KI USA CORPORATION has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan KI USA CORPORATION WELFARE BENEFIT PLAN
Measure | Date | Value |
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2022: KI USA CORPORATION WELFARE BENEFIT PLAN 2022 401k membership |
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Total participants, beginning-of-year | 2022-04-01 | 195 |
Total number of active participants reported on line 7a of the Form 5500 | 2022-04-01 | 111 |
Number of retired or separated participants receiving benefits | 2022-04-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2022-04-01 | 0 |
Total of all active and inactive participants | 2022-04-01 | 111 |
Number of employers contributing to the scheme | 2022-04-01 | 0 |
2021: KI USA CORPORATION WELFARE BENEFIT PLAN 2021 401k membership |
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Total participants, beginning-of-year | 2021-04-01 | 199 |
Total number of active participants reported on line 7a of the Form 5500 | 2021-04-01 | 195 |
Number of retired or separated participants receiving benefits | 2021-04-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2021-04-01 | 0 |
Total of all active and inactive participants | 2021-04-01 | 195 |
Number of employers contributing to the scheme | 2021-04-01 | 0 |
2020: KI USA CORPORATION WELFARE BENEFIT PLAN 2020 401k membership |
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Total participants, beginning-of-year | 2020-04-01 | 225 |
Total number of active participants reported on line 7a of the Form 5500 | 2020-04-01 | 199 |
Number of retired or separated participants receiving benefits | 2020-04-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2020-04-01 | 0 |
Total of all active and inactive participants | 2020-04-01 | 199 |
Number of employers contributing to the scheme | 2020-04-01 | 0 |
2019: KI USA CORPORATION WELFARE BENEFIT PLAN 2019 401k membership |
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Total participants, beginning-of-year | 2019-04-01 | 138 |
Total number of active participants reported on line 7a of the Form 5500 | 2019-04-01 | 225 |
Number of retired or separated participants receiving benefits | 2019-04-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2019-04-01 | 0 |
Total of all active and inactive participants | 2019-04-01 | 225 |
Number of employers contributing to the scheme | 2019-04-01 | 0 |
2018: KI USA CORPORATION WELFARE BENEFIT PLAN 2018 401k membership |
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Total participants, beginning-of-year | 2018-04-01 | 136 |
Total number of active participants reported on line 7a of the Form 5500 | 2018-04-01 | 138 |
Number of retired or separated participants receiving benefits | 2018-04-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2018-04-01 | 0 |
Total of all active and inactive participants | 2018-04-01 | 138 |
Number of employers contributing to the scheme | 2018-04-01 | 0 |
2017: KI USA CORPORATION WELFARE BENEFIT PLAN 2017 401k membership |
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Total participants, beginning-of-year | 2017-04-01 | 126 |
Total number of active participants reported on line 7a of the Form 5500 | 2017-04-01 | 136 |
Number of retired or separated participants receiving benefits | 2017-04-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2017-04-01 | 0 |
Total of all active and inactive participants | 2017-04-01 | 136 |
2016: KI USA CORPORATION WELFARE BENEFIT PLAN 2016 401k membership |
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Total participants, beginning-of-year | 2016-04-01 | 126 |
Total number of active participants reported on line 7a of the Form 5500 | 2016-04-01 | 126 |
Number of retired or separated participants receiving benefits | 2016-04-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2016-04-01 | 0 |
Total of all active and inactive participants | 2016-04-01 | 126 |
2015: KI USA CORPORATION WELFARE BENEFIT PLAN 2015 401k membership |
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Total participants, beginning-of-year | 2015-04-01 | 117 |
Total number of active participants reported on line 7a of the Form 5500 | 2015-04-01 | 126 |
Number of retired or separated participants receiving benefits | 2015-04-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2015-04-01 | 0 |
Total of all active and inactive participants | 2015-04-01 | 126 |
2014: KI USA CORPORATION WELFARE BENEFIT PLAN 2014 401k membership |
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Total participants, beginning-of-year | 2014-04-01 | 113 |
Total number of active participants reported on line 7a of the Form 5500 | 2014-04-01 | 116 |
Number of retired or separated participants receiving benefits | 2014-04-01 | 1 |
Number of other retired or separated participants entitled to future benefits | 2014-04-01 | 0 |
Total of all active and inactive participants | 2014-04-01 | 117 |
2013: KI USA CORPORATION WELFARE BENEFIT PLAN 2013 401k membership |
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Total participants, beginning-of-year | 2013-04-01 | 103 |
Total number of active participants reported on line 7a of the Form 5500 | 2013-04-01 | 113 |
Number of retired or separated participants receiving benefits | 2013-04-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2013-04-01 | 0 |
Total of all active and inactive participants | 2013-04-01 | 113 |
2011: KI USA CORPORATION WELFARE BENEFIT PLAN 2011 401k membership |
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Total participants, beginning-of-year | 2011-04-01 | 112 |
Total number of active participants reported on line 7a of the Form 5500 | 2011-04-01 | 96 |
Number of retired or separated participants receiving benefits | 2011-04-01 | 2 |
Number of other retired or separated participants entitled to future benefits | 2011-04-01 | 0 |
