JOHNS ISLAND CLUB, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan THE JOHN'S ISLAND CLUB INC. HEALTH & WELFARE BENEFIT PLAN
401k plan membership statisitcs for THE JOHN'S ISLAND CLUB INC. HEALTH & WELFARE BENEFIT PLAN
Measure | Date | Value |
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2022: THE JOHN'S ISLAND CLUB INC. HEALTH & WELFARE BENEFIT PLAN 2022 401k membership |
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Total participants, beginning-of-year | 2022-03-01 | 312 |
Total number of active participants reported on line 7a of the Form 5500 | 2022-03-01 | 273 |
Number of retired or separated participants receiving benefits | 2022-03-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2022-03-01 | 0 |
Total of all active and inactive participants | 2022-03-01 | 273 |
2021: THE JOHN'S ISLAND CLUB INC. HEALTH & WELFARE BENEFIT PLAN 2021 401k membership |
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Total participants, beginning-of-year | 2021-03-01 | 329 |
Total number of active participants reported on line 7a of the Form 5500 | 2021-03-01 | 312 |
Number of retired or separated participants receiving benefits | 2021-03-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2021-03-01 | 0 |
Total of all active and inactive participants | 2021-03-01 | 312 |
2020: THE JOHN'S ISLAND CLUB INC. HEALTH & WELFARE BENEFIT PLAN 2020 401k membership |
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Total participants, beginning-of-year | 2020-03-01 | 380 |
Total number of active participants reported on line 7a of the Form 5500 | 2020-03-01 | 329 |
Number of retired or separated participants receiving benefits | 2020-03-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2020-03-01 | 0 |
Total of all active and inactive participants | 2020-03-01 | 329 |
2019: THE JOHN'S ISLAND CLUB INC. HEALTH & WELFARE BENEFIT PLAN 2019 401k membership |
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Total participants, beginning-of-year | 2019-03-01 | 366 |
Total number of active participants reported on line 7a of the Form 5500 | 2019-03-01 | 380 |
Number of retired or separated participants receiving benefits | 2019-03-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2019-03-01 | 0 |
Total of all active and inactive participants | 2019-03-01 | 380 |
2018: THE JOHN'S ISLAND CLUB INC. HEALTH & WELFARE BENEFIT PLAN 2018 401k membership |
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Total participants, beginning-of-year | 2018-03-01 | 354 |
Total number of active participants reported on line 7a of the Form 5500 | 2018-03-01 | 366 |
Number of retired or separated participants receiving benefits | 2018-03-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2018-03-01 | 0 |
Total of all active and inactive participants | 2018-03-01 | 366 |
2017: THE JOHN'S ISLAND CLUB INC. HEALTH & WELFARE BENEFIT PLAN 2017 401k membership |
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Total participants, beginning-of-year | 2017-03-01 | 353 |
Total number of active participants reported on line 7a of the Form 5500 | 2017-03-01 | 352 |
Number of retired or separated participants receiving benefits | 2017-03-01 | 2 |
Number of other retired or separated participants entitled to future benefits | 2017-03-01 | 0 |
Total of all active and inactive participants | 2017-03-01 | 354 |
Number of employers contributing to the scheme | 2017-03-01 | 0 |
2016: THE JOHN'S ISLAND CLUB INC. HEALTH & WELFARE BENEFIT PLAN 2016 401k membership |
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Total participants, beginning-of-year | 2016-03-01 | 331 |
Total number of active participants reported on line 7a of the Form 5500 | 2016-03-01 | 337 |
Number of retired or separated participants receiving benefits | 2016-03-01 | 1 |
Number of other retired or separated participants entitled to future benefits | 2016-03-01 | 0 |
Total of all active and inactive participants | 2016-03-01 | 338 |
2015: THE JOHN'S ISLAND CLUB INC. HEALTH & WELFARE BENEFIT PLAN 2015 401k membership |
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Total participants, beginning-of-year | 2015-03-01 | 286 |
Total number of active participants reported on line 7a of the Form 5500 | 2015-03-01 | 320 |
Number of retired or separated participants receiving benefits | 2015-03-01 | 3 |
Number of other retired or separated participants entitled to future benefits | 2015-03-01 | 0 |
Total of all active and inactive participants | 2015-03-01 | 323 |
2014: THE JOHN'S ISLAND CLUB INC. HEALTH & WELFARE BENEFIT PLAN 2014 401k membership |
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Total participants, beginning-of-year | 2014-03-01 | 225 |
Total number of active participants reported on line 7a of the Form 5500 | 2014-03-01 | 224 |
Number of retired or separated participants receiving benefits | 2014-03-01 | 1 |
Total of all active and inactive participants | 2014-03-01 | 225 |
2013: THE JOHN'S ISLAND CLUB INC. HEALTH & WELFARE BENEFIT PLAN 2013 401k membership |
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Total participants, beginning-of-year | 2013-03-01 | 240 |
Total number of active participants reported on line 7a of the Form 5500 | 2013-03-01 | 223 |
Number of retired or separated participants receiving benefits | 2013-03-01 | 3 |
Number of other retired or separated participants entitled to future benefits | 2013-03-01 | 6 |
Total of all active and inactive participants | 2013-03-01 | 232 |
2012: THE JOHN'S ISLAND CLUB INC. HEALTH & WELFARE BENEFIT PLAN 2012 401k membership |
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Total participants, beginning-of-year | 2012-03-01 | 251 |
Total number of active participants reported on line 7a of the Form 5500 | 2012-03-01 | 231 |
Number of retired or separated participants receiving benefits | 2012-03-01 | 3 |
Number of other retired or separated participants entitled to future benefits | 2012-03-01 | 6 |
Total of all active and inactive participants | 2012-03-01 | 240 |
2011: THE JOHN'S ISLAND CLUB INC. HEALTH & WELFARE BENEFIT PLAN 2011 401k membership |
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Total participants, beginning-of-year | 2011-03-01 | 254 |
Total number of active participants reported on line 7a of the Form 5500 | 2011-03-01 | 244 |
Number of retired or separated participants receiving benefits | 2011-03-01 | 6 |
Number of other retired or separated participants entitled to future benefits | 2011-03-01 | 1 |
Total of all active and inactive participants | 2011-03-01 | 251 |
2010: THE JOHN'S ISLAND CLUB INC. HEALTH & WELFARE BENEFIT PLAN 2010 401k membership |
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Total participants, beginning-of-year | 2010-03-01 | 259 |
Total number of active participants reported on line 7a of the Form 5500 | 2010-03-01 | 248 |
Number of retired or separated participants receiving benefits | 2010-03-01 | 3 |
Number of other retired or separated participants entitled to future benefits | 2010-03-01 | 3 |
