ANSLEY GOLF CLUB, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan ANSLEY GOLF CLUB, INC. WELFARE BENEFIT HEALTH, STD, LTD, AD&D, VISION, DENTAL, LIFE
401k plan membership statisitcs for ANSLEY GOLF CLUB, INC. WELFARE BENEFIT HEALTH, STD, LTD, AD&D, VISION, DENTAL, LIFE
| Measure | Date | Value |
|---|
| 2021: ANSLEY GOLF CLUB, INC. WELFARE BENEFIT HEALTH, STD, LTD, AD&D, VISION, DENTAL, LIFE 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-11-01 | 195 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-11-01 | 216 |
| Total of all active and inactive participants | 2021-11-01 | 216 |
| Total participants | 2021-11-01 | 216 |
| 2020: ANSLEY GOLF CLUB, INC. WELFARE BENEFIT HEALTH, STD, LTD, AD&D, VISION, DENTAL, LIFE 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-11-01 | 192 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-11-01 | 195 |
| Total of all active and inactive participants | 2020-11-01 | 195 |
| Total participants | 2020-11-01 | 195 |
| 2019: ANSLEY GOLF CLUB, INC. WELFARE BENEFIT HEALTH, STD, LTD, AD&D, VISION, DENTAL, LIFE 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-11-01 | 213 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-11-01 | 192 |
| Total of all active and inactive participants | 2019-11-01 | 192 |
| Total participants | 2019-11-01 | 192 |
| 2018: ANSLEY GOLF CLUB, INC. WELFARE BENEFIT HEALTH, STD, LTD, AD&D, VISION, DENTAL, LIFE 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-11-01 | 175 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-11-01 | 213 |
| Total of all active and inactive participants | 2018-11-01 | 213 |
| Total participants | 2018-11-01 | 213 |
| 2017: ANSLEY GOLF CLUB, INC. WELFARE BENEFIT HEALTH, STD, LTD, AD&D, VISION, DENTAL, LIFE 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-11-01 | 200 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-11-01 | 175 |
| Total of all active and inactive participants | 2017-11-01 | 175 |
| Total participants | 2017-11-01 | 175 |
| 2016: ANSLEY GOLF CLUB, INC. WELFARE BENEFIT HEALTH, STD, LTD, AD&D, VISION, DENTAL, LIFE 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-11-01 | 185 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-11-01 | 200 |
| Total of all active and inactive participants | 2016-11-01 | 200 |
| Total participants | 2016-11-01 | 200 |
| 2015: ANSLEY GOLF CLUB, INC. WELFARE BENEFIT HEALTH, STD, LTD, AD&D, VISION, DENTAL, LIFE 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-11-01 | 182 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-11-01 | 185 |
| Total of all active and inactive participants | 2015-11-01 | 185 |
| Total participants | 2015-11-01 | 185 |
| 2014: ANSLEY GOLF CLUB, INC. WELFARE BENEFIT HEALTH, STD, LTD, AD&D, VISION, DENTAL, LIFE 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-11-01 | 178 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-11-01 | 182 |
| Total of all active and inactive participants | 2014-11-01 | 182 |
| Total participants | 2014-11-01 | 182 |
| 2013: ANSLEY GOLF CLUB, INC. WELFARE BENEFIT HEALTH, STD, LTD, AD&D, VISION, DENTAL, LIFE 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-11-01 | 138 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-11-01 | 178 |
| Total of all active and inactive participants | 2013-11-01 | 178 |
| Total participants | 2013-11-01 | 178 |
| 2012: ANSLEY GOLF CLUB, INC. WELFARE BENEFIT HEALTH, STD, LTD, AD&D, VISION, DENTAL, LIFE 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-11-01 | 136 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-11-01 | 138 |
| Total of all active and inactive participants | 2012-11-01 | 138 |
| Total participants | 2012-11-01 | 138 |
| 2011: ANSLEY GOLF CLUB, INC. WELFARE BENEFIT HEALTH, STD, LTD, AD&D, VISION, DENTAL, LIFE 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-11-01 | 149 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-11-01 | 136 |
| Total of all active and inactive participants | 2011-11-01 | 136 |
| Total participants | 2011-11-01 | 136 |
| 2010: ANSLEY GOLF CLUB, INC. WELFARE BENEFIT HEALTH, STD, LTD, AD&D, VISION, DENTAL, LIFE 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-11-01 | 144 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-11-01 | 149 |
| Total of all active and inactive participants | 2010-11-01 | 149 |
| Total participants | 2010-11-01 | 149 |