Total of all active and inactive participants | 2011-04-01 | 98 |
2009: KI USA CORPORATION WELFARE BENEFIT PLAN 2009 401k membership |
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Total participants, beginning-of-year | 2009-04-01 | 184 |
Total number of active participants reported on line 7a of the Form 5500 | 2009-04-01 | 113 |
Number of retired or separated participants receiving benefits | 2009-04-01 | 2 |
Number of other retired or separated participants entitled to future benefits | 2009-04-01 | 0 |
Total of all active and inactive participants | 2009-04-01 | 115 |
2022: KI USA CORPORATION WELFARE BENEFIT PLAN 2022 form 5500 responses |
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2022-04-01 | Type of plan entity | Single employer plan |
2022-04-01 | Plan funding arrangement – Insurance | Yes |
2022-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2022-04-01 | Plan benefit arrangement – Insurance | Yes |
2022-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2021: KI USA CORPORATION WELFARE BENEFIT PLAN 2021 form 5500 responses |
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2021-04-01 | Type of plan entity | Single employer plan |
2021-04-01 | Plan funding arrangement – Insurance | Yes |
2021-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2021-04-01 | Plan benefit arrangement – Insurance | Yes |
2021-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2020: KI USA CORPORATION WELFARE BENEFIT PLAN 2020 form 5500 responses |
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2020-04-01 | Type of plan entity | Single employer plan |
2020-04-01 | Plan funding arrangement – Insurance | Yes |
2020-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2020-04-01 | Plan benefit arrangement – Insurance | Yes |
2020-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2019: KI USA CORPORATION WELFARE BENEFIT PLAN 2019 form 5500 responses |
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2019-04-01 | Type of plan entity | Single employer plan |
2019-04-01 | Plan funding arrangement – Insurance | Yes |
2019-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2019-04-01 | Plan benefit arrangement – Insurance | Yes |
2019-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2018: KI USA CORPORATION WELFARE BENEFIT PLAN 2018 form 5500 responses |
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2018-04-01 | Type of plan entity | Single employer plan |
2018-04-01 | Plan funding arrangement – Insurance | Yes |
2018-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2018-04-01 | Plan benefit arrangement – Insurance | Yes |
2018-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2017: KI USA CORPORATION WELFARE BENEFIT PLAN 2017 form 5500 responses |
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2017-04-01 | Type of plan entity | Single employer plan |
2017-04-01 | Plan funding arrangement – Insurance | Yes |
2017-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2017-04-01 | Plan benefit arrangement – Insurance | Yes |
2017-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2016: KI USA CORPORATION WELFARE BENEFIT PLAN 2016 form 5500 responses |
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2016-04-01 | Type of plan entity | Single employer plan |
2016-04-01 | Submission has been amended | No |
2016-04-01 | This submission is the final filing | No |
2016-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2016-04-01 | Plan is a collectively bargained plan | No |
2016-04-01 | Plan funding arrangement – Insurance | Yes |
2016-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2016-04-01 | Plan benefit arrangement – Insurance | Yes |
2016-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2015: KI USA CORPORATION WELFARE BENEFIT PLAN 2015 form 5500 responses |
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2015-04-01 | Type of plan entity | Single employer plan |
2015-04-01 | Submission has been amended | No |
2015-04-01 | This submission is the final filing | No |
2015-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2015-04-01 | Plan is a collectively bargained plan | No |
2015-04-01 | Plan funding arrangement – Insurance | Yes |
2015-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2015-04-01 | Plan benefit arrangement – Insurance | Yes |
2015-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2014: KI USA CORPORATION WELFARE BENEFIT PLAN 2014 form 5500 responses |
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2014-04-01 | Type of plan entity | Single employer plan |
2014-04-01 | Submission has been amended | No |
2014-04-01 | This submission is the final filing | No |
2014-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2014-04-01 | Plan is a collectively bargained plan | No |
2014-04-01 | Plan funding arrangement – Insurance | Yes |
2014-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2014-04-01 | Plan benefit arrangement – Insurance | Yes |
2014-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2013: KI USA CORPORATION WELFARE BENEFIT PLAN 2013 form 5500 responses |
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2013-04-01 | Type of plan entity | Single employer plan |
2013-04-01 | Submission has been amended | Yes |
2013-04-01 | This submission is the final filing | No |
2013-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2013-04-01 | Plan is a collectively bargained plan | No |
2013-04-01 | Plan funding arrangement – Insurance | Yes |
2013-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2013-04-01 | Plan benefit arrangement – Insurance | Yes |
2013-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2011: KI USA CORPORATION WELFARE BENEFIT PLAN 2011 form 5500 responses |
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2011-04-01 | Type of plan entity | Single employer plan |