Total of all active and inactive participants | 2010-03-01 | 254 |
2009: THE JOHN'S ISLAND CLUB INC. HEALTH & WELFARE BENEFIT PLAN 2009 401k membership |
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Total participants, beginning-of-year | 2009-03-01 | 249 |
Total number of active participants reported on line 7a of the Form 5500 | 2009-03-01 | 250 |
Number of retired or separated participants receiving benefits | 2009-03-01 | 7 |
Number of other retired or separated participants entitled to future benefits | 2009-03-01 | 2 |
Total of all active and inactive participants | 2009-03-01 | 259 |
2022: THE JOHN'S ISLAND CLUB INC. HEALTH & WELFARE BENEFIT PLAN 2022 form 5500 responses |
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2022-03-01 | Type of plan entity | Single employer plan |
2022-03-01 | Submission has been amended | No |
2022-03-01 | This submission is the final filing | No |
2022-03-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2022-03-01 | Plan is a collectively bargained plan | No |
2022-03-01 | Plan funding arrangement – Insurance | Yes |
2022-03-01 | Plan benefit arrangement – Insurance | Yes |
2021: THE JOHN'S ISLAND CLUB INC. HEALTH & WELFARE BENEFIT PLAN 2021 form 5500 responses |
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2021-03-01 | Type of plan entity | Single employer plan |
2021-03-01 | Submission has been amended | No |
2021-03-01 | This submission is the final filing | No |
2021-03-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2021-03-01 | Plan is a collectively bargained plan | No |
2021-03-01 | Plan funding arrangement – Insurance | Yes |
2021-03-01 | Plan benefit arrangement – Insurance | Yes |
2020: THE JOHN'S ISLAND CLUB INC. HEALTH & WELFARE BENEFIT PLAN 2020 form 5500 responses |
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2020-03-01 | Type of plan entity | Single employer plan |
2020-03-01 | Submission has been amended | No |
2020-03-01 | This submission is the final filing | No |
2020-03-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2020-03-01 | Plan is a collectively bargained plan | No |
2020-03-01 | Plan funding arrangement – Insurance | Yes |
2020-03-01 | Plan benefit arrangement – Insurance | Yes |
2019: THE JOHN'S ISLAND CLUB INC. HEALTH & WELFARE BENEFIT PLAN 2019 form 5500 responses |
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2019-03-01 | Type of plan entity | Single employer plan |
2019-03-01 | Submission has been amended | No |
2019-03-01 | This submission is the final filing | No |
2019-03-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2019-03-01 | Plan is a collectively bargained plan | No |
2019-03-01 | Plan funding arrangement – Insurance | Yes |
2019-03-01 | Plan benefit arrangement – Insurance | Yes |
2018: THE JOHN'S ISLAND CLUB INC. HEALTH & WELFARE BENEFIT PLAN 2018 form 5500 responses |
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2018-03-01 | Type of plan entity | Single employer plan |
2018-03-01 | Submission has been amended | No |
2018-03-01 | This submission is the final filing | No |
2018-03-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2018-03-01 | Plan is a collectively bargained plan | No |
2018-03-01 | Plan funding arrangement – Insurance | Yes |
2018-03-01 | Plan benefit arrangement – Insurance | Yes |
2017: THE JOHN'S ISLAND CLUB INC. HEALTH & WELFARE BENEFIT PLAN 2017 form 5500 responses |
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2017-03-01 | Type of plan entity | Single employer plan |
2017-03-01 | Plan funding arrangement – Insurance | Yes |
2017-03-01 | Plan benefit arrangement – Insurance | Yes |
2016: THE JOHN'S ISLAND CLUB INC. HEALTH & WELFARE BENEFIT PLAN 2016 form 5500 responses |
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2016-03-01 | Type of plan entity | Single employer plan |
2016-03-01 | Submission has been amended | No |
2016-03-01 | This submission is the final filing | No |
2016-03-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2016-03-01 | Plan is a collectively bargained plan | No |
2016-03-01 | Plan funding arrangement – Insurance | Yes |
2016-03-01 | Plan benefit arrangement – Insurance | Yes |
2015: THE JOHN'S ISLAND CLUB INC. HEALTH & WELFARE BENEFIT PLAN 2015 form 5500 responses |
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2015-03-01 | Type of plan entity | Single employer plan |
2015-03-01 | Submission has been amended | No |
2015-03-01 | This submission is the final filing | No |
2015-03-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2015-03-01 | Plan is a collectively bargained plan | No |
2015-03-01 | Plan funding arrangement – Insurance | Yes |
2015-03-01 | Plan benefit arrangement – Insurance | Yes |
2014: THE JOHN'S ISLAND CLUB INC. HEALTH & WELFARE BENEFIT PLAN 2014 form 5500 responses |
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2014-03-01 | Type of plan entity | Single employer plan |
2014-03-01 | Submission has been amended | No |
2014-03-01 | This submission is the final filing | No |
2014-03-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2014-03-01 | Plan is a collectively bargained plan | No |
2014-03-01 | Plan funding arrangement – Insurance | Yes |
2014-03-01 | Plan benefit arrangement – Insurance | Yes |
2013: THE JOHN'S ISLAND CLUB INC. HEALTH & WELFARE BENEFIT PLAN 2013 form 5500 responses |
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2013-03-01 | Type of plan entity | Single employer plan |
2013-03-01 | Submission has been amended | No |
2013-03-01 | This submission is the final filing | No |
2013-03-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2013-03-01 | Plan is a collectively bargained plan | No |
2013-03-01 | Plan funding arrangement – Insurance | Yes |
2013-03-01 | Plan benefit arrangement – Insurance | Yes |
2012: THE JOHN'S ISLAND CLUB INC. HEALTH & WELFARE BENEFIT PLAN 2012 form 5500 responses |
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2012-03-01 | Type of plan entity | Single employer plan |
2012-03-01 | Submission has been amended | No |
2012-03-01 | This submission is the final filing | No |
2012-03-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2012-03-01 | Plan is a collectively bargained plan | No |
2012-03-01 | Plan funding arrangement – Insurance | Yes |
2012-03-01 | Plan benefit arrangement – Insurance | Yes |
2011: THE JOHN'S ISLAND CLUB INC. HEALTH & WELFARE BENEFIT PLAN 2011 form 5500 responses |
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2011-03-01 | Type of plan entity | Single employer plan |
2011-03-01 | Submission has been amended | No |
2011-03-01 | This submission is the final filing | No |
2011-03-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2011-03-01 | Plan is a collectively bargained plan | No |
2011-03-01 | Plan funding arrangement – Insurance | Yes |
2011-03-01 | Plan benefit arrangement – Insurance | Yes |
2010: THE JOHN'S ISLAND CLUB INC. HEALTH & WELFARE BENEFIT PLAN 2010 form 5500 responses |
