WESTMINSTER PRESBYTERIAN CENTER, IN DBA WESTMINSTER TOWERS RETIREMENT has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan WESTMINSTER PRESBYTERIAN CENTER, INC. WESTMINSTER TOWERS
401k plan membership statisitcs for WESTMINSTER PRESBYTERIAN CENTER, INC. WESTMINSTER TOWERS
| Measure | Date | Value |
|---|
| 2021: WESTMINSTER PRESBYTERIAN CENTER, INC. WESTMINSTER TOWERS 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 99 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 88 |
| Number of retired or separated participants receiving benefits | 2021-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-01-01 | 0 |
| Total of all active and inactive participants | 2021-01-01 | 88 |
| 2020: WESTMINSTER PRESBYTERIAN CENTER, INC. WESTMINSTER TOWERS 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-10-01 | 100 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-10-01 | 102 |
| Number of retired or separated participants receiving benefits | 2020-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2020-10-01 | 0 |
| Total of all active and inactive participants | 2020-10-01 | 102 |
| Number of employers contributing to the scheme | 2020-10-01 | 0 |
| 2018: WESTMINSTER PRESBYTERIAN CENTER, INC. WESTMINSTER TOWERS 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-10-01 | 116 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-10-01 | 95 |
| Number of retired or separated participants receiving benefits | 2018-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-10-01 | 0 |
| Total of all active and inactive participants | 2018-10-01 | 95 |
| Number of employers contributing to the scheme | 2018-10-01 | 0 |
| Total participants, beginning-of-year | 2018-02-01 | 105 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-02-01 | 116 |
| Number of retired or separated participants receiving benefits | 2018-02-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-02-01 | 0 |
| Total of all active and inactive participants | 2018-02-01 | 116 |
| Number of employers contributing to the scheme | 2018-02-01 | 0 |
| 2017: WESTMINSTER PRESBYTERIAN CENTER, INC. WESTMINSTER TOWERS 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-02-01 | 207 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-02-01 | 105 |
| Number of retired or separated participants receiving benefits | 2017-02-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-02-01 | 0 |
| Total of all active and inactive participants | 2017-02-01 | 105 |
| 2016: WESTMINSTER PRESBYTERIAN CENTER, INC. WESTMINSTER TOWERS 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-02-01 | 198 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-02-01 | 206 |
| Number of retired or separated participants receiving benefits | 2016-02-01 | 1 |
| Number of other retired or separated participants entitled to future benefits | 2016-02-01 | 0 |
| Total of all active and inactive participants | 2016-02-01 | 207 |
| 2015: WESTMINSTER PRESBYTERIAN CENTER, INC. WESTMINSTER TOWERS 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-02-01 | 173 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-02-01 | 198 |
| Total of all active and inactive participants | 2015-02-01 | 198 |
| Total participants | 2015-02-01 | 198 |
| 2014: WESTMINSTER PRESBYTERIAN CENTER, INC. WESTMINSTER TOWERS 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-02-01 | 117 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-02-01 | 173 |
| Total of all active and inactive participants | 2014-02-01 | 173 |
| Total participants | 2014-02-01 | 173 |
| 2013: WESTMINSTER PRESBYTERIAN CENTER, INC. WESTMINSTER TOWERS 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-02-01 | 123 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-02-01 | 117 |
| Total of all active and inactive participants | 2013-02-01 | 117 |
| 2012: WESTMINSTER PRESBYTERIAN CENTER, INC. WESTMINSTER TOWERS 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-02-01 | 130 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-02-01 | 123 |
| Total of all active and inactive participants | 2012-02-01 | 123 |
| 2011: WESTMINSTER PRESBYTERIAN CENTER, INC. WESTMINSTER TOWERS 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-02-01 | 126 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-02-01 | 130 |
| Total of all active and inactive participants | 2011-02-01 | 130 |
| 2010: WESTMINSTER PRESBYTERIAN CENTER, INC. WESTMINSTER TOWERS 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-02-01 | 115 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-02-01 | 126 |
| Total of all active and inactive participants | 2010-02-01 | 126 |
| 2009: WESTMINSTER PRESBYTERIAN CENTER, INC. WESTMINSTER TOWERS 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-02-01 | 129 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-02-01 | 115 |
| Total of all active and inactive participants | 2009-02-01 | 115 |
| 2008: WESTMINSTER PRESBYTERIAN CENTER, INC. WESTMINSTER TOWERS 2008 401k membership |
|---|
| Total participants, beginning-of-year | 2008-02-01 | 97 |
