SIMON WILLIAMSON CLINIC, P.C. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan SIMON-WILLIAMSON CLINIC, P.C. GROUP HEALTH AND WELFARE BENEFITS PLAN
401k plan membership statisitcs for SIMON-WILLIAMSON CLINIC, P.C. GROUP HEALTH AND WELFARE BENEFITS PLAN
| Measure | Date | Value |
|---|
| 2021: SIMON-WILLIAMSON CLINIC, P.C. GROUP HEALTH AND WELFARE BENEFITS PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 136 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 129 |
| Total of all active and inactive participants | 2021-01-01 | 129 |
| 2020: SIMON-WILLIAMSON CLINIC, P.C. GROUP HEALTH AND WELFARE BENEFITS PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 136 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 136 |
| Total of all active and inactive participants | 2020-01-01 | 136 |
| 2019: SIMON-WILLIAMSON CLINIC, P.C. GROUP HEALTH AND WELFARE BENEFITS PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 286 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 244 |
| Total of all active and inactive participants | 2019-01-01 | 244 |
| 2018: SIMON-WILLIAMSON CLINIC, P.C. GROUP HEALTH AND WELFARE BENEFITS PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 286 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 286 |
| Total of all active and inactive participants | 2018-01-01 | 286 |
| 2017: SIMON-WILLIAMSON CLINIC, P.C. GROUP HEALTH AND WELFARE BENEFITS PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 389 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 357 |
| Total of all active and inactive participants | 2017-01-01 | 357 |
| 2016: SIMON-WILLIAMSON CLINIC, P.C. GROUP HEALTH AND WELFARE BENEFITS PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 376 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 389 |
| Total of all active and inactive participants | 2016-01-01 | 389 |
| 2015: SIMON-WILLIAMSON CLINIC, P.C. GROUP HEALTH AND WELFARE BENEFITS PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 383 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 376 |
| Total of all active and inactive participants | 2015-01-01 | 376 |
| 2014: SIMON-WILLIAMSON CLINIC, P.C. GROUP HEALTH AND WELFARE BENEFITS PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 364 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 383 |
| Total of all active and inactive participants | 2014-01-01 | 383 |
| 2013: SIMON-WILLIAMSON CLINIC, P.C. GROUP HEALTH AND WELFARE BENEFITS PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 185 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 184 |
| Total of all active and inactive participants | 2013-01-01 | 184 |
| Total participants | 2013-01-01 | 184 |
| 2012: SIMON-WILLIAMSON CLINIC, P.C. GROUP HEALTH AND WELFARE BENEFITS PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 220 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 185 |
| Total of all active and inactive participants | 2012-01-01 | 185 |
| Total participants | 2012-01-01 | 185 |
| 2011: SIMON-WILLIAMSON CLINIC, P.C. GROUP HEALTH AND WELFARE BENEFITS PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-01-01 | 210 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 220 |
| Number of retired or separated participants receiving benefits | 2011-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2011-01-01 | 0 |
| Total of all active and inactive participants | 2011-01-01 | 220 |
| Total participants | 2011-01-01 | 220 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2011-01-01 | 0 |
| 2010: SIMON-WILLIAMSON CLINIC, P.C. GROUP HEALTH AND WELFARE BENEFITS PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-01-01 | 206 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-01-01 | 206 |
| Number of retired or separated participants receiving benefits | 2010-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2010-01-01 | 0 |
| Total of all active and inactive participants | 2010-01-01 | 206 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2010-01-01 | 0 |
| Total participants | 2010-01-01 | 206 |
| 2009: SIMON-WILLIAMSON CLINIC, P.C. GROUP HEALTH AND WELFARE BENEFITS PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-01-01 | 206 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 206 |
| Number of retired or separated participants receiving benefits | 2009-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2009-01-01 | 0 |
| Total of all active and inactive participants | 2009-01-01 | 206 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2009-01-01 | 0 |
| Total participants | 2009-01-01 | 206 |
| 2008: SIMON-WILLIAMSON CLINIC, P.C. GROUP HEALTH AND WELFARE BENEFITS PLAN 2008 401k membership |
|---|
| Total participants, beginning-of-year | 2008-01-01 | 209 |
| Total number of active participants reported on line 7a of the Form 5500 | 2008-01-01 | 209 |
| Number of retired or separated participants receiving benefits | 2008-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2008-01-01 | 0 |
| Total of all active and inactive participants | 2008-01-01 | 209 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2008-01-01 | 0 |
| Total participants | 2008-01-01 | 209 |
| 2007: SIMON-WILLIAMSON CLINIC, P.C. GROUP HEALTH AND WELFARE BENEFITS PLAN 2007 401k membership |
|---|
| Total participants, beginning-of-year | 2007-01-01 | 204 |
| Total number of active participants reported on line 7a of the Form 5500 | 2007-01-01 | 204 |
| Number of retired or separated participants receiving benefits | 2007-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2007-01-01 | 0 |
| Total of all active and inactive participants | 2007-01-01 | 204 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2007-01-01 | 0 |
| Total participants | 2007-01-01 | 204 |
| 2006: SIMON-WILLIAMSON CLINIC, P.C. GROUP HEALTH AND WELFARE BENEFITS PLAN 2006 401k membership |
|---|
| Total participants, beginning-of-year | 2006-01-01 | 205 |
| Total number of active participants reported on line 7a of the Form 5500 | 2006-01-01 | 205 |
| Number of retired or separated participants receiving benefits | 2006-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2006-01-01 | 0 |
| Total of all active and inactive participants | 2006-01-01 | 205 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2006-01-01 | 0 |
| Total participants | 2006-01-01 | 205 |
| 2005: SIMON-WILLIAMSON CLINIC, P.C. GROUP HEALTH AND WELFARE BENEFITS PLAN 2005 401k membership |