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2010-03-01 | Type of plan entity | Single employer plan |
2010-03-01 | Submission has been amended | No |
2010-03-01 | This submission is the final filing | No |
2010-03-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2010-03-01 | Plan is a collectively bargained plan | No |
2010-03-01 | Plan funding arrangement – Insurance | Yes |
2010-03-01 | Plan benefit arrangement – Insurance | Yes |
2009: THE JOHN'S ISLAND CLUB INC. HEALTH & WELFARE BENEFIT PLAN 2009 form 5500 responses |
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2009-03-01 | Type of plan entity | Single employer plan |
2009-03-01 | Submission has been amended | No |
2009-03-01 | This submission is the final filing | No |
2009-03-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2009-03-01 | Plan is a collectively bargained plan | No |
2009-03-01 | Plan funding arrangement – Insurance | Yes |
2009-03-01 | Plan benefit arrangement – Insurance | Yes |
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000BPY3 |
Policy instance | 4 |
Insurance contract or identification number | G000BPY3 | Number of Individuals Covered | 273 | Insurance policy start date | 2022-03-01 | Insurance policy end date | 2023-02-28 | Total amount of commissions paid to insurance broker | USD $31,878 | Total amount of fees paid to insurance company | USD $12,804 | 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 | ACCIDENTAL DEATH & DISMEMBERMENT | 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 $212,520 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $31,878 | Amount paid for insurance broker fees | 12804 | Additional information about fees paid to insurance broker | FEES | Insurance broker organization code? | 3 |
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THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 445746 |
Policy instance | 3 |
Insurance contract or identification number | 445746 | Number of Individuals Covered | 179 | Insurance policy start date | 2022-03-01 | Insurance policy end date | 2023-02-28 | Total amount of commissions paid to insurance broker | USD $2,346 | Total amount of fees paid to insurance company | USD $253 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | 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 $15,625 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,346 | Amount paid for insurance broker fees | 253 | Additional information about fees paid to insurance broker | FEES | Insurance broker organization code? | 3 |
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CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
Policy contract number | 0629160 |
Policy instance | 2 |
Insurance contract or identification number | 0629160 | Number of Individuals Covered | 237 | Insurance policy start date | 2022-03-01 | Insurance policy end date | 2023-02-28 | Total amount of commissions paid to insurance broker | USD $20,858 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $140,815 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $20,858 | Insurance broker organization code? | 3 |
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CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
Policy contract number | 00629160 |
Policy instance | 1 |
Insurance contract or identification number | 00629160 | Number of Individuals Covered | 419 | Insurance policy start date | 2022-03-01 | Insurance policy end date | 2023-02-28 | Total amount of commissions paid to insurance broker | USD $140,221 | Total amount of fees paid to insurance company | USD $9,000 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $846,632 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $139,800 | Amount paid for insurance broker fees | 9000 | Additional information about fees paid to insurance broker | INCENTIVE COMPENSATION | Insurance broker organization code? | 3 |
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CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
Policy contract number | 00629160 |
Policy instance | 1 |
Insurance contract or identification number | 00629160 | Number of Individuals Covered | 400 | Insurance policy start date | 2021-03-01 | Insurance policy end date | 2022-02-28 | Total amount of commissions paid to insurance broker | USD $114,963 | Total amount of fees paid to insurance company | USD $9,516 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $443,234 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $114,963 | Amount paid for insurance broker fees | 9516 | Additional information about fees paid to insurance broker | INCENTIVE COMPENSATION | Insurance broker organization code? | 3 |
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CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
Policy contract number | 0629160 |
Policy instance | 2 |
Insurance contract or identification number | 0629160 | Number of Individuals Covered | 222 | Insurance policy start date | 2021-03-01 | Insurance policy end date | 2022-02-28 | Total amount of commissions paid to insurance broker | USD $20,620 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $139,401 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $11,893 | Insurance broker organization code? | 3 |
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THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 445746 |
Policy instance | 3 |
Insurance contract or identification number | 445746 | Number of Individuals Covered | 174 | Insurance policy start date | 2021-03-01 | Insurance policy end date | 2022-02-28 | Total amount of commissions paid to insurance broker | USD $2,517 | 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 $16,804 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,517 | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000BPY3 |
Policy instance | 4 |
Insurance contract or identification number | G000BPY3 | Number of Individuals Covered | 259 | Insurance policy start date | 2021-03-01 | Insurance policy end date | 2022-02-28 | Total amount of commissions paid to insurance broker | USD $29,272 | Total amount of fees paid to insurance company | USD $12,122 | 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 | ACCIDENTAL DEATH & DISMEMBERMENT | 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 $195,152 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $29,272 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 12122 | Additional information about fees paid to insurance broker | FEES |
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CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
Policy contract number | 00629160 |
Policy instance | 1 |
Insurance contract or identification number | 00629160 | Number of Individuals Covered | 427 | Insurance policy start date | 2020-03-01 | Insurance policy end date | 2021-02-28 | Total amount of commissions paid to insurance broker | USD $133,256 | Total amount of fees paid to insurance company | USD $9,000 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $767,765 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $133,256 | Amount paid for insurance broker fees | 9000 | Additional information about fees paid to insurance broker | INCENTIVE COMPENSATION | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000BPY3 |