| 2009: ANSLEY GOLF CLUB, INC. WELFARE BENEFIT HEALTH, STD, LTD, AD&D, VISION, DENTAL, LIFE 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-11-01 | 145 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-11-01 | 144 |
| Total of all active and inactive participants | 2009-11-01 | 144 |
| Total participants | 2009-11-01 | 144 |
| 2021: ANSLEY GOLF CLUB, INC. WELFARE BENEFIT HEALTH, STD, LTD, AD&D, VISION, DENTAL, LIFE 2021 form 5500 responses |
|---|
| 2021-11-01 | Type of plan entity | Single employer plan |
| 2021-11-01 | Plan funding arrangement – Insurance | Yes |
| 2021-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: ANSLEY GOLF CLUB, INC. WELFARE BENEFIT HEALTH, STD, LTD, AD&D, VISION, DENTAL, LIFE 2020 form 5500 responses |
|---|
| 2020-11-01 | Type of plan entity | Single employer plan |
| 2020-11-01 | Plan funding arrangement – Insurance | Yes |
| 2020-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: ANSLEY GOLF CLUB, INC. WELFARE BENEFIT HEALTH, STD, LTD, AD&D, VISION, DENTAL, LIFE 2019 form 5500 responses |
|---|
| 2019-11-01 | Type of plan entity | Single employer plan |
| 2019-11-01 | Plan funding arrangement – Insurance | Yes |
| 2019-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: ANSLEY GOLF CLUB, INC. WELFARE BENEFIT HEALTH, STD, LTD, AD&D, VISION, DENTAL, LIFE 2018 form 5500 responses |
|---|
| 2018-11-01 | Type of plan entity | Single employer plan |
| 2018-11-01 | Plan funding arrangement – Insurance | Yes |
| 2018-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: ANSLEY GOLF CLUB, INC. WELFARE BENEFIT HEALTH, STD, LTD, AD&D, VISION, DENTAL, LIFE 2017 form 5500 responses |
|---|
| 2017-11-01 | Type of plan entity | Single employer plan |
| 2017-11-01 | Plan funding arrangement – Insurance | Yes |
| 2017-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: ANSLEY GOLF CLUB, INC. WELFARE BENEFIT HEALTH, STD, LTD, AD&D, VISION, DENTAL, LIFE 2016 form 5500 responses |
|---|
| 2016-11-01 | Type of plan entity | Single employer plan |
| 2016-11-01 | Plan funding arrangement – Insurance | Yes |
| 2016-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: ANSLEY GOLF CLUB, INC. WELFARE BENEFIT HEALTH, STD, LTD, AD&D, VISION, DENTAL, LIFE 2015 form 5500 responses |
|---|
| 2015-11-01 | Type of plan entity | Single employer plan |
| 2015-11-01 | Plan funding arrangement – Insurance | Yes |
| 2015-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: ANSLEY GOLF CLUB, INC. WELFARE BENEFIT HEALTH, STD, LTD, AD&D, VISION, DENTAL, LIFE 2014 form 5500 responses |
|---|
| 2014-11-01 | Type of plan entity | Single employer plan |
| 2014-11-01 | Plan funding arrangement – Insurance | Yes |
| 2014-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: ANSLEY GOLF CLUB, INC. WELFARE BENEFIT HEALTH, STD, LTD, AD&D, VISION, DENTAL, LIFE 2013 form 5500 responses |
|---|
| 2013-11-01 | Type of plan entity | Single employer plan |
| 2013-11-01 | Plan funding arrangement – Insurance | Yes |
| 2013-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: ANSLEY GOLF CLUB, INC. WELFARE BENEFIT HEALTH, STD, LTD, AD&D, VISION, DENTAL, LIFE 2012 form 5500 responses |
|---|
| 2012-11-01 | Type of plan entity | Single employer plan |
| 2012-11-01 | Plan funding arrangement – Insurance | Yes |
| 2012-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: ANSLEY GOLF CLUB, INC. WELFARE BENEFIT HEALTH, STD, LTD, AD&D, VISION, DENTAL, LIFE 2011 form 5500 responses |
|---|
| 2011-11-01 | Type of plan entity | Single employer plan |
| 2011-11-01 | Plan funding arrangement – Insurance | Yes |
| 2011-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2010: ANSLEY GOLF CLUB, INC. WELFARE BENEFIT HEALTH, STD, LTD, AD&D, VISION, DENTAL, LIFE 2010 form 5500 responses |
|---|
| 2010-11-01 | Type of plan entity | Single employer plan |
| 2010-11-01 | Plan funding arrangement – Insurance | Yes |
| 2010-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: ANSLEY GOLF CLUB, INC. WELFARE BENEFIT HEALTH, STD, LTD, AD&D, VISION, DENTAL, LIFE 2009 form 5500 responses |
|---|
| 2009-11-01 | Type of plan entity | Single employer plan |
| 2009-11-01 | Submission has been amended | Yes |
| 2009-11-01 | Plan funding arrangement – Insurance | Yes |
| 2009-11-01 | Plan benefit arrangement – Insurance | Yes |