|---|
| Total participants, beginning-of-year | 2005-01-01 | 195 |
| Total number of active participants reported on line 7a of the Form 5500 | 2005-01-01 | 195 |
| Number of retired or separated participants receiving benefits | 2005-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2005-01-01 | 0 |
| Total of all active and inactive participants | 2005-01-01 | 195 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2005-01-01 | 0 |
| Total participants | 2005-01-01 | 195 |
| 2004: SIMON-WILLIAMSON CLINIC, P.C. GROUP HEALTH AND WELFARE BENEFITS PLAN 2004 401k membership |
|---|
| Total participants, beginning-of-year | 2004-01-01 | 192 |
| Total number of active participants reported on line 7a of the Form 5500 | 2004-01-01 | 192 |
| Number of retired or separated participants receiving benefits | 2004-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2004-01-01 | 0 |
| Total of all active and inactive participants | 2004-01-01 | 192 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2004-01-01 | 0 |
| Total participants | 2004-01-01 | 192 |
| 2003: SIMON-WILLIAMSON CLINIC, P.C. GROUP HEALTH AND WELFARE BENEFITS PLAN 2003 401k membership |
|---|
| Total participants, beginning-of-year | 2003-01-01 | 168 |
| Total number of active participants reported on line 7a of the Form 5500 | 2003-01-01 | 168 |
| Number of retired or separated participants receiving benefits | 2003-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2003-01-01 | 0 |
| Total of all active and inactive participants | 2003-01-01 | 168 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2003-01-01 | 0 |
| Total participants | 2003-01-01 | 168 |
| 2002: SIMON-WILLIAMSON CLINIC, P.C. GROUP HEALTH AND WELFARE BENEFITS PLAN 2002 401k membership |
|---|
| Total participants, beginning-of-year | 2002-01-01 | 165 |
| Total number of active participants reported on line 7a of the Form 5500 | 2002-01-01 | 165 |
| Number of retired or separated participants receiving benefits | 2002-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2002-01-01 | 0 |
| Total of all active and inactive participants | 2002-01-01 | 165 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2002-01-01 | 0 |
| Total participants | 2002-01-01 | 165 |
| 2001: SIMON-WILLIAMSON CLINIC, P.C. GROUP HEALTH AND WELFARE BENEFITS PLAN 2001 401k membership |
|---|
| Total participants, beginning-of-year | 2001-01-01 | 167 |
| Total number of active participants reported on line 7a of the Form 5500 | 2001-01-01 | 167 |
| Number of retired or separated participants receiving benefits | 2001-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2001-01-01 | 0 |
| Total of all active and inactive participants | 2001-01-01 | 167 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2001-01-01 | 0 |
| Total participants | 2001-01-01 | 167 |
| 2000: SIMON-WILLIAMSON CLINIC, P.C. GROUP HEALTH AND WELFARE BENEFITS PLAN 2000 401k membership |
|---|
| Total participants, beginning-of-year | 2000-01-01 | 159 |
| Total number of active participants reported on line 7a of the Form 5500 | 2000-01-01 | 159 |
| Number of retired or separated participants receiving benefits | 2000-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2000-01-01 | 0 |
| Total of all active and inactive participants | 2000-01-01 | 159 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2000-01-01 | 0 |
| Total participants | 2000-01-01 | 159 |
| 1999: SIMON-WILLIAMSON CLINIC, P.C. GROUP HEALTH AND WELFARE BENEFITS PLAN 1999 401k membership |
|---|
| Total participants, beginning-of-year | 1999-01-01 | 171 |
| Total number of active participants reported on line 7a of the Form 5500 | 1999-01-01 | 171 |
| Number of retired or separated participants receiving benefits | 1999-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 1999-01-01 | 0 |
| Total of all active and inactive participants | 1999-01-01 | 171 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 1999-01-01 | 0 |
| Total participants | 1999-01-01 | 171 |
| 1998: SIMON-WILLIAMSON CLINIC, P.C. GROUP HEALTH AND WELFARE BENEFITS PLAN 1998 401k membership |
|---|
| Total participants, beginning-of-year | 1998-01-01 | 253 |
| Total number of active participants reported on line 7a of the Form 5500 | 1998-01-01 | 253 |
| Number of retired or separated participants receiving benefits | 1998-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 1998-01-01 | 0 |
| Total of all active and inactive participants | 1998-01-01 | 253 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 1998-01-01 | 0 |
| Total participants | 1998-01-01 | 253 |
| 1997: SIMON-WILLIAMSON CLINIC, P.C. GROUP HEALTH AND WELFARE BENEFITS PLAN 1997 401k membership |
|---|
| Total participants, beginning-of-year | 1997-01-01 | 260 |
| Total number of active participants reported on line 7a of the Form 5500 | 1997-01-01 | 260 |
| Number of retired or separated participants receiving benefits | 1997-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 1997-01-01 | 0 |
| Total of all active and inactive participants | 1997-01-01 | 260 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 1997-01-01 | 0 |
| Total participants | 1997-01-01 | 260 |
| 1996: SIMON-WILLIAMSON CLINIC, P.C. GROUP HEALTH AND WELFARE BENEFITS PLAN 1996 401k membership |
|---|
| Total participants, beginning-of-year | 1996-01-01 | 237 |
| Total number of active participants reported on line 7a of the Form 5500 | 1996-01-01 | 237 |
| Number of retired or separated participants receiving benefits | 1996-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 1996-01-01 | 0 |
| Total of all active and inactive participants | 1996-01-01 | 237 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 1996-01-01 | 0 |
| Total participants | 1996-01-01 | 237 |
| 1995: SIMON-WILLIAMSON CLINIC, P.C. GROUP HEALTH AND WELFARE BENEFITS PLAN 1995 401k membership |
|---|
| Total participants, beginning-of-year | 1995-01-01 | 229 |
| Total number of active participants reported on line 7a of the Form 5500 | 1995-01-01 | 229 |
| Number of retired or separated participants receiving benefits | 1995-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 1995-01-01 | 0 |
| Total of all active and inactive participants | 1995-01-01 | 229 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 1995-01-01 | 0 |
| Total participants | 1995-01-01 | 229 |