| Total number of active participants reported on line 7a of the Form 5500 | 2008-02-01 | 129 |
| Total of all active and inactive participants | 2008-02-01 | 129 |
| 2021: WESTMINSTER PRESBYTERIAN CENTER, INC. WESTMINSTER TOWERS 2021 form 5500 responses |
|---|
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | Submission has been amended | No |
| 2021-01-01 | This submission is the final filing | No |
| 2021-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2021-01-01 | Plan is a collectively bargained plan | No |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: WESTMINSTER PRESBYTERIAN CENTER, INC. WESTMINSTER TOWERS 2020 form 5500 responses |
|---|
| 2020-10-01 | Type of plan entity | Single employer plan |
| 2020-10-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2020-10-01 | Plan funding arrangement – Insurance | Yes |
| 2020-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: WESTMINSTER PRESBYTERIAN CENTER, INC. WESTMINSTER TOWERS 2018 form 5500 responses |
|---|
| 2018-10-01 | Type of plan entity | Single employer plan |
| 2018-10-01 | Plan funding arrangement – Insurance | Yes |
| 2018-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-02-01 | Type of plan entity | Single employer plan |
| 2018-02-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2018-02-01 | Plan funding arrangement – Insurance | Yes |
| 2018-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: WESTMINSTER PRESBYTERIAN CENTER, INC. WESTMINSTER TOWERS 2017 form 5500 responses |
|---|
| 2017-02-01 | Type of plan entity | Single employer plan |
| 2017-02-01 | Plan funding arrangement – Insurance | Yes |
| 2017-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: WESTMINSTER PRESBYTERIAN CENTER, INC. WESTMINSTER TOWERS 2016 form 5500 responses |
|---|
| 2016-02-01 | Type of plan entity | Single employer plan |
| 2016-02-01 | Submission has been amended | No |
| 2016-02-01 | This submission is the final filing | No |
| 2016-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-02-01 | Plan is a collectively bargained plan | No |
| 2016-02-01 | Plan funding arrangement – Insurance | Yes |
| 2016-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: WESTMINSTER PRESBYTERIAN CENTER, INC. WESTMINSTER TOWERS 2015 form 5500 responses |
|---|
| 2015-02-01 | Type of plan entity | Single employer plan |
| 2015-02-01 | Plan funding arrangement – Insurance | Yes |
| 2015-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: WESTMINSTER PRESBYTERIAN CENTER, INC. WESTMINSTER TOWERS 2014 form 5500 responses |
|---|
| 2014-02-01 | Type of plan entity | Single employer plan |
| 2014-02-01 | Plan funding arrangement – Insurance | Yes |
| 2014-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: WESTMINSTER PRESBYTERIAN CENTER, INC. WESTMINSTER TOWERS 2013 form 5500 responses |
|---|
| 2013-02-01 | Type of plan entity | Single employer plan |
| 2013-02-01 | Plan funding arrangement – Insurance | Yes |
| 2013-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2012: WESTMINSTER PRESBYTERIAN CENTER, INC. WESTMINSTER TOWERS 2012 form 5500 responses |
|---|
| 2012-02-01 | Type of plan entity | Single employer plan |
| 2012-02-01 | Plan funding arrangement – Insurance | Yes |
| 2012-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2012-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2011: WESTMINSTER PRESBYTERIAN CENTER, INC. WESTMINSTER TOWERS 2011 form 5500 responses |
|---|
| 2011-02-01 | Type of plan entity | Single employer plan |
| 2011-02-01 | Plan funding arrangement – Insurance | Yes |
| 2011-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2011-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2010: WESTMINSTER PRESBYTERIAN CENTER, INC. WESTMINSTER TOWERS 2010 form 5500 responses |
|---|
| 2010-02-01 | Type of plan entity | Single employer plan |
| 2010-02-01 | Plan funding arrangement – Insurance | Yes |
| 2010-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: WESTMINSTER PRESBYTERIAN CENTER, INC. WESTMINSTER TOWERS 2009 form 5500 responses |
|---|
| 2009-02-01 | Type of plan entity | Single employer plan |
| 2009-02-01 | Plan funding arrangement – Insurance | Yes |
| 2009-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2008: WESTMINSTER PRESBYTERIAN CENTER, INC. WESTMINSTER TOWERS 2008 form 5500 responses |
|---|
| 2008-02-01 | Type of plan entity | Single employer plan |
| 2008-02-01 | First time form 5500 has been submitted | Yes |
| 2008-02-01 | Plan funding arrangement – Insurance | Yes |
| 2008-02-01 | Plan benefit arrangement – Insurance | Yes |
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 70470 |
| Policy instance | 2 |
| Insurance contract or identification number | 70470 | | Number of Individuals Covered | 105 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $3,005 | | 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 | 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 | VOLUNTARY LIFE, BASIC AD&D, VOL DEP LIFE SPOUSE/FAM, VOL DEP LIFE CHILD, | | 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 $30,045 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,555 | | Insurance broker organization code? | 3 |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010-437615 |