2011-04-01 | Submission has been amended | No |
2011-04-01 | This submission is the final filing | No |
2011-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2011-04-01 | Plan is a collectively bargained plan | No |
2011-04-01 | Plan funding arrangement – Insurance | Yes |
2011-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2011-04-01 | Plan benefit arrangement – Insurance | Yes |
2011-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2009: KI USA CORPORATION WELFARE BENEFIT PLAN 2009 form 5500 responses |
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2009-04-01 | Type of plan entity | Single employer plan |
2009-04-01 | Submission has been amended | No |
2009-04-01 | This submission is the final filing | No |
2009-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2009-04-01 | Plan is a collectively bargained plan | No |
2009-04-01 | Plan funding arrangement – Insurance | Yes |
2009-04-01 | Plan benefit arrangement – Insurance | Yes |
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
Policy contract number | 165752 |
Policy instance | 3 |
Insurance contract or identification number | 165752 | Number of Individuals Covered | 111 | Insurance policy start date | 2022-04-01 | Insurance policy end date | 2023-03-31 | Total amount of commissions paid to insurance broker | USD $20,251 | Total amount of fees paid to insurance company | USD $2,612 | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $20,251 | Amount paid for insurance broker fees | 2612 | Additional information about fees paid to insurance broker | CONTINGENT COMPENSATION | Insurance broker organization code? | 3 |
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AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
Policy contract number | 15550 |
Policy instance | 2 |
Insurance contract or identification number | 15550 | Number of Individuals Covered | 59 | Insurance policy start date | 2022-04-01 | Insurance policy end date | 2023-03-31 | Total amount of commissions paid to insurance broker | USD $4,157 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | ACCIDENT, CANCER | Welfare Benefit Premiums Paid to Carrier | USD $33,179 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,137 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 96932681001 |
Policy instance | 1 |
Insurance contract or identification number | 96932681001 | Number of Individuals Covered | 153 | Insurance policy start date | 2022-04-01 | Insurance policy end date | 2023-03-31 | Total amount of commissions paid to insurance broker | USD $1,140 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $13,278 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $1,140 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
|
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 96932681001 |
Policy instance | 1 |
Insurance contract or identification number | 96932681001 | Number of Individuals Covered | 203 | Insurance policy start date | 2021-04-01 | Insurance policy end date | 2022-03-31 | Total amount of commissions paid to insurance broker | USD $1,574 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $13,410 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $1,574 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
|
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
Policy contract number | 15550 |
Policy instance | 2 |
Insurance contract or identification number | 15550 | Number of Individuals Covered | 62 | Insurance policy start date | 2021-04-01 | Insurance policy end date | 2022-03-31 | Total amount of commissions paid to insurance broker | USD $4,066 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | ACCIDENT, CANCER | Welfare Benefit Premiums Paid to Carrier | USD $36,645 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,729 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 0 |
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STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
Policy contract number | 165752 |
Policy instance | 3 |
Insurance contract or identification number | 165752 | Number of Individuals Covered | 119 | Insurance policy start date | 2021-04-01 | Insurance policy end date | 2022-03-31 | Total amount of commissions paid to insurance broker | USD $20,694 | Total amount of fees paid to insurance company | USD $2,813 | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $20,694 | Amount paid for insurance broker fees | 2813 | Additional information about fees paid to insurance broker | CONTINGENT COMPENSATION | Insurance broker organization code? | 3 |
|
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 96932681001 |
Policy instance | 1 |
Insurance contract or identification number | 96932681001 | Number of Individuals Covered | 206 | Insurance policy start date | 2020-04-01 | Insurance policy end date | 2021-03-31 | Total amount of commissions paid to insurance broker | USD $1,350 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $13,445 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $1,350 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
|
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
Policy contract number | 15550 |
Policy instance | 2 |
Insurance contract or identification number | 15550 | Number of Individuals Covered | 62 | Insurance policy start date | 2020-04-01 | Insurance policy end date | 2021-03-31 | Total amount of commissions paid to insurance broker | USD $4,205 | Total amount of fees paid to insurance company | USD $39 | Other welfare benefits provided | ACCIDENT, CANCER | Welfare Benefit Premiums Paid to Carrier | USD $41,673 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,851 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION |
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STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
