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KELLEY MANUFACTURING CO. EMPLOYEE HEALTH & WELFARE BENEFIT PLAN 401k Plan overview

Plan NameKELLEY MANUFACTURING CO. EMPLOYEE HEALTH & WELFARE BENEFIT PLAN
Plan identification number 502

KELLEY MANUFACTURING CO. EMPLOYEE HEALTH & WELFARE BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Long-term disability cover

401k Sponsoring company profile

KELLEY MANUFACTURING CO. has sponsored the creation of one or more 401k plans.

Company Name:KELLEY MANUFACTURING CO.
Employer identification number (EIN):581503716
NAIC Classification:333100

Additional information about KELLEY MANUFACTURING CO.

Jurisdiction of Incorporation: Georgia Department of States Corporations Division
Incorporation Date: 1982-08-02
Company Identification Number: 639165
Legal Registered Office Address: 80 Vernon Drive

Tifton
United States of America (USA)
31793

More information about KELLEY MANUFACTURING CO.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan KELLEY MANUFACTURING CO. EMPLOYEE HEALTH & WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022022-09-01
5022021-09-01
5022020-09-01
5022019-09-01
5022018-09-01
5022017-09-01
5022016-09-01JIMMY TOMBERLIN, CFO JIMMY TOMBERLIN, CFO2018-07-17
5022015-09-01JIMMY TOMBERLIN, CFO JIMMY TOMBERLIN, CFO2017-03-23
5022014-09-01JIMMY TOMBERLIN, CFO JIMMY TOMBERLIN, CFO2016-02-17
5022013-09-01JIMMY TOMBERLIN JIMMY TOMBERLIN2015-03-25
5022012-09-01JIMMY TOMBERLIN, CPA JIMMY TOMBERLIN, CPA2014-06-12
5022011-09-01JIMMY TOMBERLIN, CPA JIMMY TOMBERLIN, CPA2013-06-14
5022009-09-01JIMMY TOMBERLIN, CPA JIMMY TOMBERLIN, CPA2011-03-22

Plan Statistics for KELLEY MANUFACTURING CO. EMPLOYEE HEALTH & WELFARE BENEFIT PLAN

401k plan membership statisitcs for KELLEY MANUFACTURING CO. EMPLOYEE HEALTH & WELFARE BENEFIT PLAN

Measure Date Value
2022: KELLEY MANUFACTURING CO. EMPLOYEE HEALTH & WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year2022-09-01191
Total of all active and inactive participants2022-09-010
Total participants2022-09-010
2021: KELLEY MANUFACTURING CO. EMPLOYEE HEALTH & WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-09-01179
Total number of active participants reported on line 7a of the Form 55002021-09-01191
Total of all active and inactive participants2021-09-01191
Total participants2021-09-01191
2020: KELLEY MANUFACTURING CO. EMPLOYEE HEALTH & WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-09-01175
Total number of active participants reported on line 7a of the Form 55002020-09-01179
Total of all active and inactive participants2020-09-01179
Total participants2020-09-01179
2019: KELLEY MANUFACTURING CO. EMPLOYEE HEALTH & WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-09-01172
Total number of active participants reported on line 7a of the Form 55002019-09-01175
Total of all active and inactive participants2019-09-01175
Total participants2019-09-01175
2018: KELLEY MANUFACTURING CO. EMPLOYEE HEALTH & WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-09-01202
Total number of active participants reported on line 7a of the Form 55002018-09-01172
Total of all active and inactive participants2018-09-01172
Total participants2018-09-01172
2017: KELLEY MANUFACTURING CO. EMPLOYEE HEALTH & WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-09-01174
Total number of active participants reported on line 7a of the Form 55002017-09-01202
Total of all active and inactive participants2017-09-01202
Total participants2017-09-01202
2016: KELLEY MANUFACTURING CO. EMPLOYEE HEALTH & WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-09-01181
Total number of active participants reported on line 7a of the Form 55002016-09-01174
Total of all active and inactive participants2016-09-01174
Total participants2016-09-01174
2015: KELLEY MANUFACTURING CO. EMPLOYEE HEALTH & WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-09-01190
Total number of active participants reported on line 7a of the Form 55002015-09-01181
Total of all active and inactive participants2015-09-01181
Total participants2015-09-01181
2014: KELLEY MANUFACTURING CO. EMPLOYEE HEALTH & WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-09-01178
Total number of active participants reported on line 7a of the Form 55002014-09-01190
Total of all active and inactive participants2014-09-01190
Total participants2014-09-01190
2013: KELLEY MANUFACTURING CO. EMPLOYEE HEALTH & WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-09-01174
Total number of active participants reported on line 7a of the Form 55002013-09-01178
Total of all active and inactive participants2013-09-01178
Total participants2013-09-01178
2012: KELLEY MANUFACTURING CO. EMPLOYEE HEALTH & WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year2012-09-01176
Total number of active participants reported on line 7a of the Form 55002012-09-01174
Total of all active and inactive participants2012-09-01174
Total participants2012-09-01174
2011: KELLEY MANUFACTURING CO. EMPLOYEE HEALTH & WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year2011-09-01161
Total number of active participants reported on line 7a of the Form 55002011-09-01176
Total of all active and inactive participants2011-09-01176
Total participants2011-09-01176
2009: KELLEY MANUFACTURING CO. EMPLOYEE HEALTH & WELFARE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year2009-09-01160
Total number of active participants reported on line 7a of the Form 55002009-09-01157
Total of all active and inactive participants2009-09-01157
Total participants2009-09-01157