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 166415 |
| Policy instance | 6 |
| Insurance contract or identification number | 166415 | | Number of Individuals Covered | 86 | | Insurance policy start date | 2021-11-01 | | Insurance policy end date | 2022-10-31 | | Total amount of commissions paid to insurance broker | USD $991 | | Vision 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 $991 | | Insurance broker organization code? | 3 |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 166415 |
| Policy instance | 5 |
| Insurance contract or identification number | 166415 | | Number of Individuals Covered | 65 | | Insurance policy start date | 2021-11-01 | | Insurance policy end date | 2022-10-31 | | Total amount of commissions paid to insurance broker | USD $2,160 | | Temporary Disability 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 $2,160 | | Insurance broker organization code? | 3 |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 166415 |
| Policy instance | 4 |
| Insurance contract or identification number | 166415 | | Number of Individuals Covered | 47 | | Insurance policy start date | 2021-11-01 | | Insurance policy end date | 2022-10-31 | | Total amount of commissions paid to insurance broker | USD $1,468 | | Long Term Disability 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 $1,468 | | Insurance broker organization code? | 3 |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 166415 |
| Policy instance | 3 |
| Insurance contract or identification number | 166415 | | Number of Individuals Covered | 138 | | Insurance policy start date | 2021-11-01 | | Insurance policy end date | 2022-10-31 | | Total amount of commissions paid to insurance broker | USD $2,660 | | Life 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 $2,660 | | Insurance broker organization code? | 3 |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 166415 |
| Policy instance | 2 |
| Insurance contract or identification number | 166415 | | Number of Individuals Covered | 110 | | Insurance policy start date | 2021-11-01 | | Insurance policy end date | 2022-10-31 | | Total amount of commissions paid to insurance broker | USD $6,589 | | Dental 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 $6,589 | | Insurance broker organization code? | 3 |
|
| KAISER FOUNDATION HEALTH PLAN OF GEORGIA INC. (National Association of Insurance Commissioners NAIC id number: 96237 ) |
| Policy contract number | 10134 |
| Policy instance | 1 |
| Insurance contract or identification number | 10134 | | Number of Individuals Covered | 195 | | Insurance policy start date | 2021-11-01 | | Insurance policy end date | 2022-10-31 | | Total amount of commissions paid to insurance broker | USD $50,572 | | Welfare Benefit Premiums Paid to Carrier | USD $986,502 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $50,572 | | Insurance broker organization code? | 3 |
|
| KAISER FOUNDATION HEALTH PLAN OF GEORGIA INC. (National Association of Insurance Commissioners NAIC id number: 96237 ) |
| Policy contract number | 10134 |
| Policy instance | 1 |
| Insurance contract or identification number | 10134 | | Number of Individuals Covered | 226 | | Insurance policy start date | 2020-11-01 | | Insurance policy end date | 2021-10-31 | | Total amount of commissions paid to insurance broker | USD $52,171 | | Welfare Benefit Premiums Paid to Carrier | USD $1,051,984 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $52,171 | | Insurance broker organization code? | 3 |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 166415 |
| Policy instance | 2 |
| Insurance contract or identification number | 166415 | | Number of Individuals Covered | 117 | | Insurance policy start date | 2020-11-01 | | Insurance policy end date | 2021-10-31 | | Total amount of commissions paid to insurance broker | USD $6,268 | | Dental 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 $6,268 | | Insurance broker organization code? | 3 |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 166415 |
| Policy instance | 3 |
| Insurance contract or identification number | 166415 | | Number of Individuals Covered | 131 | | Insurance policy start date | 2020-11-01 | | Insurance policy end date | 2021-10-31 | | Total amount of commissions paid to insurance broker | USD $2,608 | | Life 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 $2,608 | | Insurance broker organization code? | 3 |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 166415 |
