes |
2021-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2020: SPAN-AMERICA MEDICAL SYSTEMS, INC. EMPLOYEE BENEFIT PLAN 2020 form 5500 responses |
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2020-04-01 | Type of plan entity | Single employer plan |
2020-04-01 | Submission has been amended | No |
2020-04-01 | This submission is the final filing | No |
2020-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2020-04-01 | Plan is a collectively bargained plan | No |
2020-04-01 | Plan funding arrangement – Insurance | Yes |
2020-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2020-04-01 | Plan benefit arrangement – Insurance | Yes |
2020-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2019: SPAN-AMERICA MEDICAL SYSTEMS, INC. EMPLOYEE BENEFIT PLAN 2019 form 5500 responses |
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2019-04-01 | Type of plan entity | Single employer plan |
2019-04-01 | Submission has been amended | No |
2019-04-01 | This submission is the final filing | No |
2019-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2019-04-01 | Plan is a collectively bargained plan | No |
2019-04-01 | Plan funding arrangement – Insurance | Yes |
2019-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2019-04-01 | Plan benefit arrangement – Insurance | Yes |
2019-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2018: SPAN-AMERICA MEDICAL SYSTEMS, INC. EMPLOYEE BENEFIT PLAN 2018 form 5500 responses |
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2018-04-01 | Type of plan entity | Single employer plan |
2018-04-01 | Submission has been amended | No |
2018-04-01 | This submission is the final filing | No |
2018-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2018-04-01 | Plan is a collectively bargained plan | No |
2018-04-01 | Plan funding arrangement – Insurance | Yes |
2018-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2018-04-01 | Plan benefit arrangement – Insurance | Yes |
2018-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2017: SPAN-AMERICA MEDICAL SYSTEMS, INC. EMPLOYEE BENEFIT PLAN 2017 form 5500 responses |
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2017-04-01 | Type of plan entity | Single employer plan |
2017-04-01 | Submission has been amended | No |
2017-04-01 | This submission is the final filing | No |
2017-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2017-04-01 | Plan is a collectively bargained plan | No |
2017-04-01 | Plan funding arrangement – Insurance | Yes |
2017-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2017-04-01 | Plan benefit arrangement – Insurance | Yes |
2017-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2016: SPAN-AMERICA MEDICAL SYSTEMS, INC. EMPLOYEE BENEFIT PLAN 2016 form 5500 responses |
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2016-04-01 | Type of plan entity | Single employer plan |
2016-04-01 | Submission has been amended | No |
2016-04-01 | This submission is the final filing | No |
2016-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2016-04-01 | Plan is a collectively bargained plan | No |
2016-04-01 | Plan funding arrangement – Insurance | Yes |
2016-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2016-04-01 | Plan benefit arrangement – Insurance | Yes |
2016-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2015: SPAN-AMERICA MEDICAL SYSTEMS, INC. EMPLOYEE BENEFIT PLAN 2015 form 5500 responses |
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2015-04-01 | Type of plan entity | Single employer plan |
2015-04-01 | Submission has been amended | No |
2015-04-01 | This submission is the final filing | No |
2015-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2015-04-01 | Plan is a collectively bargained plan | No |
2015-04-01 | Plan funding arrangement – Insurance | Yes |
2015-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2015-04-01 | Plan benefit arrangement – Insurance | Yes |
2015-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2014: SPAN-AMERICA MEDICAL SYSTEMS, INC. EMPLOYEE BENEFIT PLAN 2014 form 5500 responses |
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2014-04-01 | Type of plan entity | Single employer plan |
2014-04-01 | Submission has been amended | No |
2014-04-01 | This submission is the final filing | No |
2014-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2014-04-01 | Plan is a collectively bargained plan | No |
2014-04-01 | Plan funding arrangement – Insurance | Yes |
2014-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2014-04-01 | Plan benefit arrangement – Insurance | Yes |
2014-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2013: SPAN-AMERICA MEDICAL SYSTEMS, INC. EMPLOYEE BENEFIT PLAN 2013 form 5500 responses |
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2013-04-01 | Type of plan entity | Single employer plan |
2013-04-01 | Plan funding arrangement – Insurance | Yes |
2013-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2013-04-01 | Plan benefit arrangement – Insurance | Yes |
2013-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2012: SPAN-AMERICA MEDICAL SYSTEMS, INC. EMPLOYEE BENEFIT PLAN 2012 form 5500 responses |
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2012-04-01 | Type of plan entity | Single employer plan |
2012-04-01 | Plan funding arrangement – Insurance | Yes |
2012-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2012-04-01 | Plan benefit arrangement – Insurance | Yes |