Form 5500 Responses for KELLEY MANUFACTURING CO. EMPLOYEE HEALTH & WELFARE BENEFIT PLAN

2022: KELLEY MANUFACTURING CO. EMPLOYEE HEALTH & WELFARE BENEFIT PLAN 2022 form 5500 responses
2022-09-01Type of plan entitySingle employer plan
2022-09-01Plan funding arrangement – InsuranceYes
2022-09-01Plan funding arrangement – General assets of the sponsorYes
2022-09-01Plan benefit arrangement – InsuranceYes
2022-09-01Plan benefit arrangement – General assets of the sponsorYes
2021: KELLEY MANUFACTURING CO. EMPLOYEE HEALTH & WELFARE BENEFIT PLAN 2021 form 5500 responses
2021-09-01Type of plan entitySingle employer plan
2021-09-01Plan funding arrangement – InsuranceYes
2021-09-01Plan funding arrangement – General assets of the sponsorYes
2021-09-01Plan benefit arrangement – InsuranceYes
2021-09-01Plan benefit arrangement – General assets of the sponsorYes
2020: KELLEY MANUFACTURING CO. EMPLOYEE HEALTH & WELFARE BENEFIT PLAN 2020 form 5500 responses
2020-09-01Type of plan entitySingle employer plan
2020-09-01Plan funding arrangement – InsuranceYes
2020-09-01Plan funding arrangement – General assets of the sponsorYes
2020-09-01Plan benefit arrangement – InsuranceYes
2020-09-01Plan benefit arrangement – General assets of the sponsorYes
2019: KELLEY MANUFACTURING CO. EMPLOYEE HEALTH & WELFARE BENEFIT PLAN 2019 form 5500 responses
2019-09-01Type of plan entitySingle employer plan
2019-09-01Plan funding arrangement – InsuranceYes
2019-09-01Plan funding arrangement – General assets of the sponsorYes
2019-09-01Plan benefit arrangement – InsuranceYes
2019-09-01Plan benefit arrangement – General assets of the sponsorYes
2018: KELLEY MANUFACTURING CO. EMPLOYEE HEALTH & WELFARE BENEFIT PLAN 2018 form 5500 responses
2018-09-01Type of plan entitySingle employer plan
2018-09-01Plan funding arrangement – InsuranceYes
2018-09-01Plan funding arrangement – General assets of the sponsorYes
2018-09-01Plan benefit arrangement – InsuranceYes
2018-09-01Plan benefit arrangement – General assets of the sponsorYes
2017: KELLEY MANUFACTURING CO. EMPLOYEE HEALTH & WELFARE BENEFIT PLAN 2017 form 5500 responses
2017-09-01Type of plan entitySingle employer plan
2017-09-01Plan funding arrangement – InsuranceYes
2017-09-01Plan funding arrangement – General assets of the sponsorYes
2017-09-01Plan benefit arrangement – InsuranceYes
2017-09-01Plan benefit arrangement – General assets of the sponsorYes
2016: KELLEY MANUFACTURING CO. EMPLOYEE HEALTH & WELFARE BENEFIT PLAN 2016 form 5500 responses
2016-09-01Type of plan entitySingle employer plan