| Policy instance | 4 |
| Insurance contract or identification number | 166415 | | Number of Individuals Covered | 49 | | Insurance policy start date | 2020-11-01 | | Insurance policy end date | 2021-10-31 | | Total amount of commissions paid to insurance broker | USD $1,490 | | Long Term Disability 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 $1,490 | | Insurance broker organization code? | 3 |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 166415 |
| Policy instance | 5 |
| Insurance contract or identification number | 166415 | | Number of Individuals Covered | 74 | | Insurance policy start date | 2020-11-01 | | Insurance policy end date | 2021-10-31 | | Total amount of commissions paid to insurance broker | USD $2,393 | | Temporary Disability 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 $2,393 | | Insurance broker organization code? | 3 |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 166415 |
| Policy instance | 6 |
| Insurance contract or identification number | 166415 | | Number of Individuals Covered | 88 | | Insurance policy start date | 2020-11-01 | | Insurance policy end date | 2021-10-31 | | Total amount of commissions paid to insurance broker | USD $981 | | Vision 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 $981 | | Insurance broker organization code? | 3 |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 166415 |
| Policy instance | 6 |
| Insurance contract or identification number | 166415 | | Number of Individuals Covered | 75 | | Insurance policy start date | 2019-11-01 | | Insurance policy end date | 2020-10-31 | | Total amount of commissions paid to insurance broker | USD $1,518 | | Vision 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 $1,518 | | Insurance broker organization code? | 3 |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 166415 |
| Policy instance | 5 |
| Insurance contract or identification number | 166415 | | Number of Individuals Covered | 52 | | Insurance policy start date | 2019-11-01 | | Insurance policy end date | 2020-10-31 | | Total amount of commissions paid to insurance broker | USD $2,326 | | Temporary Disability 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 $2,326 | | Insurance broker organization code? | 3 |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 166415 |
| Policy instance | 4 |
| Insurance contract or identification number | 166415 | | Number of Individuals Covered | 44 | | Insurance policy start date | 2019-11-01 | | Insurance policy end date | 2020-10-31 | | Total amount of commissions paid to insurance broker | USD $2,015 | | Long Term Disability 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 $2,015 | | Insurance broker organization code? | 3 |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 166415 |
| Policy instance | 3 |
| Insurance contract or identification number | 166415 | | Number of Individuals Covered | 127 | | Insurance policy start date | 2019-11-01 | | Insurance policy end date | 2020-10-31 | | Total amount of commissions paid to insurance broker | USD $3,844 | | Life 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 $3,844 | | Insurance broker organization code? | 3 |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 166415 |
| Policy instance | 2 |
| Insurance contract or identification number | 166415 | | Number of Individuals Covered | 111 | | Insurance policy start date | 2019-11-01 | | Insurance policy end date | 2020-10-31 | | Total amount of commissions paid to insurance broker | USD $8,460 | | Dental 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 $8,460 | | Insurance broker organization code? | 3 |
|
| KAISER FOUNDATION HEALTH PLAN OF GEORGIA INC. (National Association of Insurance Commissioners NAIC id number: 96237 ) |
| Policy contract number | 10134 |
| Policy instance | 1 |
| Insurance contract or identification number | 10134 | | Number of Individuals Covered | 210 | | Insurance policy start date | 2019-11-01 | | Insurance policy end date | 2020-10-31 | | Total amount of commissions paid to insurance broker | USD $46,875 | | Welfare Benefit Premiums Paid to Carrier | USD $923,479 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $46,875 | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00391702 |