2012-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2011: SPAN-AMERICA MEDICAL SYSTEMS, INC. EMPLOYEE BENEFIT PLAN 2011 form 5500 responses |
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2011-04-01 | Type of plan entity | Single employer plan |
2011-04-01 | Plan funding arrangement – Insurance | Yes |
2011-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2011-04-01 | Plan benefit arrangement – Insurance | Yes |
2011-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2010: SPAN-AMERICA MEDICAL SYSTEMS, INC. EMPLOYEE BENEFIT PLAN 2010 form 5500 responses |
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2010-04-01 | Type of plan entity | Single employer plan |
2010-04-01 | Submission has been amended | No |
2010-04-01 | This submission is the final filing | No |
2010-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2010-04-01 | Plan is a collectively bargained plan | No |
2010-04-01 | Plan funding arrangement – Insurance | Yes |
2010-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2010-04-01 | Plan benefit arrangement – Insurance | Yes |
2010-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2009: SPAN-AMERICA MEDICAL SYSTEMS, INC. EMPLOYEE BENEFIT PLAN 2009 form 5500 responses |
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2009-04-01 | Type of plan entity | Single employer plan |
2009-04-01 | Submission has been amended | No |
2009-04-01 | This submission is the final filing | No |
2009-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2009-04-01 | Plan is a collectively bargained plan | No |
2009-04-01 | Plan funding arrangement – Insurance | Yes |
2009-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2009-04-01 | Plan benefit arrangement – Insurance | Yes |
2009-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 38520 ) |
Policy contract number | 66-17539 |
Policy instance | 3 |
Insurance contract or identification number | 66-17539 | Number of Individuals Covered | 104 | Insurance policy start date | 2022-04-01 | Insurance policy end date | 2023-03-31 | Total amount of commissions paid to insurance broker | USD $42,770 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $0 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $42,770 | Amount paid for insurance broker fees | 0 | Additional information about fees paid to insurance broker | COMMISSIONS | Insurance broker organization code? | 3 |
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DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 ) |
Policy contract number | 04192150 |
Policy instance | 2 |
Insurance contract or identification number | 04192150 | Number of Individuals Covered | 308 | Insurance policy start date | 2022-04-01 | Insurance policy end date | 2023-03-31 | Total amount of commissions paid to insurance broker | USD $24,162 | Total amount of fees paid to insurance company | USD $1,027 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $140,469 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $19,632 | Amount paid for insurance broker fees | 1027 | Additional information about fees paid to insurance broker | COMMISSIONS & FEES | Insurance broker organization code? | 3 |
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THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00526445 |
Policy instance | 1 |
Insurance contract or identification number | 00526445 | Number of Individuals Covered | 239 | Insurance policy start date | 2022-04-01 | Insurance policy end date | 2023-03-31 | Total amount of commissions paid to insurance broker | USD $32,031 | Total amount of fees paid to insurance company | USD $8,993 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D, CANCER | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $282,118 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $32,031 | Amount paid for insurance broker fees | 8993 | Additional information about fees paid to insurance broker | COMMISSIONS & FEES | Insurance broker organization code? | 3 |
|
BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 38520 ) |
Policy contract number | 66-17539 |
Policy instance | 3 |
Insurance contract or identification number | 66-17539 | Number of Individuals Covered | 98 | Insurance policy start date | 2021-04-01 | Insurance policy end date | 2022-03-31 | Total amount of commissions paid to insurance broker | USD $43,120 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $0 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $43,120 | Amount paid for insurance broker fees | 0 | Additional information about fees paid to insurance broker | COMMISSIONS | Insurance broker organization code? | 3 |
|
DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 ) |
Policy contract number | 04192150 |
Policy instance | 2 |
Insurance contract or identification number | 04192150 | Number of Individuals Covered | 307 | Insurance policy start date | 2021-04-01 | Insurance policy end date | 2022-03-31 | Total amount of commissions paid to insurance broker | USD $21,916 | Total amount of fees paid to insurance company | USD $322 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $137,022 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $17,807 | Amount paid for insurance broker fees | 322 | Additional information about fees paid to insurance broker | COMMISSIONS & FEES | Insurance broker organization code? | 3 |
|
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00526445 |
Policy instance | 1 |