2016-09-01Plan funding arrangement – InsuranceYes
2016-09-01Plan funding arrangement – General assets of the sponsorYes
2016-09-01Plan benefit arrangement – InsuranceYes
2016-09-01Plan benefit arrangement – General assets of the sponsorYes
2015: KELLEY MANUFACTURING CO. EMPLOYEE HEALTH & WELFARE BENEFIT PLAN 2015 form 5500 responses
2015-09-01Type of plan entitySingle employer plan
2015-09-01Plan funding arrangement – InsuranceYes
2015-09-01Plan funding arrangement – General assets of the sponsorYes
2015-09-01Plan benefit arrangement – InsuranceYes
2015-09-01Plan benefit arrangement – General assets of the sponsorYes
2014: KELLEY MANUFACTURING CO. EMPLOYEE HEALTH & WELFARE BENEFIT PLAN 2014 form 5500 responses
2014-09-01Type of plan entitySingle employer plan
2014-09-01Plan funding arrangement – InsuranceYes
2014-09-01Plan funding arrangement – General assets of the sponsorYes
2014-09-01Plan benefit arrangement – InsuranceYes
2014-09-01Plan benefit arrangement – General assets of the sponsorYes
2013: KELLEY MANUFACTURING CO. EMPLOYEE HEALTH & WELFARE BENEFIT PLAN 2013 form 5500 responses
2013-09-01Type of plan entitySingle employer plan
2013-09-01Plan funding arrangement – InsuranceYes
2013-09-01Plan funding arrangement – General assets of the sponsorYes
2013-09-01Plan benefit arrangement – InsuranceYes
2013-09-01Plan benefit arrangement – General assets of the sponsorYes
2012: KELLEY MANUFACTURING CO. EMPLOYEE HEALTH & WELFARE BENEFIT PLAN 2012 form 5500 responses
2012-09-01Type of plan entitySingle employer plan
2012-09-01Plan funding arrangement – InsuranceYes
2012-09-01Plan funding arrangement – General assets of the sponsorYes
2012-09-01Plan benefit arrangement – InsuranceYes
2012-09-01Plan benefit arrangement – General assets of the sponsorYes
2011: KELLEY MANUFACTURING CO. EMPLOYEE HEALTH & WELFARE BENEFIT PLAN 2011 form 5500 responses
2011-09-01Type of plan entitySingle employer plan
2011-09-01Plan funding arrangement – InsuranceYes
2011-09-01Plan funding arrangement – General assets of the sponsorYes
2011-09-01Plan benefit arrangement – InsuranceYes
2011-09-01Plan benefit arrangement – General assets of the sponsorYes
2009: KELLEY MANUFACTURING CO. EMPLOYEE HEALTH & WELFARE BENEFIT PLAN 2009 form 5500 responses
2009-09-01Type of plan entitySingle employer plan
2009-09-01Plan funding arrangement – InsuranceYes
2009-09-01Plan funding arrangement – General assets of the sponsorYes
2009-09-01Plan benefit arrangement – InsuranceYes
2009-09-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