| Policy instance | 1 |
| Insurance contract or identification number | 010-437615 | | Number of Individuals Covered | 143 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $2,582 | | 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 | 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 $42,731 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,521 | | Insurance broker organization code? | 3 |
|
| BLUECHOICE HEALTHPLAN (National Association of Insurance Commissioners NAIC id number: 95741 ) |
| Policy contract number | 332 |
| Policy instance | 1 |
| Insurance contract or identification number | 332 | | Number of Individuals Covered | 75 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $11,135 | | 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? | Yes | | Commission paid to Insurance Broker | USD $11,135 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010-437615 |
| Policy instance | 2 |
| Insurance contract or identification number | 010-437615 | | Number of Individuals Covered | 160 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $343 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $9,866 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $343 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 70470 |
| Policy instance | 3 |
| Insurance contract or identification number | 70470 | | Number of Individuals Covered | 102 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $628 | | 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 | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $6,281 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $628 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| BLUECHOICE HEALTHPLAN (National Association of Insurance Commissioners NAIC id number: 95741 ) |
| Policy contract number | 332 |
| Policy instance | 1 |
| Insurance contract or identification number | 332 | | Number of Individuals Covered | 72 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-09-30 | | Total amount of commissions paid to insurance broker | USD $31,916 | | 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? | Yes | | Commission paid to Insurance Broker | USD $31,916 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010 – 437615 |
| Policy instance | 2 |
| Insurance contract or identification number | 010 – 437615 | | Number of Individuals Covered | 151 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-09-30 | | Total amount of commissions paid to insurance broker | USD $5,065 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $46,612 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,734 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 112364 |
| Policy instance | 3 |
| Insurance contract or identification number | 112364 | | Number of Individuals Covered | 95 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-09-30 | | Total amount of commissions paid to insurance broker | USD $5,289 | | Total amount of fees paid to insurance company | USD $435 | | 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 | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $30,618 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,773 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Additional information about fees paid to insurance broker | CONTINGENT COMPENSATION |
|
| BLUECHOICE HEALTHPLAN (National Association of Insurance Commissioners NAIC id number: 95741 ) |
| Policy contract number | BA631 |
| Policy instance | 1 |
| Insurance contract or identification number | BA631 | | Number of Individuals Covered | 78 | | Insurance policy start date | 2018-02-01 | | Insurance policy end date | 2018-09-30 | | Total amount of commissions paid to insurance broker | USD $19,138 | | 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? | Yes | | Commission paid to Insurance Broker | USD $19,138 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 112364 |
| Policy instance | 3 |
| Insurance contract or identification number | 112364 | | Number of Individuals Covered | 116 | | Insurance policy start date | 2018-02-01 | | Insurance policy end date | 2018-09-30 | | Total amount of commissions paid to insurance broker | USD $3,377 | | Total amount of fees paid to insurance company | USD $632 | | 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 | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $19,247 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,415 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Additional information about fees paid to insurance broker | CONTINGENT COMPENSATION |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010 – 437615 |
| Policy instance | 2 |