| 1994: SIMON-WILLIAMSON CLINIC, P.C. GROUP HEALTH AND WELFARE BENEFITS PLAN 1994 401k membership |
|---|
| Total participants, beginning-of-year | 1994-01-01 | 172 |
| Total number of active participants reported on line 7a of the Form 5500 | 1994-01-01 | 172 |
| Number of retired or separated participants receiving benefits | 1994-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 1994-01-01 | 0 |
| Total of all active and inactive participants | 1994-01-01 | 172 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 1994-01-01 | 0 |
| Total participants | 1994-01-01 | 172 |
| 1993: SIMON-WILLIAMSON CLINIC, P.C. GROUP HEALTH AND WELFARE BENEFITS PLAN 1993 401k membership |
|---|
| Total participants, beginning-of-year | 1993-01-01 | 159 |
| Total number of active participants reported on line 7a of the Form 5500 | 1993-01-01 | 159 |
| Number of retired or separated participants receiving benefits | 1993-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 1993-01-01 | 0 |
| Total of all active and inactive participants | 1993-01-01 | 159 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 1993-01-01 | 0 |
| Total participants | 1993-01-01 | 159 |
| 1992: SIMON-WILLIAMSON CLINIC, P.C. GROUP HEALTH AND WELFARE BENEFITS PLAN 1992 401k membership |
|---|
| Total participants, beginning-of-year | 1992-01-01 | 163 |
| Total number of active participants reported on line 7a of the Form 5500 | 1992-01-01 | 163 |
| Number of retired or separated participants receiving benefits | 1992-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 1992-01-01 | 0 |
| Total of all active and inactive participants | 1992-01-01 | 163 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 1992-01-01 | 0 |
| Total participants | 1992-01-01 | 163 |
| 1991: SIMON-WILLIAMSON CLINIC, P.C. GROUP HEALTH AND WELFARE BENEFITS PLAN 1991 401k membership |
|---|
| Total participants, beginning-of-year | 1991-01-01 | 145 |
| Total number of active participants reported on line 7a of the Form 5500 | 1991-01-01 | 145 |
| Number of retired or separated participants receiving benefits | 1991-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 1991-01-01 | 0 |
| Total of all active and inactive participants | 1991-01-01 | 145 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 1991-01-01 | 0 |
| Total participants | 1991-01-01 | 145 |
| 1990: SIMON-WILLIAMSON CLINIC, P.C. GROUP HEALTH AND WELFARE BENEFITS PLAN 1990 401k membership |
|---|
| Total participants, beginning-of-year | 1990-01-01 | 143 |
| Total number of active participants reported on line 7a of the Form 5500 | 1990-01-01 | 143 |
| Number of retired or separated participants receiving benefits | 1990-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 1990-01-01 | 0 |
| Total of all active and inactive participants | 1990-01-01 | 143 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 1990-01-01 | 0 |
| Total participants | 1990-01-01 | 143 |
| 2021: SIMON-WILLIAMSON CLINIC, P.C. GROUP HEALTH AND WELFARE BENEFITS PLAN 2021 form 5500 responses |
|---|
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | Submission has been amended | Yes |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: SIMON-WILLIAMSON CLINIC, P.C. GROUP HEALTH AND WELFARE BENEFITS PLAN 2020 form 5500 responses |
|---|
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: SIMON-WILLIAMSON CLINIC, P.C. GROUP HEALTH AND WELFARE BENEFITS PLAN 2019 form 5500 responses |
|---|
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: SIMON-WILLIAMSON CLINIC, P.C. GROUP HEALTH AND WELFARE BENEFITS PLAN 2018 form 5500 responses |
|---|
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: SIMON-WILLIAMSON CLINIC, P.C. GROUP HEALTH AND WELFARE BENEFITS PLAN 2017 form 5500 responses |
|---|
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: SIMON-WILLIAMSON CLINIC, P.C. GROUP HEALTH AND WELFARE BENEFITS PLAN 2016 form 5500 responses |
|---|
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: SIMON-WILLIAMSON CLINIC, P.C. GROUP HEALTH AND WELFARE BENEFITS PLAN 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: SIMON-WILLIAMSON CLINIC, P.C. GROUP HEALTH AND WELFARE BENEFITS PLAN 2014 form 5500 responses |
|---|
| 2014-01-01 | Type of plan entity | Single employer plan |
| 2014-01-01 | Plan funding arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: SIMON-WILLIAMSON CLINIC, P.C. GROUP HEALTH AND WELFARE BENEFITS PLAN 2013 form 5500 responses |
|---|
| 2013-01-01 | Type of plan entity | Single employer plan |
| 2013-01-01 | Submission has been amended | No |
| 2013-01-01 | This submission is the final filing | No |
| 2013-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-01-01 | Plan is a collectively bargained plan | No |
| 2013-01-01 | Plan funding arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: SIMON-WILLIAMSON CLINIC, P.C. GROUP HEALTH AND WELFARE BENEFITS PLAN 2012 form 5500 responses |
|---|
| 2012-01-01 | Type of plan entity | Single employer plan |
| 2012-01-01 | Submission has been amended | No |
| 2012-01-01 | This submission is the final filing | No |
| 2012-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-01-01 | Plan is a collectively bargained plan | No |
| 2012-01-01 | Plan funding arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: SIMON-WILLIAMSON CLINIC, P.C. GROUP HEALTH AND WELFARE BENEFITS PLAN 2011 form 5500 responses |
|---|
| 2011-01-01 | Type of plan entity | Single employer plan |
| 2011-01-01 | Submission has been amended | No |
| 2011-01-01 | This submission is the final filing | No |
| 2011-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-01-01 | Plan is a collectively bargained plan | No |
| 2011-01-01 | Plan funding arrangement – Insurance | Yes |
| 2011-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2010: SIMON-WILLIAMSON CLINIC, P.C. GROUP HEALTH AND WELFARE BENEFITS PLAN 2010 form 5500 responses |
|---|
| 2010-01-01 | Type of plan entity | Single employer plan |
| 2010-01-01 | Submission has been amended | No |
| 2010-01-01 | This submission is the final filing | No |
| 2010-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2010-01-01 | Plan is a collectively bargained plan | No |
| 2010-01-01 | Plan funding arrangement – Insurance | Yes |
| 2010-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: SIMON-WILLIAMSON CLINIC, P.C. GROUP HEALTH AND WELFARE BENEFITS PLAN 2009 form 5500 responses |