KISMET RISK MANAGEMENT ASSOCIATES LLC (National Association of Insurance Commissioners NAIC id number: 66281 )
Policy contract number6150
Policy instance 4
Insurance contract or identification number6150
Number of Individuals Covered185
Insurance policy start date2022-09-01
Insurance policy end date2023-08-31
Total amount of commissions paid to insurance brokerUSD $28,741
Total amount of fees paid to insurance companyUSD $71,124
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees36086
Additional information about fees paid to insurance brokerADMINISTRATIVE FEES
Insurance broker organization code?5
Commission paid to Insurance BrokerUSD $28,741
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00319956
Policy instance 3
Insurance contract or identification number00319956
Number of Individuals Covered169
Insurance policy start date2022-09-01
Insurance policy end date2023-08-31
Total amount of commissions paid to insurance brokerUSD $3,178
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $78,500
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,178
Insurance broker organization code?3
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract number9002550539
Policy instance 2
Insurance contract or identification number9002550539
Number of Individuals Covered185
Insurance policy start date2022-09-01
Insurance policy end date2023-08-31
Total amount of commissions paid to insurance brokerUSD $3,894
Other welfare benefits providedDEPENDENT LIFE AND ADD
Welfare Benefit Premiums Paid to CarrierUSD $25,717
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $519
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000850054524000
Policy instance 1
Insurance contract or identification number000850054524000
Number of Individuals Covered168
Insurance policy start date2022-09-01
Insurance policy end date2023-08-31
Total amount of commissions paid to insurance brokerUSD $8,389
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $85,178
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,389
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000850054524 00
Policy instance 1
Insurance contract or identification number000850054524 00
Number of Individuals Covered172
Insurance policy start date2021-09-01
Insurance policy end date2022-08-31
Total amount of commissions paid to insurance brokerUSD $8,325
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $77,586
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,325
Insurance broker organization code?3
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract number900-25-50539
Policy instance 2
Insurance contract or identification number900-25-50539
Number of Individuals Covered191
Insurance policy start date2021-09-01
Insurance policy end date2022-08-31
Total amount of commissions paid to insurance brokerUSD $4,114
Life Insurance Welfare BenefitYes
Other welfare benefits providedDEPENDENT LIFE AND ADD
Welfare Benefit Premiums Paid to CarrierUSD $25,558
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $549
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00319956
Policy instance 3
Insurance contract or identification number00319956
Number of Individuals Covered172
Insurance policy start date2021-09-01
Insurance policy end date2022-08-31
Total amount of commissions paid to insurance brokerUSD $3,331
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $88,754
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,331
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberSLM540247
Policy instance 4
Insurance contract or identification numberSLM540247
Number of Individuals Covered191
Insurance policy start date2021-09-01
Insurance policy end date2022-08-31
Total amount of commissions paid to insurance brokerUSD $27,341
Total amount of fees paid to insurance companyUSD $64,323
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees32882
Additional information about fees paid to insurance brokerADMINISTRATIVE FEES
Insurance broker organization code?5
Commission paid to Insurance BrokerUSD $27,341
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberSLM540247
Policy instance 4
Insurance contract or identification numberSLM540247
Number of Individuals Covered179
Insurance policy start date2020-09-01
Insurance policy end date2021-08-31
Total amount of commissions paid to insurance brokerUSD $21,976
Total amount of fees paid to insurance companyUSD $64,069
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $21,976
Insurance broker organization code?3
Amount paid for insurance broker fees31140
Additional information about fees paid to insurance brokerPRE-CERTIFICATION FEES
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00319956
Policy instance 3
Insurance contract or identification number00319956
Number of Individuals Covered160
Insurance policy start date2020-09-01
Insurance policy end date2021-08-31
Total amount of commissions paid to insurance brokerUSD $3,125
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $75,002
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,125
Insurance broker organization code?3
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract number900-25-50539
Policy instance 2
Insurance contract or identification number900-25-50539
Number of Individuals Covered179
Insurance policy start date2020-09-01
Insurance policy end date2021-08-31
Total amount of commissions paid to insurance brokerUSD $3,065
Life Insurance Welfare BenefitYes
Other welfare benefits providedDEPENDENT LIFE AND ADD
Welfare Benefit Premiums Paid to CarrierUSD $20,323
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $409
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000850054524 00
Policy instance 1
Insurance contract or identification number000850054524 00
Number of Individuals Covered167
Insurance policy start date2020-09-01
Insurance policy end date2021-08-31
Total amount of commissions paid to insurance brokerUSD $8,090
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $71,955