| Insurance contract or identification number | 010 – 437615 | | Number of Individuals Covered | 184 | | Insurance policy start date | 2018-02-01 | | Insurance policy end date | 2018-09-30 | | Total amount of commissions paid to insurance broker | USD $3,194 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $24,445 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,972 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 112364 |
| Policy instance | 3 |
| Insurance contract or identification number | 112364 | | Number of Individuals Covered | 105 | | Insurance policy start date | 2017-02-01 | | Insurance policy end date | 2018-01-31 | | Total amount of commissions paid to insurance broker | USD $4,877 | | Total amount of fees paid to insurance company | USD $1,272 | | 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 | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $27,765 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,489 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Additional information about fees paid to insurance broker | CONTINGENT COMPENSATION | | Insurance broker name | IBSI HOLDING, INC. |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010-437615 |
| Policy instance | 2 |
| Insurance contract or identification number | 010-437615 | | Number of Individuals Covered | 176 | | Insurance policy start date | 2017-02-01 | | Insurance policy end date | 2018-01-31 | | Total amount of commissions paid to insurance broker | USD $5,005 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $46,312 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,689 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Insurance broker name | IBSI HOLDINGS, INC. |
|
| BLUECHOICE HEALTHPLAN (National Association of Insurance Commissioners NAIC id number: 95741 ) |
| Policy contract number | BA631 |
| Policy instance | 1 |
| Insurance contract or identification number | BA631 | | Number of Individuals Covered | 70 | | Insurance policy start date | 2017-02-01 | | Insurance policy end date | 2018-01-31 | | 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 | | 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 |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010-028033 |
| Policy instance | 3 |
| Insurance contract or identification number | 010-028033 | | Number of Individuals Covered | 198 | | Insurance policy start date | 2016-02-01 | | Insurance policy end date | 2016-01-31 | | Total amount of commissions paid to insurance broker | USD $1,431 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $14,309 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,431 | | Insurance broker organization code? | 3 | | Insurance broker name | ECM BENEFITS LLC |
|
| SECURITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68721 ) |
| Policy contract number | 39436 |
| Policy instance | 1 |
| Insurance contract or identification number | 39436 | | Number of Individuals Covered | 117 | | Insurance policy start date | 2015-02-01 | | Insurance policy end date | 2016-01-31 | | Total amount of commissions paid to insurance broker | USD $12,904 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $76,970 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,552 | | Insurance broker organization code? | 3 | | Insurance broker name | ECM BENEFITS LLC |
|
| BLUECHOICE HEALTHPLAN (National Association of Insurance Commissioners NAIC id number: 95741 ) |
| Policy contract number | BA631 |
| Policy instance | 2 |
| Insurance contract or identification number | BA631 | | Number of Individuals Covered | 105 | | Insurance policy start date | 2015-02-01 | | Insurance policy end date | 2016-01-31 | | Total amount of commissions paid to insurance broker | USD $55,285 | | 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 | | Commission paid to Insurance Broker | USD $55,285 | | Insurance broker organization code? | 3 | | Insurance broker name | BLUECHOICE HEALTHPLAN |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010-028033 |
| Policy instance | 3 |
| Insurance contract or identification number | 010-028033 | | Number of Individuals Covered | 173 | | Insurance policy start date | 2015-02-01 | | Insurance policy end date | 2015-01-31 | | Total amount of commissions paid to insurance broker | USD $1,145 | | 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 $11,454 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,044 | | Insurance broker organization code? | 3 | | Insurance broker name | ESTATE PLANNING CONSULTANTS |
|
| BLUECHOICE HEALTHPLAN (National Association of Insurance Commissioners NAIC id number: 95741 ) |
| Policy contract number | BA631 |
| Policy instance | 2 |
| Insurance contract or identification number | BA631 | | Number of Individuals Covered | 104 | | Insurance policy start date | 2014-02-01 | | Insurance policy end date | 2015-01-31 | | Total amount of commissions paid to insurance broker | USD $0 | | 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 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 | | Insurance broker name | BLUECHOICE HEALTHPLAN |
|
| SECURITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68721 ) |
| Policy contract number | 39436 |
| Policy instance | 1 |