Policy instance | 3 |
Insurance contract or identification number | G000BPY3 | Number of Individuals Covered | 276 | Insurance policy start date | 2020-03-01 | Insurance policy end date | 2021-02-28 | Total amount of commissions paid to insurance broker | USD $29,320 | 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 | No | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | 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 $195,464 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $29,320 | Insurance broker organization code? | 3 |
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THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 445746 |
Policy instance | 2 |
Insurance contract or identification number | 445746 | Number of Individuals Covered | 245 | Insurance policy start date | 2020-03-01 | Insurance policy end date | 2021-02-28 | Total amount of commissions paid to insurance broker | USD $17,594 | 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 $167,146 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $17,594 | Insurance broker organization code? | 3 |
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SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
Policy contract number | 235439 |
Policy instance | 2 |
Insurance contract or identification number | 235439 | Number of Individuals Covered | 268 | Insurance policy start date | 2019-03-01 | Insurance policy end date | 2020-02-29 | Total amount of commissions paid to insurance broker | USD $17,412 | Total amount of fees paid to insurance company | USD $9,529 | 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 | ACCIDENTAL DEATH & DISMEMBERMENT | 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 $174,122 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $10,244 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 9529 | Additional information about fees paid to insurance broker | BONUS |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 754022 |
Policy instance | 3 |
Insurance contract or identification number | 754022 | Number of Individuals Covered | 573 | Insurance policy start date | 2019-03-01 | Insurance policy end date | 2020-02-29 | Total amount of commissions paid to insurance broker | USD $9,306 | Total amount of fees paid to insurance company | USD $110,092 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $2,154,539 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $9,306 | Amount paid for insurance broker fees | 50632 | Additional information about fees paid to insurance broker | FEES | Insurance broker organization code? | 3 |
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THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 445746 |
Policy instance | 1 |
Insurance contract or identification number | 445746 | Number of Individuals Covered | 239 | Insurance policy start date | 2019-03-01 | Insurance policy end date | 2020-02-29 | Total amount of commissions paid to insurance broker | USD $17,649 | Total amount of fees paid to insurance company | USD $6,465 | 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 $168,090 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $10,255 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 6465 | Additional information about fees paid to insurance broker | FEES |
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HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 ) |
Policy contract number | 741153 |
Policy instance | 2 |
Insurance contract or identification number | 741153 | Number of Individuals Covered | 167 | Insurance policy start date | 2018-03-01 | Insurance policy end date | 2019-02-28 | Total amount of commissions paid to insurance broker | USD $2,023 | 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 | 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 $22,044 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,023 | Insurance broker organization code? | 3 |
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THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 445746 |
Policy instance | 1 |
Insurance contract or identification number | 445746 | Number of Individuals Covered | 235 | Insurance policy start date | 2018-03-01 | Insurance policy end date | 2019-02-28 | Total amount of commissions paid to insurance broker | USD $14,359 | Total amount of fees paid to insurance company | USD $6,500 | 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 $143,585 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $14,359 | Amount paid for insurance broker fees | 6500 | Additional information about fees paid to insurance broker | FEES | Insurance broker organization code? | 3 |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 754022 |
Policy instance | 4 |
Insurance contract or identification number | 754022 | Number of Individuals Covered | 584 | Insurance policy start date | 2018-03-01 | Insurance policy end date | 2019-02-28 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $122,817 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $2,236,330 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 122817 | Additional information about fees paid to insurance broker | FEES, BONUS | Insurance broker organization code? | 3 |
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SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
Policy contract number | 235439 |
Policy instance | 3 |
Insurance contract or identification number | 235439 | Number of Individuals Covered | 270 | Insurance policy start date | 2018-03-01 | Insurance policy end date | 2019-02-28 | Total amount of commissions paid to insurance broker | USD $16,326 | Total amount of fees paid to insurance company | USD $2,260 | 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 | ACCIDENTAL DEATH & DISABILITY EMPLOYEE ASSISTANCE PLAN | 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 $163,261 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $16,326 | Amount paid for insurance broker fees | 2260 | Additional information about fees paid to insurance broker | BONUS | Insurance broker organization code? | 3 |
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THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 445746 |
Policy instance | 2 |
Insurance contract or identification number | 445746 | Number of Individuals Covered | 229 | Insurance policy start date | 2017-03-01 | Insurance policy end date | 2018-02-28 | Total amount of commissions paid to insurance broker | USD $14,522 | Total amount of fees paid to insurance company | USD $7,599 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $145,223 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $14,522 | Amount paid for insurance broker fees | 7599 | Additional information about fees paid to insurance broker | FEES | Insurance broker organization code? | 3 | Insurance broker name | USI INSURANCE SERVICES LLC |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 754022 |