|---|
| 2009-01-01 | Type of plan entity | Single employer plan |
| 2009-01-01 | Submission has been amended | No |
| 2009-01-01 | This submission is the final filing | No |
| 2009-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-01-01 | Plan is a collectively bargained plan | No |
| 2009-01-01 | Plan funding arrangement – Insurance | Yes |
| 2009-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2008: SIMON-WILLIAMSON CLINIC, P.C. GROUP HEALTH AND WELFARE BENEFITS PLAN 2008 form 5500 responses |
|---|
| 2008-01-01 | Type of plan entity | Single employer plan |
| 2008-01-01 | Submission has been amended | No |
| 2008-01-01 | This submission is the final filing | No |
| 2008-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2008-01-01 | Plan is a collectively bargained plan | No |
| 2008-01-01 | Plan funding arrangement – Insurance | Yes |
| 2008-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2007: SIMON-WILLIAMSON CLINIC, P.C. GROUP HEALTH AND WELFARE BENEFITS PLAN 2007 form 5500 responses |
|---|
| 2007-01-01 | Type of plan entity | Single employer plan |
| 2007-01-01 | Submission has been amended | No |
| 2007-01-01 | This submission is the final filing | No |
| 2007-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2007-01-01 | Plan is a collectively bargained plan | No |
| 2007-01-01 | Plan funding arrangement – Insurance | Yes |
| 2007-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2006: SIMON-WILLIAMSON CLINIC, P.C. GROUP HEALTH AND WELFARE BENEFITS PLAN 2006 form 5500 responses |
|---|
| 2006-01-01 | Type of plan entity | Single employer plan |
| 2006-01-01 | Submission has been amended | No |
| 2006-01-01 | This submission is the final filing | No |
| 2006-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2006-01-01 | Plan is a collectively bargained plan | No |
| 2006-01-01 | Plan funding arrangement – Insurance | Yes |
| 2006-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2005: SIMON-WILLIAMSON CLINIC, P.C. GROUP HEALTH AND WELFARE BENEFITS PLAN 2005 form 5500 responses |
|---|
| 2005-01-01 | Type of plan entity | Single employer plan |
| 2005-01-01 | Submission has been amended | No |
| 2005-01-01 | This submission is the final filing | No |
| 2005-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2005-01-01 | Plan is a collectively bargained plan | No |
| 2005-01-01 | Plan funding arrangement – Insurance | Yes |
| 2005-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2004: SIMON-WILLIAMSON CLINIC, P.C. GROUP HEALTH AND WELFARE BENEFITS PLAN 2004 form 5500 responses |
|---|
| 2004-01-01 | Type of plan entity | Single employer plan |
| 2004-01-01 | Submission has been amended | No |
| 2004-01-01 | This submission is the final filing | No |
| 2004-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2004-01-01 | Plan is a collectively bargained plan | No |
| 2004-01-01 | Plan funding arrangement – Insurance | Yes |
| 2004-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2003: SIMON-WILLIAMSON CLINIC, P.C. GROUP HEALTH AND WELFARE BENEFITS PLAN 2003 form 5500 responses |
|---|
| 2003-01-01 | Type of plan entity | Single employer plan |
| 2003-01-01 | Submission has been amended | No |
| 2003-01-01 | This submission is the final filing | No |
| 2003-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2003-01-01 | Plan is a collectively bargained plan | No |
| 2003-01-01 | Plan funding arrangement – Insurance | Yes |
| 2003-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2002: SIMON-WILLIAMSON CLINIC, P.C. GROUP HEALTH AND WELFARE BENEFITS PLAN 2002 form 5500 responses |
|---|
| 2002-01-01 | Type of plan entity | Single employer plan |
| 2002-01-01 | Submission has been amended | No |
| 2002-01-01 | This submission is the final filing | No |
| 2002-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2002-01-01 | Plan is a collectively bargained plan | No |
| 2002-01-01 | Plan funding arrangement – Insurance | Yes |
| 2002-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2001: SIMON-WILLIAMSON CLINIC, P.C. GROUP HEALTH AND WELFARE BENEFITS PLAN 2001 form 5500 responses |
|---|
| 2001-01-01 | Type of plan entity | Single employer plan |
| 2001-01-01 | Submission has been amended | No |
| 2001-01-01 | This submission is the final filing | No |
| 2001-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2001-01-01 | Plan is a collectively bargained plan | No |
| 2001-01-01 | Plan funding arrangement – Insurance | Yes |
| 2001-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2000: SIMON-WILLIAMSON CLINIC, P.C. GROUP HEALTH AND WELFARE BENEFITS PLAN 2000 form 5500 responses |
|---|
| 2000-01-01 | Type of plan entity | Single employer plan |
| 2000-01-01 | Submission has been amended | No |
| 2000-01-01 | This submission is the final filing | No |
| 2000-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2000-01-01 | Plan is a collectively bargained plan | No |
| 2000-01-01 | Plan funding arrangement – Insurance | Yes |
| 2000-01-01 | Plan benefit arrangement – Insurance | Yes |
| 1999: SIMON-WILLIAMSON CLINIC, P.C. GROUP HEALTH AND WELFARE BENEFITS PLAN 1999 form 5500 responses |
|---|
| 1999-01-01 | Type of plan entity | Single employer plan |
| 1999-01-01 | Submission has been amended | No |
| 1999-01-01 | This submission is the final filing | No |
| 1999-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 1999-01-01 | Plan is a collectively bargained plan | No |
| 1999-01-01 | Plan funding arrangement – Insurance | Yes |
| 1999-01-01 | Plan benefit arrangement – Insurance | Yes |
| 1998: SIMON-WILLIAMSON CLINIC, P.C. GROUP HEALTH AND WELFARE BENEFITS PLAN 1998 form 5500 responses |
|---|
| 1998-01-01 | Type of plan entity | Single employer plan |
| 1998-01-01 | Submission has been amended | No |
| 1998-01-01 | This submission is the final filing | No |
| 1998-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 1998-01-01 | Plan is a collectively bargained plan | No |
| 1998-01-01 | Plan funding arrangement – Insurance | Yes |
| 1998-01-01 | Plan benefit arrangement – Insurance | Yes |
| 1997: SIMON-WILLIAMSON CLINIC, P.C. GROUP HEALTH AND WELFARE BENEFITS PLAN 1997 form 5500 responses |
|---|
| 1997-01-01 | Type of plan entity | Single employer plan |
| 1997-01-01 | Submission has been amended | No |
| 1997-01-01 | This submission is the final filing | No |