| Insurance contract or identification number | 39436 | | Number of Individuals Covered | 112 | | Insurance policy start date | 2014-02-01 | | Insurance policy end date | 2015-01-31 | | Total amount of commissions paid to insurance broker | USD $13,348 | | 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 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $79,407 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,899 | | Insurance broker organization code? | 3 | | Insurance broker name | WILLIAM J. BRANNON |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010-028033 |
| Policy instance | 3 |
| Insurance contract or identification number | 010-028033 | | Number of Individuals Covered | 176 | | Insurance policy start date | 2014-02-01 | | Insurance policy end date | 2014-01-31 | | Total amount of commissions paid to insurance broker | USD $1,438 | | 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 $14,382 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,438 | | Insurance broker organization code? | 3 | | Insurance broker name | ESTATE PLANNING CONSULTANTS |
|
| BLUECHOICE HEALTHPLAN (National Association of Insurance Commissioners NAIC id number: 95741 ) |
| Policy contract number | BA631 |
| Policy instance | 2 |
| Insurance contract or identification number | BA631 | | Number of Individuals Covered | 96 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $42,790 | | Total amount of fees paid to insurance company | USD $4,148 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $42,790 | | Amount paid for insurance broker fees | 4148 | | Additional information about fees paid to insurance broker | CONTINGENCY CHARGES | | Insurance broker organization code? | 3 | | Insurance broker name | BLUECHOICE HEALTHPLAN |
|
| SECURITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68721 ) |
| Policy contract number | 39436 |
| Policy instance | 1 |
| Insurance contract or identification number | 39436 | | Number of Individuals Covered | 117 | | Insurance policy start date | 2013-02-01 | | Insurance policy end date | 2014-01-31 | | Total amount of commissions paid to insurance broker | USD $12,772 | | 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 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $77,217 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,515 | | Insurance broker organization code? | 3 | | Insurance broker name | WILLIAM J. BRANNON |
|
| BLUECHOICE HEALTHPLAN (National Association of Insurance Commissioners NAIC id number: 95741 ) |
| Policy contract number | BA631 |
| Policy instance | 2 |
| Insurance contract or identification number | BA631 | | Number of Individuals Covered | 97 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $41,276 | | Total amount of fees paid to insurance company | USD $6,133 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $824,152 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $41,276 | | Amount paid for insurance broker fees | 6133 | | Additional information about fees paid to insurance broker | CONTINGENCY CHARGES | | Insurance broker organization code? | 3 | | Insurance broker name | BLUECHOICE HEALTHPLAN |
|
| SECURITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68721 ) |
| Policy contract number | 39436 |
| Policy instance | 1 |
| Insurance contract or identification number | 39436 | | Number of Individuals Covered | 123 | | Insurance policy start date | 2012-02-01 | | Insurance policy end date | 2013-01-31 | | Total amount of commissions paid to insurance broker | USD $12,675 | | 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 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $76,601 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,450 | | Insurance broker organization code? | 3 | | Insurance broker name | WILLIAM J. BRANNON |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010-028033 |
| Policy instance | 3 |
| Insurance contract or identification number | 010-028033 | | Number of Individuals Covered | 198 | | Insurance policy start date | 2013-02-01 | | Insurance policy end date | 2013-01-31 | | Total amount of commissions paid to insurance broker | USD $1,454 | | 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 $14,540 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,454 | | Insurance broker organization code? | 3 | | Insurance broker name | ESTATE PLANNING CONSULTANTS |
|
| BLUECHOICE HEALTHPLAN (National Association of Insurance Commissioners NAIC id number: 95741 ) |
| Policy contract number | BA631 |
| Policy instance | 2 |
| Insurance contract or identification number | BA631 | | Number of Individuals Covered | 103 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $40,342 | | Total amount of fees paid to insurance company | USD $4,378 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $807,753 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SECURITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68721 ) |
| Policy contract number | 39436 |
| Policy instance | 1 |