Policy contract number | 165752 |
Policy instance | 3 |
Insurance contract or identification number | 165752 | Number of Individuals Covered | 199 | Insurance policy start date | 2020-04-01 | Insurance policy end date | 2021-03-31 | Total amount of commissions paid to insurance broker | USD $20,855 | 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 | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $20,855 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
|
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 96932681001 |
Policy instance | 1 |
Insurance contract or identification number | 96932681001 | Number of Individuals Covered | 234 | Insurance policy start date | 2019-04-01 | Insurance policy end date | 2020-03-31 | Total amount of commissions paid to insurance broker | USD $1,560 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $15,574 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $1,560 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
Policy contract number | 165752 |
Policy instance | 3 |
Insurance contract or identification number | 165752 | Number of Individuals Covered | 225 | Insurance policy start date | 2019-04-01 | Insurance policy end date | 2020-03-31 | Total amount of commissions paid to insurance broker | USD $24,060 | Total amount of fees paid to insurance company | USD $9,998 | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $24,060 | Amount paid for insurance broker fees | 9998 | Additional information about fees paid to insurance broker | CONTINGENT COMPENSATION | Insurance broker organization code? | 3 |
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AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
Policy contract number | 15550 |
Policy instance | 2 |
Insurance contract or identification number | 15550 | Number of Individuals Covered | 67 | Insurance policy start date | 2019-04-01 | Insurance policy end date | 2020-03-31 | Total amount of commissions paid to insurance broker | USD $6,969 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | ACCIDENT, CANCER | Welfare Benefit Premiums Paid to Carrier | USD $47,901 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,617 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
Policy contract number | 15550 |
Policy instance | 3 |
Insurance contract or identification number | 15550 | Number of Individuals Covered | 58 | Insurance policy start date | 2017-04-01 | Insurance policy end date | 2018-03-31 | Total amount of commissions paid to insurance broker | USD $6,500 | 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 | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | CANCER,ACCIDENT | Welfare Benefit Premiums Paid to Carrier | USD $43,524 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,397 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Insurance broker name | ASSUREDPARTNERS |
|
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 96932681001 |
Policy instance | 1 |
Insurance contract or identification number | 96932681001 | Number of Individuals Covered | 239 | Insurance policy start date | 2017-04-01 | Insurance policy end date | 2018-03-31 | Total amount of commissions paid to insurance broker | USD $1,682 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $15,813 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $1,331 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Insurance broker name | ASSUREDPARTNERS |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 10174382 |
Policy instance | 2 |
Insurance contract or identification number | 10174382 | Number of Individuals Covered | 136 | Insurance policy start date | 2017-04-01 | Insurance policy end date | 2018-03-31 | Total amount of commissions paid to insurance broker | USD $28,050 | Total amount of fees paid to insurance company | USD $9,569 | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $167,877 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $28,050 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Additional information about fees paid to insurance broker | BROKER BONUS | 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 | 10174383 |
Policy instance | 6 |
Insurance contract or identification number | 10174383 | Number of Individuals Covered | 102 | Insurance policy start date | 2015-04-01 | Insurance policy end date | 2016-03-31 | Total amount of commissions paid to insurance broker | USD $7,083 | 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 $47,222 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,083 | Insurance broker organization code? | 3 | Insurance broker name | USA INSURANCE SERVICES |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 10174382 |
Policy instance | 1 |
Insurance contract or identification number | 10174382 | Number of Individuals Covered | 126 | Insurance policy start date | 2015-04-01 | Insurance policy end date | 2016-03-31 | Total amount of commissions paid to insurance broker | USD $1,979 | 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 | 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 $13,190 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,979 | Insurance broker organization code? | 3 | Insurance broker name | USI INSURANCE |
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AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
Policy contract number | 15550 |
Policy instance | 2 |
Insurance contract or identification number | 15550 | Number of Individuals Covered | 57 | Insurance policy start date | 2015-04-01 | Insurance policy end date | 2016-03-31 | Total amount of commissions paid to insurance broker | USD $3,959 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $36,342 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,959 | Insurance broker organization code? | 3 | Insurance broker name | WELLS FARGO |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 10174384 |