Insurance contract or identification number | 00526445 | Number of Individuals Covered | 237 | Insurance policy start date | 2021-04-01 | Insurance policy end date | 2022-03-31 | Total amount of commissions paid to insurance broker | USD $32,590 | Total amount of fees paid to insurance company | USD $10,253 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D, CANCER | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $287,878 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $32,590 | Amount paid for insurance broker fees | 10253 | Additional information about fees paid to insurance broker | COMMISSIONS & FEES | Insurance broker organization code? | 3 |
|
DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 ) |
Policy contract number | 04192150 |
Policy instance | 2 |
Insurance contract or identification number | 04192150 | Number of Individuals Covered | 297 | Insurance policy start date | 2020-04-01 | Insurance policy end date | 2021-03-31 | Total amount of commissions paid to insurance broker | USD $18,445 | Total amount of fees paid to insurance company | USD $1,824 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $134,152 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $14,987 | Amount paid for insurance broker fees | 1824 | Additional information about fees paid to insurance broker | COMMISSIONS & FEES | Insurance broker organization code? | 3 |
|
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00526445 |
Policy instance | 1 |
Insurance contract or identification number | 00526445 | Number of Individuals Covered | 240 | Insurance policy start date | 2020-04-01 | Insurance policy end date | 2021-03-31 | Total amount of commissions paid to insurance broker | USD $32,568 | Total amount of fees paid to insurance company | USD $11,952 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D, CANCER | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $288,461 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $32,568 | Amount paid for insurance broker fees | 11952 | Additional information about fees paid to insurance broker | COMMISSIONS & FEES | Insurance broker organization code? | 3 |
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THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00526445 |
Policy instance | 1 |
Insurance contract or identification number | 00526445 | Number of Individuals Covered | 133 | Insurance policy start date | 2019-04-01 | Insurance policy end date | 2020-03-31 | Total amount of commissions paid to insurance broker | USD $21,687 | Total amount of fees paid to insurance company | USD $9,017 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D, CANCER | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $185,775 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $21,687 | Amount paid for insurance broker fees | 9017 | Additional information about fees paid to insurance broker | COMMISSIONS & FEES | Insurance broker organization code? | 3 |
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DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 ) |
Policy contract number | 04192150 |
Policy instance | 2 |
Insurance contract or identification number | 04192150 | Number of Individuals Covered | 193 | Insurance policy start date | 2019-04-01 | Insurance policy end date | 2020-03-31 | Total amount of commissions paid to insurance broker | USD $12,609 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $79,101 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $10,245 | Amount paid for insurance broker fees | 0 | Additional information about fees paid to insurance broker | COMMISSIONS | Insurance broker organization code? | 3 |
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THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00526445 |
Policy instance | 1 |
Insurance contract or identification number | 00526445 | Number of Individuals Covered | 174 | Insurance policy start date | 2018-04-01 | Insurance policy end date | 2019-03-31 | Total amount of commissions paid to insurance broker | USD $33,847 | Total amount of fees paid to insurance company | USD $11,532 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D, CANCER | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $304,922 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $33,847 | Amount paid for insurance broker fees | 11532 | Additional information about fees paid to insurance broker | COMMISSIONS & FEES | Insurance broker organization code? | 3 |
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THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00526445 |
Policy instance | 1 |
Insurance contract or identification number | 00526445 | Number of Individuals Covered | 176 | Insurance policy start date | 2017-04-01 | Insurance policy end date | 2018-03-31 | Total amount of commissions paid to insurance broker | USD $31,468 | Total amount of fees paid to insurance company | USD $9,807 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D, CANCER | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $281,864 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $31,468 | Amount paid for insurance broker fees | 9807 | Additional information about fees paid to insurance broker | COMMISSIONS & FEES | Insurance broker organization code? | 3 | Insurance broker name | MARSH & MCLENNAN AGENCY LLC |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 30013248 |
Policy instance | 2 |