Policy instance | 1 |
Insurance contract or identification number | 754022 | Number of Individuals Covered | 586 | Insurance policy start date | 2017-03-01 | Insurance policy end date | 2018-02-28 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $115,900 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $2,222,478 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $0 | Amount paid for insurance broker fees | 115900 | Additional information about fees paid to insurance broker | SERVICE FEE AGREEMENT | Insurance broker organization code? | 3 | Insurance broker name | USI INSURANCE SERVICES LLC |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 10188309 |
Policy instance | 5 |
Insurance contract or identification number | 10188309 | Number of Individuals Covered | 257 | Insurance policy start date | 2017-03-01 | Insurance policy end date | 2018-02-28 | Total amount of commissions paid to insurance broker | USD $8,355 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Welfare Benefit Premiums Paid to Carrier | USD $83,553 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8,355 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Insurance broker name | USI INSURANCE SERVICES LLC |
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COMPBENEFITS COMPANY (National Association of Insurance Commissioners NAIC id number: 52015 ) |
Policy contract number | 741153 |
Policy instance | 4 |
Insurance contract or identification number | 741153 | Number of Individuals Covered | 162 | Insurance policy start date | 2017-03-01 | Insurance policy end date | 2018-02-28 | Total amount of commissions paid to insurance broker | USD $2,074 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $21,695 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,074 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Insurance broker name | USI INSURANCE SERVICES LLC |
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SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
Policy contract number | 235439 |
Policy instance | 3 |
Insurance contract or identification number | 235439 | Number of Individuals Covered | 257 | Insurance policy start date | 2017-03-01 | Insurance policy end date | 2018-02-28 | Total amount of commissions paid to insurance broker | USD $7,840 | Total amount of fees paid to insurance company | USD $1,811 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $78,398 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,840 | Amount paid for insurance broker fees | 1811 | Additional information about fees paid to insurance broker | BONUS | Insurance broker organization code? | 3 | Insurance broker name | USI INSURANCE SERVICES LLC |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 754022 |
Policy instance | 1 |
Insurance contract or identification number | 754022 | Number of Individuals Covered | 541 | Insurance policy start date | 2015-03-01 | Insurance policy end date | 2016-02-29 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $98,615 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $2,011,586 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 93417 | Additional information about fees paid to insurance broker | SERVICE FEE AGREEMENT | Insurance broker organization code? | 3 | Insurance broker name | USI INSURANCE SERVICES LLC |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 10188310 |
Policy instance | 2 |
Insurance contract or identification number | 10188310 | Number of Individuals Covered | 76 | Insurance policy start date | 2015-03-01 | Insurance policy end date | 2016-02-28 | Total amount of commissions paid to insurance broker | USD $1,582 | Total amount of fees paid to insurance company | USD $578 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $15,819 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,582 | Amount paid for insurance broker fees | 578 | Additional information about fees paid to insurance broker | BROKER BONUS | Insurance broker organization code? | 3 | Insurance broker name | USI INSURANCE SVCS LLC |
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THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00445746 |
Policy instance | 4 |
Insurance contract or identification number | 00445746 | Number of Individuals Covered | 241 | Insurance policy start date | 2015-03-01 | Insurance policy end date | 2016-02-29 | Total amount of commissions paid to insurance broker | USD $13,797 | Total amount of fees paid to insurance company | USD $6,220 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $137,978 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,874 | Amount paid for insurance broker fees | 6220 | Additional information about fees paid to insurance broker | FEES PAID | Insurance broker organization code? | 3 | Insurance broker name | USI INSURANCE SERVICES LLC |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 10188309 |
Policy instance | 5 |
Insurance contract or identification number | 10188309 | Number of Individuals Covered | 263 | Insurance policy start date | 2015-03-01 | Insurance policy end date | 2016-02-29 | Total amount of commissions paid to insurance broker | USD $5,407 | Total amount of fees paid to insurance company | USD $1,837 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $54,075 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,407 | Amount paid for insurance broker fees | 1837 | Additional information about fees paid to insurance broker | BROKER BONUS | Insurance broker organization code? | 3 | Insurance broker name | USI INSURANCE SVCS LLC |
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SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
Policy contract number | 235439 |
Policy instance | 6 |
Insurance contract or identification number | 235439 | Number of Individuals Covered | 263 | Insurance policy start date | 2015-03-01 | Insurance policy end date | 2016-02-29 | Total amount of commissions paid to insurance broker | USD $8,096 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $75,205 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8,096 | Insurance broker organization code? | 3 | Insurance broker name | USI INSURANCE SERVICES OF FLORIDA |
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COMPBENEFITS COMPANY (National Association of Insurance Commissioners NAIC id number: 52015 ) |
Policy contract number | 741153 |
Policy instance | 3 |
Insurance contract or identification number | 741153 | Number of Individuals Covered | 174 | Insurance policy start date | 2015-03-01 | Insurance policy end date | 2016-02-29 | Total amount of commissions paid to insurance broker | USD $2,092 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $21,281 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,092 | Insurance broker organization code? | 3 | Insurance broker name | KARP, MICHAEL C |