| Policy instance | 1 |
| Insurance contract or identification number | 00391702 | | Number of Individuals Covered | 118 | | Insurance policy start date | 2018-11-01 | | Insurance policy end date | 2019-10-31 | | Total amount of commissions paid to insurance broker | USD $7,516 | | Total amount of fees paid to insurance company | USD $4,762 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $70,375 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,045 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 4762 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 592788 |
| Policy instance | 2 |
| Insurance contract or identification number | 592788 | | Number of Individuals Covered | 130 | | Insurance policy start date | 2018-11-01 | | Insurance policy end date | 2019-11-01 | | Total amount of commissions paid to insurance broker | USD $3,118 | | Total amount of fees paid to insurance company | USD $437 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $26,492 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,567 | | Amount paid for insurance broker fees | 437 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| KAISER FOUNDATION HEALTH PLAN OF GEORGIA INC. (National Association of Insurance Commissioners NAIC id number: 96237 ) |
| Policy contract number | 10134 |
| Policy instance | 3 |
| Insurance contract or identification number | 10134 | | Number of Individuals Covered | 181 | | Insurance policy start date | 2018-11-01 | | Insurance policy end date | 2019-10-31 | | Total amount of commissions paid to insurance broker | USD $44,487 | | Welfare Benefit Premiums Paid to Carrier | USD $910,035 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $24,512 | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 701051 |
| Policy instance | 4 |
| Insurance contract or identification number | 701051 | | Number of Individuals Covered | 31 | | Insurance policy start date | 2018-11-01 | | Insurance policy end date | 2019-11-01 | | Total amount of commissions paid to insurance broker | USD $1,523 | | Total amount of fees paid to insurance company | USD $167 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,158 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,252 | | Amount paid for insurance broker fees | 167 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 701051 |
| Policy instance | 4 |
| Insurance contract or identification number | 701051 | | Number of Individuals Covered | 33 | | Insurance policy start date | 2017-11-01 | | Insurance policy end date | 2018-11-01 | | Total amount of commissions paid to insurance broker | USD $1,358 | | Total amount of fees paid to insurance company | USD $181 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $9,050 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF GEORGIA INC. (National Association of Insurance Commissioners NAIC id number: 96237 ) |
| Policy contract number | 10134 |
| Policy instance | 3 |
| Insurance contract or identification number | 10134 | | Number of Individuals Covered | 173 | | Insurance policy start date | 2017-11-01 | | Insurance policy end date | 2018-10-31 | | Total amount of commissions paid to insurance broker | USD $42,327 | | Total amount of fees paid to insurance company | USD $92 | | Welfare Benefit Premiums Paid to Carrier | USD $849,762 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00391702 |
| Policy instance | 1 |
| Insurance contract or identification number | 00391702 | | Number of Individuals Covered | 111 | | Insurance policy start date | 2017-11-01 | | Insurance policy end date | 2018-10-31 | | Total amount of commissions paid to insurance broker | USD $3,808 | | Total amount of fees paid to insurance company | USD $4,088 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $72,549 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 592788 |
| Policy instance | 2 |
| Insurance contract or identification number | 592788 | | Number of Individuals Covered | 167 | | Insurance policy start date | 2017-11-01 | | Insurance policy end date | 2018-11-01 | | Total amount of commissions paid to insurance broker | USD $3,385 | | Total amount of fees paid to insurance company | USD $575 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $28,731 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