Insurance contract or identification number | 30013248 | Number of Individuals Covered | 100 | Insurance policy start date | 2015-04-01 | Insurance policy end date | 2016-03-31 | Total amount of commissions paid to insurance broker | USD $1,608 | Total amount of fees paid to insurance company | USD $138 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $16,082 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,608 | Amount paid for insurance broker fees | 138 | Additional information about fees paid to insurance broker | BROKER COMMISSION | Insurance broker organization code? | 3 | Insurance broker name | MARSH & MCLENNAN AGENCY, LLC |
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SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
Policy contract number | 240469 |
Policy instance | 3 |
Insurance contract or identification number | 240469 | Number of Individuals Covered | 120 | Insurance policy start date | 2015-04-01 | Insurance policy end date | 2016-03-31 | Total amount of commissions paid to insurance broker | USD $8,602 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $86,020 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,408 | Amount paid for insurance broker fees | 0 | Additional information about fees paid to insurance broker | COMMISSION | Insurance broker organization code? | 3 | Insurance broker name | MARSH & MCLENNAN AGENCY LLC |
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AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
Policy contract number | 97290 |
Policy instance | 4 |
Insurance contract or identification number | 97290 | Number of Individuals Covered | 65 | Insurance policy start date | 2015-04-01 | Insurance policy end date | 2016-03-31 | Total amount of commissions paid to insurance broker | USD $2,661 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $25,965 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,661 | Amount paid for insurance broker fees | 0 | Additional information about fees paid to insurance broker | COMMISSION | Insurance broker organization code? | 3 | Insurance broker name | EMC BENEFITS LLC |
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SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
Policy contract number | 067368 |
Policy instance | 1 |
Insurance contract or identification number | 067368 | Number of Individuals Covered | 153 | Insurance policy start date | 2015-04-01 | Insurance policy end date | 2016-03-31 | Total amount of commissions paid to insurance broker | USD $3,432 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $29,549 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,432 | Amount paid for insurance broker fees | 0 | Additional information about fees paid to insurance broker | BROKER COMMISSION | Insurance broker organization code? | 3 | Insurance broker name | MARSH & MCLENNAN AGENCY LLC |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 30013248 |
Policy instance | 2 |
Insurance contract or identification number | 30013248 | Number of Individuals Covered | 101 | Insurance policy start date | 2014-04-01 | Insurance policy end date | 2015-03-31 | Total amount of commissions paid to insurance broker | USD $1,511 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $15,117 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,007 | Amount paid for insurance broker fees | 0 | Additional information about fees paid to insurance broker | BROKER COMMISSION | Insurance broker organization code? | 3 | Insurance broker name | MARSH & MCLENNAN AGENCY, LLC |
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SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
Policy contract number | 067368 |
Policy instance | 1 |
Insurance contract or identification number | 067368 | Number of Individuals Covered | 146 | Insurance policy start date | 2014-04-01 | Insurance policy end date | 2015-03-31 | Total amount of commissions paid to insurance broker | USD $5,788 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $34,965 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,788 | Amount paid for insurance broker fees | 0 | Additional information about fees paid to insurance broker | BROKER COMMISSION | Insurance broker organization code? | 3 | Insurance broker name | ECM BENEFITS LLC |
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SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
Policy contract number | 067368 |
Policy instance | 3 |
Insurance contract or identification number | 067368 | Number of Individuals Covered | 146 | Insurance policy start date | 2014-04-01 | Insurance policy end date | 2015-03-31 | Total amount of commissions paid to insurance broker | USD $823 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $4,897 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $823 | Amount paid for insurance broker fees | 0 | Additional information about fees paid to insurance broker | BROKER COMMISSION | Insurance broker organization code? | 3 | Insurance broker name | ECM BENEFITS LLC |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 30013248 |
Policy instance | 2 |
Insurance contract or identification number | 30013248 | Number of Individuals Covered | 96 | Insurance policy start date | 2013-04-01 | Insurance policy end date | 2014-03-31 | Total amount of commissions paid to insurance broker | USD $1,775 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $17,749 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,775 | Insurance broker organization code? | 3 | Insurance broker name | ESTATE PLANNING CONSULTANTS INC |
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SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