| 1997-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 1997-01-01 | Plan is a collectively bargained plan | No |
| 1997-01-01 | Plan funding arrangement – Insurance | Yes |
| 1997-01-01 | Plan benefit arrangement – Insurance | Yes |
| 1996: SIMON-WILLIAMSON CLINIC, P.C. GROUP HEALTH AND WELFARE BENEFITS PLAN 1996 form 5500 responses |
|---|
| 1996-01-01 | Type of plan entity | Single employer plan |
| 1996-01-01 | Submission has been amended | No |
| 1996-01-01 | This submission is the final filing | No |
| 1996-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 1996-01-01 | Plan is a collectively bargained plan | No |
| 1996-01-01 | Plan funding arrangement – Insurance | Yes |
| 1996-01-01 | Plan benefit arrangement – Insurance | Yes |
| 1995: SIMON-WILLIAMSON CLINIC, P.C. GROUP HEALTH AND WELFARE BENEFITS PLAN 1995 form 5500 responses |
|---|
| 1995-01-01 | Type of plan entity | Single employer plan |
| 1995-01-01 | Submission has been amended | No |
| 1995-01-01 | This submission is the final filing | No |
| 1995-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 1995-01-01 | Plan is a collectively bargained plan | No |
| 1995-01-01 | Plan funding arrangement – Insurance | Yes |
| 1995-01-01 | Plan benefit arrangement – Insurance | Yes |
| 1994: SIMON-WILLIAMSON CLINIC, P.C. GROUP HEALTH AND WELFARE BENEFITS PLAN 1994 form 5500 responses |
|---|
| 1994-01-01 | Type of plan entity | Single employer plan |
| 1994-01-01 | Submission has been amended | No |
| 1994-01-01 | This submission is the final filing | No |
| 1994-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 1994-01-01 | Plan is a collectively bargained plan | No |
| 1994-01-01 | Plan funding arrangement – Insurance | Yes |
| 1994-01-01 | Plan benefit arrangement – Insurance | Yes |
| 1993: SIMON-WILLIAMSON CLINIC, P.C. GROUP HEALTH AND WELFARE BENEFITS PLAN 1993 form 5500 responses |
|---|
| 1993-01-01 | Type of plan entity | Single employer plan |
| 1993-01-01 | Submission has been amended | No |
| 1993-01-01 | This submission is the final filing | No |
| 1993-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 1993-01-01 | Plan is a collectively bargained plan | No |
| 1993-01-01 | Plan funding arrangement – Insurance | Yes |
| 1993-01-01 | Plan benefit arrangement – Insurance | Yes |
| 1992: SIMON-WILLIAMSON CLINIC, P.C. GROUP HEALTH AND WELFARE BENEFITS PLAN 1992 form 5500 responses |
|---|
| 1992-01-01 | Type of plan entity | Single employer plan |
| 1992-01-01 | Submission has been amended | No |
| 1992-01-01 | This submission is the final filing | No |
| 1992-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 1992-01-01 | Plan is a collectively bargained plan | No |
| 1992-01-01 | Plan funding arrangement – Insurance | Yes |
| 1992-01-01 | Plan benefit arrangement – Insurance | Yes |
| 1991: SIMON-WILLIAMSON CLINIC, P.C. GROUP HEALTH AND WELFARE BENEFITS PLAN 1991 form 5500 responses |
|---|
| 1991-01-01 | Type of plan entity | Single employer plan |
| 1991-01-01 | Submission has been amended | No |
| 1991-01-01 | This submission is the final filing | No |
| 1991-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 1991-01-01 | Plan is a collectively bargained plan | No |
| 1991-01-01 | Plan funding arrangement – Insurance | Yes |
| 1991-01-01 | Plan benefit arrangement – Insurance | Yes |
| 1990: SIMON-WILLIAMSON CLINIC, P.C. GROUP HEALTH AND WELFARE BENEFITS PLAN 1990 form 5500 responses |
|---|
| 1990-01-01 | Type of plan entity | Single employer plan |
| 1990-01-01 | First time form 5500 has been submitted | Yes |
| 1990-01-01 | Submission has been amended | No |
| 1990-01-01 | This submission is the final filing | No |
| 1990-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 1990-01-01 | Plan is a collectively bargained plan | No |
| 1990-01-01 | Plan funding arrangement – Insurance | Yes |
| 1990-01-01 | Plan benefit arrangement – Insurance | Yes |
| SOUTHLAND DENTAL CORP (National Association of Insurance Commissioners NAIC id number: 16631 ) |
| Policy contract number | SBS0003299 |
| Policy instance | 6 |
| Insurance contract or identification number | SBS0003299 | | Number of Individuals Covered | 119 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $8,446 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,223 | | Insurance broker organization code? | 3 |
|
| GUARANTEED TRUST LIFE (National Association of Insurance Commissioners NAIC id number: 64211 ) |
| Policy contract number | GTLAL53 |
| Policy instance | 5 |
| Insurance contract or identification number | GTLAL53 | | Number of Individuals Covered | 122 | | Insurance policy start date | 2020-09-01 | | Insurance policy end date | 2021-08-31 | | Total amount of commissions paid to insurance broker | USD $57,839 | | Total amount of fees paid to insurance company | USD $27,612 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $266,641 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $32,397 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 13531 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 597383 |
| Policy instance | 4 |
| Insurance contract or identification number | 597383 | | Number of Individuals Covered | 23 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $7,551 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | GROUP LONG TERM CARE | | Welfare Benefit Premiums Paid to Carrier | USD $46,507 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,551 | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 505743 |
| Policy instance | 3 |
| Insurance contract or identification number | 505743 | | Number of Individuals Covered | 49 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $6,487 | | Total amount of fees paid to insurance company | USD $324 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $38,236 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,487 | | Amount paid for insurance broker fees | 324 | | Insurance broker organization code? | 3 |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 767400G |
| Policy instance | 2 |
| Insurance contract or identification number | 767400G | | Number of Individuals Covered | 129 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $11,818 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $78,784 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,818 | | Insurance broker organization code? | 3 |
|
| BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 ) |
| Policy contract number | 16576 |
| Policy instance | 1 |
| Insurance contract or identification number | 16576 | | Number of Individuals Covered | 119 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | BABY YOURSELF, AIR MED | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 ) |
| Policy contract number | 16576 |
| Policy instance | 1 |
| Insurance contract or identification number | 16576 | | Number of Individuals Covered | 119 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | BABY YOURSELF, AIR MED | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 767400G |
| Policy instance | 2 |
| Insurance contract or identification number | 767400G | | Number of Individuals Covered | 136 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $11,446 | | Total amount of fees paid to insurance company | USD $258 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $76,310 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,446 | | Amount paid for insurance broker fees | 258 | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 505743 |
| Policy instance | 3 |
| Insurance contract or identification number | 505743 | | Number of Individuals Covered | 52 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $7,233 | | Total amount of fees paid to insurance company | USD $362 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $48,221 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,233 | | Amount paid for insurance broker fees | 362 | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 597383 |
| Policy instance | 4 |
| Insurance contract or identification number | 597383 | | Number of Individuals Covered | 24 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $7,489 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | GROUP LONG TERM CARE | | Welfare Benefit Premiums Paid to Carrier | USD $49,929 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,489 | | Insurance broker organization code? | 3 |
|
| GUARANTEED TRUST LIFE (National Association of Insurance Commissioners NAIC id number: 64211 ) |
| Policy contract number | GTLAL53 |
| Policy instance | 5 |
| Insurance contract or identification number | GTLAL53 | | Number of Individuals Covered | 116 | | Insurance policy start date | 2019-09-01 | | Insurance policy end date | 2020-08-31 | | Total amount of commissions paid to insurance broker | USD $55,216 | | Total amount of fees paid to insurance company | USD $28,037 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $83,253 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $31,750 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 12818 |
|
| SOUTHLAND DENTAL CORP (National Association of Insurance Commissioners NAIC id number: 16631 ) |
| Policy contract number | SBS0003299 |
| Policy instance | 6 |
| Insurance contract or identification number | SBS0003299 | | Number of Individuals Covered | 117 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $8,788 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,394 | | Insurance broker organization code? | 3 |
|
| SOUTHLAND NATIONAL INSURANCE CORPORATION (National Association of Insurance Commissioners NAIC id number: 79057 ) |
| Policy contract number | SOUTHLAND 3299 |
| Policy instance | 6 |
| Insurance contract or identification number | SOUTHLAND 3299 | | Number of Individuals Covered | 128 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-09-30 | | Total amount of commissions paid to insurance broker | USD $7,730 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,865 | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 597383 |
| Policy instance | 4 |
| Insurance contract or identification number | 597383 | | Number of Individuals Covered | 38 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $11,581 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | GROUP LONG TERM CARE | | Welfare Benefit Premiums Paid to Carrier | USD $74,271 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,581 | | Insurance broker organization code? | 3 |
|
| GUARANTEED TRUST LIFE (National Association of Insurance Commissioners NAIC id number: 64211 ) |
| Policy contract number | GTLAL53 |
| Policy instance | 5 |
| Insurance contract or identification number | GTLAL53 | | Number of Individuals Covered | 149 | | Insurance policy start date | 2018-09-01 | | Insurance policy end date | 2019-08-31 | | Total amount of commissions paid to insurance broker | USD $84,635 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $32,325 | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 505743 |
| Policy instance | 3 |
| Insurance contract or identification number | 505743 | | Number of Individuals Covered | 57 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $7,378 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $46,843 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,378 | | Insurance broker organization code? | 3 |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 767400G |
| Policy instance | 2 |
| Insurance contract or identification number | 767400G | | Number of Individuals Covered | 140 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $13,215 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $86,114 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,215 | | Insurance broker organization code? | 3 |
|
| BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 ) |
| Policy contract number | 16576 |
| Policy instance | 1 |
| Insurance contract or identification number | 16576 | | Number of Individuals Covered | 244 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | BABY YOURSELF, AIR MED | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SOUTHLAND DENTAL CORP (National Association of Insurance Commissioners NAIC id number: 16631 ) |
| Policy contract number | SBS0003299 |
| Policy instance | 7 |
| Insurance contract or identification number | SBS0003299 | | Number of Individuals Covered | 121 | | Insurance policy start date | 2019-09-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $2,344 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,172 | | Insurance broker organization code? | 3 |
|
| BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 ) |
| Policy contract number | 16576 |
| Policy instance | 1 |