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,090
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000850054524
Policy instance 1
Insurance contract or identification number000850054524
Number of Individuals Covered160
Insurance policy start date2019-09-01
Insurance policy end date2020-08-31
Total amount of commissions paid to insurance brokerUSD $8,094
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $69,902
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,094
Insurance broker organization code?3
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract number9002550539
Policy instance 2
Insurance contract or identification number9002550539
Number of Individuals Covered175
Insurance policy start date2019-09-01
Insurance policy end date2020-08-31
Total amount of commissions paid to insurance brokerUSD $3,863
Life Insurance Welfare BenefitYes
Other welfare benefits providedDEPENDENT LIFE AND ADD
Welfare Benefit Premiums Paid to CarrierUSD $23,880
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $507
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00319956
Policy instance 3
Insurance contract or identification number00319956
Number of Individuals Covered155
Insurance policy start date2019-09-01
Insurance policy end date2020-08-31
Total amount of commissions paid to insurance brokerUSD $3,349
Total amount of fees paid to insurance companyUSD $3,291
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $89,919
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,349
Amount paid for insurance broker fees3291
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberSLM540247
Policy instance 4
Insurance contract or identification numberSLM540247
Number of Individuals Covered175
Insurance policy start date2019-09-01
Insurance policy end date2020-08-31
Total amount of commissions paid to insurance brokerUSD $22,966
Total amount of fees paid to insurance companyUSD $63,420
Welfare Benefit Premiums Paid to CarrierUSD $185,086
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees32725
Additional information about fees paid to insurance brokerADMINISTRATIVE FEES
Insurance broker organization code?5
Commission paid to Insurance BrokerUSD $22,966
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract number9002550539
Policy instance 2
Insurance contract or identification number9002550539
Number of Individuals Covered172
Insurance policy start date2018-09-01
Insurance policy end date2019-08-31
Total amount of commissions paid to insurance brokerUSD $3,579
Life Insurance Welfare BenefitYes
Other welfare benefits providedDEPENDENT LIFE AND ADD
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $477
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00319956
Policy instance 3
Insurance contract or identification number00319956
Number of Individuals Covered154
Insurance policy start date2018-09-01
Insurance policy end date2019-08-31
Total amount of commissions paid to insurance brokerUSD $4,170
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $88,064
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,170
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000850054524
Policy instance 1
Insurance contract or identification number000850054524
Number of Individuals Covered152
Insurance policy start date2018-09-01
Insurance policy end date2019-08-31
Total amount of commissions paid to insurance brokerUSD $7,929
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $74,071
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,929
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberSLM540247
Policy instance 4
Insurance contract or identification numberSLM540247
Number of Individuals Covered172
Insurance policy start date2018-09-01
Insurance policy end date2019-08-31
Total amount of commissions paid to insurance brokerUSD $66,141
Welfare Benefit Premiums Paid to CarrierUSD $291,564
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $29,528
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000850054524
Policy instance 1
Insurance contract or identification number000850054524
Number of Individuals Covered181
Insurance policy start date2017-09-01
Insurance policy end date2018-08-31
Total amount of commissions paid to insurance brokerUSD $8,089
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $71,883
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract number9002550539
Policy instance 2
Insurance contract or identification number9002550539
Number of Individuals Covered202
Insurance policy start date2017-09-01
Insurance policy end date2018-08-31
Total amount of commissions paid to insurance brokerUSD $3,612
Life Insurance Welfare BenefitYes
Other welfare benefits providedDEPENDENT LIFE AND ADD
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberSLM540247
Policy instance 4
Insurance contract or identification numberSLM540247
Number of Individuals Covered202
Insurance policy start date2017-09-01
Insurance policy end date2018-08-31
Total amount of commissions paid to insurance brokerUSD $61,118
Welfare Benefit Premiums Paid to CarrierUSD $309,051
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 number00319956
Policy instance 3
Insurance contract or identification number00319956
Number of Individuals Covered180
Insurance policy start date2017-09-01
Insurance policy end date2018-08-31
Total amount of commissions paid to insurance brokerUSD $3,386
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $92,412
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 number000850054524
Policy instance 1
Insurance contract or identification number000850054524
Number of Individuals Covered165
Insurance policy start date2015-09-01
Insurance policy end date2016-08-31
Total amount of commissions paid to insurance brokerUSD $8,051
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $69,389
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,051
Insurance broker organization code?3