Policy contract number | 067368 |
Policy instance | 1 |
Insurance contract or identification number | 067368 | Number of Individuals Covered | 136 | Insurance policy start date | 2013-04-01 | Insurance policy end date | 2014-03-31 | Total amount of commissions paid to insurance broker | USD $5,057 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $33,716 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,290 | Insurance broker organization code? | 3 | Insurance broker name | ESTATE PLANNING CONSULTANTS INC |
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SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
Policy contract number | 067368 |
Policy instance | 3 |
Insurance contract or identification number | 067368 | Number of Individuals Covered | 136 | Insurance policy start date | 2013-04-01 | Insurance policy end date | 2014-03-31 | Total amount of commissions paid to insurance broker | USD $762 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $5,478 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $525 | Insurance broker organization code? | 3 | Insurance broker name | ESTATE PLANNING CONSULTANTS INC |
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RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | VG175288 |
Policy instance | 1 |
Insurance contract or identification number | VG175288 | Number of Individuals Covered | 111 | Insurance policy start date | 2012-04-01 | Insurance policy end date | 2013-03-31 | Total amount of commissions paid to insurance broker | USD $6,435 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $64,347 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,435 | Insurance broker organization code? | 3 | Insurance broker name | ESTATE PLANNING CONSULTANTS INC |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 30013248 |
Policy instance | 3 |
Insurance contract or identification number | 30013248 | Number of Individuals Covered | 108 | Insurance policy start date | 2012-04-01 | Insurance policy end date | 2013-03-31 | Total amount of commissions paid to insurance broker | USD $1,625 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $16,254 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,625 | Insurance broker organization code? | 3 | Insurance broker name | ESTATE PLANNING CONSULTANTS INC |
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SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
Policy contract number | 067368 |
Policy instance | 2 |
Insurance contract or identification number | 067368 | Number of Individuals Covered | 171 | Insurance policy start date | 2012-04-01 | Insurance policy end date | 2013-03-31 | Total amount of commissions paid to insurance broker | USD $6,246 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $41,639 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,246 | Insurance broker organization code? | 3 | Insurance broker name | ESTATE PLANNING CONSULTANTS INC |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 30013248 |
Policy instance | 3 |
Insurance contract or identification number | 30013248 | Number of Individuals Covered | 117 | Insurance policy start date | 2011-04-01 | Insurance policy end date | 2012-03-31 | Total amount of commissions paid to insurance broker | USD $1,867 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $18,673 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
Policy contract number | 067368 |
Policy instance | 2 |
Insurance contract or identification number | 067368 | Number of Individuals Covered | 180 | Insurance policy start date | 2011-04-01 | Insurance policy end date | 2012-03-31 | Total amount of commissions paid to insurance broker | USD $6,318 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $42,119 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | VG175288 |
Policy instance | 1 |
Insurance contract or identification number | VG175288 | Number of Individuals Covered | 113 | Insurance policy start date | 2011-04-01 | Insurance policy end date | 2012-03-31 | Total amount of commissions paid to insurance broker | USD $5,907 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $59,071 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
Policy contract number | 067368 |
Policy instance | 2 |
Insurance contract or identification number | 067368 | Number of Individuals Covered | 176 | Insurance policy start date | 2010-04-01 | Insurance policy end date | 2011-03-31 | Total amount of commissions paid to insurance broker | USD $6,018 | Total amount of fees paid to insurance company | USD $557 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $40,122 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | VG175288 |
Policy instance | 1 |
Insurance contract or identification number | VG175288 | Number of Individuals Covered | 114 | Insurance policy start date | 2010-04-01 | Insurance policy end date | 2011-03-31 | Total amount of commissions paid to insurance broker | USD $5,190 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $51,896 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 30013248 |
Policy instance | 3 |
Insurance contract or identification number | 30013248 | Number of Individuals Covered | 112 | Insurance policy start date | 2010-04-01 | Insurance policy end date | 2011-03-31 | Total amount of commissions paid to insurance broker | USD $1,837 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $18,371 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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