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SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
Policy contract number | 235439 |
Policy instance | 6 |
Insurance contract or identification number | 235439 | Number of Individuals Covered | 710 | Insurance policy start date | 2014-03-01 | Insurance policy end date | 2015-02-28 | Total amount of commissions paid to insurance broker | USD $6,546 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $71,219 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,546 | Insurance broker organization code? | 3 | Insurance broker name | USI INSURANCE SERVICES OF FLORIDA |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 10188309 |
Policy instance | 5 |
Insurance contract or identification number | 10188309 | Number of Individuals Covered | 236 | Insurance policy start date | 2014-03-01 | Insurance policy end date | 2015-02-28 | Total amount of commissions paid to insurance broker | USD $4,649 | Total amount of fees paid to insurance company | USD $0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $46,492 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,649 | Insurance broker organization code? | 3 | Insurance broker name | USI INSURANCE SVCS LLC |
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THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00445746 |
Policy instance | 4 |
Insurance contract or identification number | 00445746 | Number of Individuals Covered | 219 | Insurance policy start date | 2014-03-04 | Insurance policy end date | 2015-02-28 | Total amount of commissions paid to insurance broker | USD $13,293 | Total amount of fees paid to insurance company | USD $6,261 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $132,934 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $13,293 | Amount paid for insurance broker fees | 6261 | Additional information about fees paid to insurance broker | FEES PAID | Insurance broker organization code? | 3 | Insurance broker name | USI INSURANCE SERVICES LLC |
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COMPBENEFITS COMPANY (National Association of Insurance Commissioners NAIC id number: 52015 ) |
Policy contract number | VS2786 |
Policy instance | 3 |
Insurance contract or identification number | VS2786 | Number of Individuals Covered | 150 | Insurance policy start date | 2014-03-01 | Insurance policy end date | 2015-02-28 | Total amount of commissions paid to insurance broker | USD $1,849 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $20,240 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,849 | Insurance broker organization code? | 3 | Insurance broker name | USI INSURANCE SERVICES LLC |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 10188310 |
Policy instance | 2 |
Insurance contract or identification number | 10188310 | Number of Individuals Covered | 62 | Insurance policy start date | 2014-03-01 | Insurance policy end date | 2015-02-28 | Total amount of commissions paid to insurance broker | USD $1,420 | Total amount of fees paid to insurance company | USD $0 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $14,204 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,420 | Insurance broker organization code? | 3 | Insurance broker name | USI INSURANCE SVCS LLC |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 754022 |
Policy instance | 1 |
Insurance contract or identification number | 754022 | Number of Individuals Covered | 415 | Insurance policy start date | 2014-03-01 | Insurance policy end date | 2015-02-28 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $98,166 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,799,718 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 93856 | Additional information about fees paid to insurance broker | SERVICE FEE AGREEMENT | Insurance broker organization code? | 3 | Insurance broker name | USI INSURANCE SERVICES LLC |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 754022 |
Policy instance | 3 |
Insurance contract or identification number | 754022 | Number of Individuals Covered | 413 | Insurance policy start date | 2013-03-01 | Insurance policy end date | 2014-02-28 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $82,248 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $1,579,233 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 82248 | Additional information about fees paid to insurance broker | SERVICE FEE AGREEMENT | Insurance broker organization code? | 3 | Insurance broker name | USI INSURANCE SERVICES LLC |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GVTL0AL32 |
Policy instance | 7 |
Insurance contract or identification number | GVTL0AL32 | Number of Individuals Covered | 92 | Insurance policy start date | 2013-03-01 | Insurance policy end date | 2014-02-28 | Total amount of commissions paid to insurance broker | USD $4,098 | Total amount of fees paid to insurance company | USD $1,062 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | LIFE & ACCIDENTAL DEATH AND DISMEMBERMENT-VOLUNTARY | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $40,981 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,098 | Amount paid for insurance broker fees | 1062 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | USI INSURANCE SERVICES LLC |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GUC0AL32 |
Policy instance | 6 |
Insurance contract or identification number | GUC0AL32 | Number of Individuals Covered | 64 | Insurance policy start date | 2013-03-01 | Insurance policy end date | 2014-02-28 | Total amount of commissions paid to insurance broker | USD $1,531 | Total amount of fees paid to insurance company | USD $351 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $15,314 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,531 | Amount paid for insurance broker fees | 351 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | USI INSURANCE SERVICES LLC |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GLTD0AL32 |
Policy instance | 5 |
Insurance contract or identification number | GLTD0AL32 | Number of Individuals Covered | 231 | Insurance policy start date | 2013-03-01 | Insurance policy end date | 2014-02-28 | Total amount of commissions paid to insurance broker | USD $4,320 | Total amount of fees paid to insurance company | USD $1,127 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $43,196 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,320 | Amount paid for insurance broker fees | 1127 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | USI INSURANCE SERVICES LLC |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GLUG0AL32 |
Policy instance | 4 |