Insurance broker namePARTNERS BENEFIT GROUP LLC
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract number9002550539
Policy instance 2
Insurance contract or identification number9002550539
Number of Individuals Covered181
Insurance policy start date2015-09-01
Insurance policy end date2016-08-31
Total amount of commissions paid to insurance brokerUSD $3,516
Life Insurance Welfare BenefitYes
Other welfare benefits providedDEPENDENT LIFE AND ADD
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $469
Insurance broker organization code?3
Insurance broker nameJ.L. HERRING & ASSOC INC
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00319956
Policy instance 3
Insurance contract or identification number00319956
Number of Individuals Covered155
Insurance policy start date2015-09-01
Insurance policy end date2016-08-31
Total amount of commissions paid to insurance brokerUSD $3,149
Total amount of fees paid to insurance companyUSD $3,830
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $76,625
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,149
Amount paid for insurance broker fees3830
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
Insurance broker namePARTNERS BENEFIT GROUP
MONUMENTAL LIFE (National Association of Insurance Commissioners NAIC id number: 66281 )
Policy contract numberMLI-022-10
Policy instance 4
Insurance contract or identification numberMLI-022-10
Number of Individuals Covered181
Insurance policy start date2015-09-01
Insurance policy end date2016-08-31
Total amount of commissions paid to insurance brokerUSD $60,560
Welfare Benefit Premiums Paid to CarrierUSD $305,418
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $34,700
Insurance broker organization code?5
Insurance broker nameTHE SUMNER GROUP
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000850054524
Policy instance 1
Insurance contract or identification number000850054524
Number of Individuals Covered171
Insurance policy start date2014-09-01
Insurance policy end date2015-08-31
Total amount of commissions paid to insurance brokerUSD $8,517
Total amount of fees paid to insurance companyUSD $165
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $69,366
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,517
Amount paid for insurance broker fees165
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
Insurance broker namePARTNERS BENEFIT GROUP LLC
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract number9002550539
Policy instance 2
Insurance contract or identification number9002550539
Number of Individuals Covered190
Insurance policy start date2014-09-01
Insurance policy end date2015-08-31
Total amount of commissions paid to insurance brokerUSD $3,481
Life Insurance Welfare BenefitYes
Other welfare benefits providedDEPENDENT LIFE AND ADD
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $464
Insurance broker organization code?3
Insurance broker nameJ.L. HERRING & ASSOC INC.
MONUMENTAL LIFE (National Association of Insurance Commissioners NAIC id number: 66281 )
Policy contract numberMLI-022-10
Policy instance 4
Insurance contract or identification numberMLI-022-10
Number of Individuals Covered190
Insurance policy start date2014-09-01
Insurance policy end date2015-08-31
Total amount of commissions paid to insurance brokerUSD $70,347
Welfare Benefit Premiums Paid to CarrierUSD $358,979
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $37,501
Insurance broker organization code?5
Insurance broker nameTHE SUMNER GROUP
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00319956
Policy instance 3
Insurance contract or identification number00319956
Number of Individuals Covered158
Insurance policy start date2014-09-01
Insurance policy end date2015-08-31
Total amount of commissions paid to insurance brokerUSD $3,236
Total amount of fees paid to insurance companyUSD $1,449
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $82,399
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,236
Amount paid for insurance broker fees1449
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
Insurance broker namePARTNERS PENEFIT GROUP
MONUMENTAL LIFE (National Association of Insurance Commissioners NAIC id number: 66281 )
Policy contract numberMLI-022-10
Policy instance 4
Insurance contract or identification numberMLI-022-10
Number of Individuals Covered170
Insurance policy start date2013-09-01
Insurance policy end date2014-08-31
Total amount of commissions paid to insurance brokerUSD $77,940
Welfare Benefit Premiums Paid to CarrierUSD $363,601
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $38,401
Insurance broker organization code?5
Insurance broker nameTHE SUMNER GROUP
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000850054524
Policy instance 1
Insurance contract or identification number000850054524
Number of Individuals Covered167
Insurance policy start date2013-09-01
Insurance policy end date2014-08-31
Total amount of commissions paid to insurance brokerUSD $8,148
Total amount of fees paid to insurance companyUSD $519
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $60,431
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,148
Amount paid for insurance broker fees519
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
Insurance broker namePARTNERS BENEFIT GROUP LLC
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract number9002550539
Policy instance 2
Insurance contract or identification number9002550539
Number of Individuals Covered178
Insurance policy start date2013-09-01
Insurance policy end date2014-08-31
Total amount of commissions paid to insurance brokerUSD $3,308
Life Insurance Welfare BenefitYes
Other welfare benefits providedDEPENDENT LIFE AND ADD
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $441
Insurance broker organization code?3
Insurance broker nameJ.L. HERRING & ASSOC INC
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00319956
Policy instance 3
Insurance contract or identification number00319956