| Insurance contract or identification number | 39436 | | Number of Individuals Covered | 130 | | Insurance policy start date | 2011-02-01 | | Insurance policy end date | 2012-01-31 | | Total amount of commissions paid to insurance broker | USD $12,561 | | 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 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $75,950 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SECURITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68721 ) |
| Policy contract number | 39436 |
| Policy instance | 2 |
| Insurance contract or identification number | 39436 | | Number of Individuals Covered | 216 | | Insurance policy start date | 2010-02-01 | | Insurance policy end date | 2011-01-31 | | Total amount of commissions paid to insurance broker | USD $13,134 | | 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 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $77,787 | | 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 | |
| Policy instance | 1 |
| Number of Individuals Covered | 101 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $40,276 | | 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 | | Health 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 | |
| Policy instance | 1 |
| Number of Individuals Covered | 100 | | Insurance policy start date | 2009-01-01 | | Insurance policy end date | 2009-12-31 | | Total amount of commissions paid to insurance broker | USD $48,168 | | 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 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| EASTERN LIFE & HEALTH INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 62804 ) |
| Policy contract number | 39436 |
| Policy instance | 2 |
| Insurance contract or identification number | 39436 | | Number of Individuals Covered | 115 | | Insurance policy start date | 2009-02-01 | | Insurance policy end date | 2010-01-31 | | Total amount of commissions paid to insurance broker | USD $5,170 | | 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 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $71,748 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 433755 |
| Policy instance | 1 |
| Insurance contract or identification number | 433755 | | Number of Individuals Covered | 129 | | Insurance policy start date | 2008-02-01 | | Insurance policy end date | 2009-01-31 | | Total amount of commissions paid to insurance broker | USD $32,142 | | 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 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $594,714 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 00001D014659 |
| Policy instance | 2 |
| Insurance contract or identification number | 00001D014659 | | Number of Individuals Covered | 95 | | Insurance policy start date | 2008-02-01 | | Insurance policy end date | 2009-01-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $259 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $36,492 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000400002000 |
| Policy instance | 3 |
| Insurance contract or identification number | 000400002000 | | Number of Individuals Covered | 45 | | Insurance policy start date | 2008-02-01 | | Insurance policy end date | 2009-01-31 | | Total amount of commissions paid to insurance broker | USD $2,428 | | Total amount of fees paid to insurance company | USD $519 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | VOLUNTARY WEEKLY INCOME | | Welfare Benefit Premiums Paid to Carrier | USD $16,188 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010088888 |
| Policy instance | 4 |
| Insurance contract or identification number | 000010088888 | | Number of Individuals Covered | 14 | | Insurance policy start date | 2008-02-01 | | Insurance policy end date | 2009-01-31 | | Total amount of commissions paid to insurance broker | USD $323 | | Total amount of fees paid to insurance company | USD $191 | | 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 $6,456 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010088971 |
| Policy instance | 5 |
| Insurance contract or identification number | 000010088971 | | Number of Individuals Covered | 186 | | Insurance policy start date | 2008-02-01 | | Insurance policy end date | 2009-01-31 | | Total amount of commissions paid to insurance broker | USD $570 | | Total amount of fees paid to insurance company | USD $175 | | 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 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,705 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 0004000010000 |
| Policy instance | 6 |
| Insurance contract or identification number | 0004000010000 | | Number of Individuals Covered | 82 | | Insurance policy start date | 2008-02-01 | | Insurance policy end date | 2009-01-31 | | Total amount of commissions paid to insurance broker | USD $2,446 | | Total amount of fees paid to insurance company | USD $397 | | 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 $16,308 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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