Policy instance | 3 |
Insurance contract or identification number | 10174384 | Number of Individuals Covered | 125 | Insurance policy start date | 2015-04-01 | Insurance policy end date | 2016-03-31 | Total amount of commissions paid to insurance broker | USD $3,262 | 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 $21,748 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,262 | Insurance broker organization code? | 3 | Insurance broker name | USI INSURANCE |
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ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 ) |
Policy contract number | 9539 |
Policy instance | 4 |
Insurance contract or identification number | 9539 | Number of Individuals Covered | 265 | Insurance policy start date | 2015-04-01 | Insurance policy end date | 2016-03-31 | 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 | 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 $163,516 | 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 | 16746 |
Policy instance | 7 |
Insurance contract or identification number | 16746 | Number of Individuals Covered | 89 | Insurance policy start date | 2015-04-01 | Insurance policy end date | 2016-03-31 | Total amount of commissions paid to insurance broker | USD $11,951 | 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 | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | VOLUNTARY PRODUCTS | 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 $59,756 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $11,951 | Insurance broker organization code? | 3 | Insurance broker name | USE INSURANCE SERVICES |
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EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 9693268 |
Policy instance | 5 |
Insurance contract or identification number | 9693268 | Number of Individuals Covered | 208 | Insurance policy start date | 2015-04-01 | Insurance policy end date | 2016-03-31 | Total amount of commissions paid to insurance broker | USD $1,206 | 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 $12,194 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,206 | Insurance broker organization code? | 3 | Insurance broker name | USI INSURANCE |
|
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 9693268 |
Policy instance | 5 |
Insurance contract or identification number | 9693268 | Number of Individuals Covered | 188 | Insurance policy start date | 2014-04-01 | Insurance policy end date | 2015-03-31 | Total amount of commissions paid to insurance broker | USD $1,030 | 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 $11,349 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $572 | Insurance broker organization code? | 3 | Insurance broker name | MCGOHAN BRABENDER, INC. |
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ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 ) |
Policy contract number | 9539 |
Policy instance | 4 |
Insurance contract or identification number | 9539 | Number of Individuals Covered | 262 | Insurance policy start date | 2014-04-01 | Insurance policy end date | 2015-03-31 | 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 | 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 $136,067 | 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 | 10174384 |
Policy instance | 3 |
Insurance contract or identification number | 10174384 | Number of Individuals Covered | 126 | Insurance policy start date | 2014-04-01 | Insurance policy end date | 2015-03-31 | Total amount of commissions paid to insurance broker | USD $3,666 | 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 $24,440 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,854 | Insurance broker organization code? | 3 | Insurance broker name | WELLS FARGO |
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AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
Policy contract number | 15550 |
Policy instance | 2 |
Insurance contract or identification number | 15550 | Number of Individuals Covered | 57 | Insurance policy start date | 2014-04-01 | Insurance policy end date | 2015-03-31 | Total amount of commissions paid to insurance broker | USD $3,097 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $32,520 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,097 | Insurance broker organization code? | 3 | Insurance broker name | WELLS FARGO |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 10174382 |
Policy instance | 1 |
Insurance contract or identification number | 10174382 | Number of Individuals Covered | 126 | Insurance policy start date | 2014-04-01 | Insurance policy end date | 2015-03-31 | Total amount of commissions paid to insurance broker | USD $2,233 | 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 | 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 $14,882 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,738 | Insurance broker organization code? | 3 | Insurance broker name | WELLS FARGO |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 10174382 |
Policy instance | 1 |
Insurance contract or identification number | 10174382 | Number of Individuals Covered | 113 | Insurance policy start date | 2013-04-01 | Insurance policy end date | 2014-03-31 | 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 | 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 $13,099 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,964 | Insurance broker organization code? | 3 | Insurance broker name | WELLS FARGO |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 174383 |
Policy instance | 2 |