| Insurance contract or identification number | 16576 | | Number of Individuals Covered | 286 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | BABY YOURSELF, AIR MED | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 767400G |
| Policy instance | 2 |
| Insurance contract or identification number | 767400G | | Number of Individuals Covered | 168 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $14,921 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $99,477 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $14,921 | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 505743 |
| Policy instance | 3 |
| Insurance contract or identification number | 505743 | | Number of Individuals Covered | 77 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $7,891 | | Total amount of fees paid to insurance company | USD $395 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $52,604 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,891 | | Amount paid for insurance broker fees | 395 | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 597383 |
| Policy instance | 4 |
| Insurance contract or identification number | 597383 | | Number of Individuals Covered | 32 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $10,243 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | GROUP LONG TERM CARE | | Welfare Benefit Premiums Paid to Carrier | USD $72,649 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,243 | | Insurance broker organization code? | 3 |
|
| GUARANTEED TRUST LIFE (National Association of Insurance Commissioners NAIC id number: 64211 ) |
| Policy contract number | GTLAL53 |
| Policy instance | 5 |
| Insurance contract or identification number | GTLAL53 | | Number of Individuals Covered | 142 | | Insurance policy start date | 2017-09-01 | | Insurance policy end date | 2018-08-31 | | Total amount of commissions paid to insurance broker | USD $69,394 | | Total amount of fees paid to insurance company | USD $28,993 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $39,906 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 16488 |
|
| SOUTHLAND NATIONAL INSURANCE CORPORATION (National Association of Insurance Commissioners NAIC id number: 79057 ) |
| Policy contract number | SOUTHLAND 3299 |
| Policy instance | 6 |
| Insurance contract or identification number | SOUTHLAND 3299 | | Number of Individuals Covered | 140 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2018-09-30 | | Total amount of commissions paid to insurance broker | USD $11,950 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,975 | | Insurance broker organization code? | 3 |
|
| SOUTHLAND NATIONAL INSURANCE CORPORATION (National Association of Insurance Commissioners NAIC id number: 79057 ) |
| Policy contract number | SOUTHLAND 3299 |
| Policy instance | 6 |
| Insurance contract or identification number | SOUTHLAND 3299 | | Number of Individuals Covered | 147 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $3,246 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,623 | | Insurance broker organization code? | 3 | | Insurance broker name | LAKESHORE BENEFIT ALLIANCE, LLC |
|
| UNITED CONCORDIA DENTAL CORPORATION OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 47038 ) |
| Policy contract number | 410642 |
| Policy instance | 5 |
| Insurance contract or identification number | 410642 | | Number of Individuals Covered | 60 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-10-01 | | Total amount of commissions paid to insurance broker | USD $7,784 | | Total amount of fees paid to insurance company | USD $1,168 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,892 | | Amount paid for insurance broker fees | 584 | | Insurance broker organization code? | 3 | | Insurance broker name | LAKESHORE BENEFIT ALLIANCE, LLC |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 597383 |
| Policy instance | 4 |
| Insurance contract or identification number | 597383 | | Number of Individuals Covered | 34 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $8,968 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | GROUP LONG TERM CARE | | Welfare Benefit Premiums Paid to Carrier | USD $60,068 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,968 | | Insurance broker organization code? | 3 | | Insurance broker name | THOMAS S. JOHNSON |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 505743 |
| Policy instance | 3 |
| Insurance contract or identification number | 505743 | | Number of Individuals Covered | 79 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $399 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $53,151 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $399 | | Insurance broker organization code? | 3 | | Insurance broker name | JOHNSON STERLING PAUL & CO |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 767400G |
| Policy instance | 2 |
| Insurance contract or identification number | 767400G | | Number of Individuals Covered | 193 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $16,402 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $109,346 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $16,402 | | Insurance broker organization code? | 3 | | Insurance broker name | JOHNSON STERLING PAUL & CO |
|
| BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 ) |
| Policy contract number | 16576 |
| Policy instance | 1 |
| Insurance contract or identification number | 16576 | | Number of Individuals Covered | 357 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | BABY YOURSELF, AIR MED | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 ) |
| Policy contract number | 16576 |
| Policy instance | 1 |
| Insurance contract or identification number | 16576 | | Number of Individuals Covered | 376 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | EPS, BABY YOURSELF, AIR MED | | Welfare Benefit Premiums Paid to Carrier | USD $17,072 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 767400G |
| Policy instance | 2 |
| Insurance contract or identification number | 767400G | | Number of Individuals Covered | 188 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $16,363 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $109,084 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $16,363 | | Insurance broker organization code? | 3 | | Insurance broker name | JOHNSON STERLING PAUL & CO |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 597383 |