Insurance contract or identification number | GLUG0AL32 | Number of Individuals Covered | 231 | Insurance policy start date | 2013-03-01 | Insurance policy end date | 2014-02-28 | Total amount of commissions paid to insurance broker | USD $3,270 | Total amount of fees paid to insurance company | USD $843 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | 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 $32,701 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,270 | Amount paid for insurance broker fees | 843 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | USI INSURANCE SERVICES LLC |
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COMPBENEFITS COMPANY (National Association of Insurance Commissioners NAIC id number: 52015 ) |
Policy contract number | VS2786 |
Policy instance | 1 |
Insurance contract or identification number | VS2786 | Number of Individuals Covered | 153 | Insurance policy start date | 2013-03-01 | Insurance policy end date | 2014-02-28 | Total amount of commissions paid to insurance broker | USD $2,003 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $20,208 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,003 | Insurance broker organization code? | 3 | Insurance broker name | USI INSURANCE SERVICES LLC |
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THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00445746 |
Policy instance | 2 |
Insurance contract or identification number | 00445746 | Number of Individuals Covered | 224 | Insurance policy start date | 2013-03-01 | Insurance policy end date | 2014-02-28 | Total amount of commissions paid to insurance broker | USD $13,639 | Total amount of fees paid to insurance company | USD $6,179 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $136,392 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $13,639 | Amount paid for insurance broker fees | 6179 | Additional information about fees paid to insurance broker | FEES PAID | Insurance broker organization code? | 3 | Insurance broker name | USI INSURANCE SERVICES LLC |
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THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00445746 |
Policy instance | 2 |
Insurance contract or identification number | 00445746 | Number of Individuals Covered | 232 | Insurance policy start date | 2012-03-01 | Insurance policy end date | 2013-02-28 | Total amount of commissions paid to insurance broker | USD $13,123 | Total amount of fees paid to insurance company | USD $7,337 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $131,229 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $13,123 | Amount paid for insurance broker fees | 7337 | Additional information about fees paid to insurance broker | FEES PAID | Insurance broker organization code? | 3 | Insurance broker name | USI INSURANCE SERVICES LLC |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GVTL0AL32 |
Policy instance | 7 |
Insurance contract or identification number | GVTL0AL32 | Number of Individuals Covered | 98 | Insurance policy start date | 2012-03-01 | Insurance policy end date | 2013-02-28 | Total amount of commissions paid to insurance broker | USD $4,020 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT - VOL | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $40,198 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,020 | Insurance broker organization code? | 3 | Insurance broker name | USI INSURANCE SERVICES LLC |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GUC0AL32 |
Policy instance | 6 |
Insurance contract or identification number | GUC0AL32 | Number of Individuals Covered | 61 | Insurance policy start date | 2012-03-01 | Insurance policy end date | 2013-02-28 | Total amount of commissions paid to insurance broker | USD $1,411 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | Yes | 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 $14,106 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,052 | Insurance broker organization code? | 3 | Insurance broker name | USI INSURANCE SERVICES LLC |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GLTD0AL32 |
Policy instance | 5 |
Insurance contract or identification number | GLTD0AL32 | Number of Individuals Covered | 235 | Insurance policy start date | 2012-03-01 | Insurance policy end date | 2013-02-28 | Total amount of commissions paid to insurance broker | USD $4,407 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $44,071 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,319 | Insurance broker organization code? | 3 | Insurance broker name | USI INSURANCE SERVICES LLC |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GLUG0AL32 |
Policy instance | 4 |
Insurance contract or identification number | GLUG0AL32 | Number of Individuals Covered | 235 | Insurance policy start date | 2012-03-01 | Insurance policy end date | 2013-02-28 | Total amount of commissions paid to insurance broker | USD $3,348 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | 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 $33,482 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,515 | Insurance broker organization code? | 3 | Insurance broker name | USI INSURANCE SERVICES LLC |
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COMPBENEFITS COMPANY (National Association of Insurance Commissioners NAIC id number: 52015 ) |
Policy contract number | VS2786 |
Policy instance | 3 |
Insurance contract or identification number | VS2786 | Number of Individuals Covered | 155 | Insurance policy start date | 2012-03-01 | Insurance policy end date | 2013-02-28 | Total amount of commissions paid to insurance broker | USD $1,954 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $20,961 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,954 | Insurance broker organization code? | 3 | Insurance broker name | USI INSURANCE SERVICES LLC |
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BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 ) |
Policy contract number | 92791 |
Policy instance | 1 |
Insurance contract or identification number | 92791 | Number of Individuals Covered | 231 | Insurance policy start date | 2012-03-01 | Insurance policy end date | 2013-02-28 | Total amount of commissions paid to insurance broker | USD $82,963 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $82,963 | Insurance broker organization code? | 3 | Insurance broker name | USI INSURANCE SERVICES LLC |
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COMPBENEFITS COMPANY (National Association of Insurance Commissioners NAIC id number: 52015 ) |
Policy contract number | VS2786 |
Policy instance | 3 |
Insurance contract or identification number | VS2786 | Number of Individuals Covered | 156 | Insurance policy start date | 2011-03-01 | Insurance policy end date | 2012-02-29 | Total amount of commissions paid to insurance broker | USD $2,065 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $21,308 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 07983 |
Policy instance | 4 |
Insurance contract or identification number | 07983 | Number of Individuals Covered | 84 | Insurance policy start date | 2011-03-01 | Insurance policy end date | 2012-02-29 | Total amount of commissions paid to insurance broker | USD $1,212 | Total amount of fees paid to insurance company | USD $606 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $34,668 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 01963 |