Insurance contract or identification number | 174383 | Number of Individuals Covered | 94 | Insurance policy start date | 2013-04-10 | Insurance policy end date | 2014-03-31 | Total amount of commissions paid to insurance broker | USD $6,764 | 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 $45,091 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,764 | Insurance broker organization code? | 3 | Insurance broker name | WELLS FARGO |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 10174384 |
Policy instance | 3 |
Insurance contract or identification number | 10174384 | Number of Individuals Covered | 113 | Insurance policy start date | 2013-04-01 | Insurance policy end date | 2014-03-31 | Total amount of commissions paid to insurance broker | USD $3,237 | 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 $21,582 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,237 | Insurance broker organization code? | 3 | Insurance broker name | WELLS FARGO |
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ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 ) |
Policy contract number | 9539 |
Policy instance | 4 |
Insurance contract or identification number | 9539 | Number of Individuals Covered | 239 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | 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 | 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 $119,048 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
Policy contract number | 0257642 |
Policy instance | 4 |
Insurance contract or identification number | 0257642 | Number of Individuals Covered | 176 | Insurance policy start date | 2011-04-01 | Insurance policy end date | 2012-03-31 | Total amount of commissions paid to insurance broker | USD $18,897 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $129,370 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
Policy contract number | 8728121 |
Policy instance | 3 |
Insurance contract or identification number | 8728121 | Number of Individuals Covered | 27 | Insurance policy start date | 2011-04-01 | Insurance policy end date | 2011-03-31 | Total amount of commissions paid to insurance broker | USD $837 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | 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 | VWB | 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 $7,588 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 9652801 |
Policy instance | 2 |
Insurance contract or identification number | 9652801 | Number of Individuals Covered | 156 | Insurance policy start date | 2011-04-10 | Insurance policy end date | 2012-03-31 | Total amount of commissions paid to insurance broker | USD $1,033 | 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 $10,288 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 ) |
Policy contract number | 104562 |
Policy instance | 1 |
Insurance contract or identification number | 104562 | Number of Individuals Covered | 226 | Insurance policy start date | 2011-04-01 | Insurance policy end date | 2012-03-31 | 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 | 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 $78,310 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 ) |
Policy contract number | 104562 |
Policy instance | 1 |
Insurance contract or identification number | 104562 | Number of Individuals Covered | 234 | Insurance policy start date | 2010-04-01 | Insurance policy end date | 2011-03-31 | 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 | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $86,833 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 9652801 |
Policy instance | 2 |
Insurance contract or identification number | 9652801 | Number of Individuals Covered | 158 | Insurance policy start date | 2010-04-10 | Insurance policy end date | 2011-03-31 | Total amount of commissions paid to insurance broker | USD $1,100 | 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 $11,871 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,100 | Insurance broker organization code? | 3 | Insurance broker name | MCGOHAN BRABENDER, INC. |
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PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
Policy contract number | H46925 |
Policy instance | 3 |
Insurance contract or identification number | H46925 | Number of Individuals Covered | 111 | Insurance policy start date | 2010-04-01 | Insurance policy end date | 2010-03-31 | Total amount of commissions paid to insurance broker | USD $187 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $1,246 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $187 | Insurance broker organization code? | 3 | Insurance broker name | MCGOHAN BRABENDER, INC. |
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PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
Policy contract number | H46870 |
Policy instance | 4 |
Insurance contract or identification number | H46870 | Number of Individuals Covered | 112 | Insurance policy start date | 2010-04-01 | Insurance policy end date | 2011-03-31 | Total amount of commissions paid to insurance broker | USD $19 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | 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 $7,194 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $19 | Insurance broker organization code? | 3 | Insurance broker name | MCGOHAN BRABENDER |
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PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
Policy contract number | 0257642 |
Policy instance | 5 |
Insurance contract or identification number | 0257642 | Number of Individuals Covered | 181 | Insurance policy start date | 2010-04-01 | Insurance policy end date | 2011-03-31 | Total amount of commissions paid to insurance broker | USD $17,918 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $99,611 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $17,918 | Insurance broker organization code? | 3 | Insurance broker name | MCGOHAN BRABENDER, INC. |
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