Number of Individuals Covered148
Insurance policy start date2013-09-01
Insurance policy end date2014-08-31
Total amount of commissions paid to insurance brokerUSD $3,275
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $84,999
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,275
Insurance broker organization code?3
Insurance broker namePARTNERS BENEFIT GROUP
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract number9002550539
Policy instance 2
Insurance contract or identification number9002550539
Number of Individuals Covered174
Insurance policy start date2012-09-01
Insurance policy end date2013-08-31
Total amount of commissions paid to insurance brokerUSD $4,672
Life Insurance Welfare BenefitYes
Other welfare benefits providedDEPENDENT LIFE AND ADD
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,492
Insurance broker organization code?3
Insurance broker nameJ L HERRING & ASSOC
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00319956
Policy instance 3
Insurance contract or identification number00319956
Number of Individuals Covered147
Insurance policy start date2012-09-01
Insurance policy end date2013-08-31
Total amount of commissions paid to insurance brokerUSD $3,075
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $71,664
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,075
Insurance broker organization code?3
Insurance broker namePARTNERS BENEFIT GROUP
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000850054524
Policy instance 1
Insurance contract or identification number000850054524
Number of Individuals Covered165
Insurance policy start date2012-09-01
Insurance policy end date2013-08-31
Total amount of commissions paid to insurance brokerUSD $8,005
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $56,731
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,005
Insurance broker organization code?3
Insurance broker namePARTNERS BENEFIT GROUP LLC
MONUMENTAL LIFE (National Association of Insurance Commissioners NAIC id number: 66281 )
Policy contract numberMLI-022-10
Policy instance 4
Insurance contract or identification numberMLI-022-10
Number of Individuals Covered165
Insurance policy start date2012-09-01
Insurance policy end date2013-08-31
Total amount of commissions paid to insurance brokerUSD $76,072
Welfare Benefit Premiums Paid to CarrierUSD $361,453
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $36,487
Insurance broker organization code?5
Insurance broker nameTHE SUMNER GROUP
MONUMENTAL LIFE (National Association of Insurance Commissioners NAIC id number: 66281 )
Policy contract numberMLI-022-10
Policy instance 4
Insurance contract or identification numberMLI-022-10
Number of Individuals Covered165
Insurance policy start date2011-09-01
Insurance policy end date2012-08-31
Total amount of commissions paid to insurance brokerUSD $66,336
Welfare Benefit Premiums Paid to CarrierUSD $282,051
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 number00319956
Policy instance 3
Insurance contract or identification number00319956
Number of Individuals Covered147
Insurance policy start date2011-09-01
Insurance policy end date2012-08-31
Total amount of commissions paid to insurance brokerUSD $3,128
Total amount of fees paid to insurance companyUSD $2,794
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $75,197
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract number9002550539
Policy instance 2
Insurance contract or identification number9002550539
Number of Individuals Covered176
Insurance policy start date2011-09-01
Insurance policy end date2012-08-31
Total amount of commissions paid to insurance brokerUSD $3,129
Life Insurance Welfare BenefitYes
Other welfare benefits providedDEPENDENT LIFE AND ADD
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 number000850054524
Policy instance 1
Insurance contract or identification number000850054524
Number of Individuals Covered165
Insurance policy start date2011-09-01
Insurance policy end date2012-08-31
Total amount of commissions paid to insurance brokerUSD $7,943
Total amount of fees paid to insurance companyUSD $1,691
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $54,709
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MONUMENTAL LIFE (National Association of Insurance Commissioners NAIC id number: 66281 )
Policy contract numberMLI-022-10
Policy instance 4
Insurance contract or identification numberMLI-022-10
Number of Individuals Covered160
Insurance policy start date2010-09-01
Insurance policy end date2011-08-31
Total amount of commissions paid to insurance brokerUSD $55,998
Welfare Benefit Premiums Paid to CarrierUSD $212,563
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract number9002550539
Policy instance 2
Insurance contract or identification number9002550539
Number of Individuals Covered161
Insurance policy start date2010-09-01
Insurance policy end date2011-08-31
Total amount of commissions paid to insurance brokerUSD $2,805
Life Insurance Welfare BenefitYes
Other welfare benefits providedDEPENDENT LIFE AND ADD
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 number00319956
Policy instance 3
Insurance contract or identification number00319956
Number of Individuals Covered140
Insurance policy start date2010-09-01
Insurance policy end date2011-08-31
Total amount of commissions paid to insurance brokerUSD $3,099
Total amount of fees paid to insurance companyUSD $3,358
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $73,296
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 number000850054524
Policy instance 1
Insurance contract or identification number000850054524
Number of Individuals Covered150
Insurance policy start date2010-09-01
Insurance policy end date2011-08-31
Total amount of commissions paid to insurance brokerUSD $8,124
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $54,505
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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