Policy instance | 5 |
Insurance contract or identification number | 01963 | Number of Individuals Covered | 244 | Insurance policy start date | 2011-03-01 | Insurance policy end date | 2012-02-29 | Total amount of commissions paid to insurance broker | USD $2,774 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | 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 $27,736 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 125917 |
Policy instance | 7 |
Insurance contract or identification number | 125917 | Number of Individuals Covered | 24 | Insurance policy start date | 2011-03-01 | Insurance policy end date | 2012-02-29 | Total amount of commissions paid to insurance broker | USD $493 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $4,934 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00445746 |
Policy instance | 2 |
Insurance contract or identification number | 00445746 | Number of Individuals Covered | 241 | Insurance policy start date | 2011-03-01 | Insurance policy end date | 2012-02-29 | Total amount of commissions paid to insurance broker | USD $13,581 | Total amount of fees paid to insurance company | USD $6,313 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $135,811 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 ) |
Policy contract number | 92791 |
Policy instance | 1 |
Insurance contract or identification number | 92791 | Number of Individuals Covered | 242 | Insurance policy start date | 2011-03-01 | Insurance policy end date | 2012-02-29 | Total amount of commissions paid to insurance broker | USD $86,440 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 01964 |
Policy instance | 6 |
Insurance contract or identification number | 01964 | Number of Individuals Covered | 244 | Insurance policy start date | 2011-03-01 | Insurance policy end date | 2012-02-29 | Total amount of commissions paid to insurance broker | USD $3,847 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $38,468 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 10125917 |
Policy instance | 7 |
Insurance contract or identification number | 10125917 | Number of Individuals Covered | 19 | Insurance policy start date | 2010-03-01 | Insurance policy end date | 2011-02-28 | Total amount of commissions paid to insurance broker | USD $481 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $4,807 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $481 | Insurance broker organization code? | 3 | Insurance broker name | USI INSURANCE SERVICES LLC |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 10101963 |
Policy instance | 5 |
Insurance contract or identification number | 10101963 | Number of Individuals Covered | 248 | Insurance policy start date | 2010-03-01 | Insurance policy end date | 2011-02-28 | Total amount of commissions paid to insurance broker | USD $3,130 | Total amount of fees paid to insurance company | USD $674 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $31,296 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,130 | Amount paid for insurance broker fees | 674 | Additional information about fees paid to insurance broker | BROKER BONUS | Insurance broker organization code? | 3 | Insurance broker name | USI INSURANCE SERVICES LLC |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 40000100007983 |
Policy instance | 4 |
Insurance contract or identification number | 40000100007983 | Number of Individuals Covered | 84 | Insurance policy start date | 2010-03-01 | Insurance policy end date | 2011-02-28 | Total amount of commissions paid to insurance broker | USD $3,182 | Total amount of fees paid to insurance company | USD $2,340 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $31,819 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,182 | Amount paid for insurance broker fees | 2340 | Additional information about fees paid to insurance broker | FEES BROKER BONUS | Insurance broker organization code? | 3 | Insurance broker name | USI INSURANCE SERVICES LLC |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 10101964 |
Policy instance | 6 |
Insurance contract or identification number | 10101964 | Number of Individuals Covered | 248 | Insurance policy start date | 2010-03-01 | Insurance policy end date | 2011-02-28 | Total amount of commissions paid to insurance broker | USD $4,368 | Total amount of fees paid to insurance company | USD $938 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $43,678 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,368 | Amount paid for insurance broker fees | 938 | Additional information about fees paid to insurance broker | BROKER BONUS | Insurance broker organization code? | 3 | Insurance broker name | USI INSURANCE SERVICES LLC |
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COMPBENEFITS COMPANY (National Association of Insurance Commissioners NAIC id number: 52015 ) |
Policy contract number | VS2786 |
Policy instance | 3 |
Insurance contract or identification number | VS2786 | Number of Individuals Covered | 160 | Insurance policy start date | 2010-03-01 | Insurance policy end date | 2011-02-28 | Total amount of commissions paid to insurance broker | USD $1,964 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $21,285 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,788 | Insurance broker organization code? | 3 | Insurance broker name | USI INSURANCE SERVICES LLC |
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THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00445746 |
Policy instance | 2 |
Insurance contract or identification number | 00445746 | Number of Individuals Covered | 248 | Insurance policy start date | 2010-03-01 | Insurance policy end date | 2011-02-28 | Total amount of commissions paid to insurance broker | USD $13,743 | Total amount of fees paid to insurance company | USD $5,636 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $137,434 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $13,743 | Amount paid for insurance broker fees | 5636 | Additional information about fees paid to insurance broker | FEES | Insurance broker organization code? | 3 | Insurance broker name | USI INSURANCE SERVICES LLC |
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BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 ) |
Policy contract number | 92791 |
Policy instance | 1 |
Insurance contract or identification number | 92791 | Number of Individuals Covered | 248 | Insurance policy start date | 2010-03-01 | Insurance policy end date | 2011-02-28 | Total amount of commissions paid to insurance broker | USD $80,990 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $80,990 | Insurance broker organization code? | 3 | Insurance broker name | USI INSURANCE SERVICES OF FL |
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