| Policy instance | 4 |
| Insurance contract or identification number | 597383 | | Number of Individuals Covered | 36 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $9,653 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | GROUP LONG TERM CARE | | Welfare Benefit Premiums Paid to Carrier | USD $61,286 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,653 | | Insurance broker organization code? | 3 | | Insurance broker name | THOMAS S. JOHNSON |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 505743 |
| Policy instance | 3 |
| Insurance contract or identification number | 505743 | | Number of Individuals Covered | 66 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $6,539 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $41,520 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,539 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Insurance broker name | JOHNSON STERLING PAUL & CO |
|
| BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 ) |
| Policy contract number | 16576 |
| Policy instance | 1 |
| Insurance contract or identification number | 16576 | | Number of Individuals Covered | 383 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | EPS, BABY YOURSELF, AIR MED | | Welfare Benefit Premiums Paid to Carrier | USD $16,417 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 767400G |
| Policy instance | 2 |
| Insurance contract or identification number | 767400G | | Number of Individuals Covered | 189 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $15,550 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $103,664 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $15,550 | | Insurance broker organization code? | 3 | | Insurance broker name | JOHNSON STERLING PAUL & CO |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 505743 |
| Policy instance | 3 |
| Insurance contract or identification number | 505743 | | Number of Individuals Covered | 66 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $6,072 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $38,552 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,072 | | Insurance broker organization code? | 3 | | Insurance broker name | JOHNSON STERLING PAUL & CO |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 597383 |
| Policy instance | 4 |
| Insurance contract or identification number | 597383 | | Number of Individuals Covered | 36 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $8,138 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | GROUP LONG TERM CARE | | Welfare Benefit Premiums Paid to Carrier | USD $53,191 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,138 | | Insurance broker organization code? | 3 | | Insurance broker name | THOMAS S. JOHNSON |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 767400G |
| Policy instance | 1 |
| Insurance contract or identification number | 767400G | | Number of Individuals Covered | 184 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $15,820 | | 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 | 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 $105,467 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $15,820 | | Insurance broker organization code? | 3 | | Insurance broker name | JOHNSTON STERLING PAUL & COMPANY |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 597383 |
| Policy instance | 3 |
| Insurance contract or identification number | 597383 | | Number of Individuals Covered | 36 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $8,167 | | Total amount of fees paid to insurance company | USD $408 | | 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 | GROUP LONG TERM CARE | | 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 $54,445 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,167 | | Amount paid for insurance broker fees | 408 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | THOMAS S. JOHNSON |
|
| BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 ) |
| Policy contract number | 16576 |
| Policy instance | 2 |
| Insurance contract or identification number | 16576 | | Number of Individuals Covered | 364 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | 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 | 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 | EPS, BABY YOURSELF, AIR MEDICAL SERVICES | | 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 $16,819 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 505743 |
| Policy instance | 4 |
| Insurance contract or identification number | 505743 | | Number of Individuals Covered | 65 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $6,213 | | Total amount of fees paid to insurance company | USD $311 | | 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 | VOLUNTARY LIFE INSURANCE, VOLUNTARY 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 $41,417 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,213 | | Amount paid for insurance broker fees | 311 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | JOHNSON STERLING PAUL & COMPANY |
|
| BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 ) |
| Policy contract number | 16576 |
| Policy instance | 1 |
| Insurance contract or identification number | 16576 | | Number of Individuals Covered | 394 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | 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 | 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 | EPS, BABY YOURSELF, AIR MEDICAL SERVICES | | 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 $17,022 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 767400G |
| Policy instance | 2 |
| Insurance contract or identification number | 767400G | | Number of Individuals Covered | 185 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $15,040 | | 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 | 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 $100,265 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $15,040 | | Insurance broker organization code? | 3 | | Insurance broker name | JOHNSTON STERLING PAUL & COMPANY |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 505743 |
| Policy instance | 3 |
| Insurance contract or identification number | 505743 | | Number of Individuals Covered | 65 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $5,701 | | Total amount of fees paid to insurance company | USD $285 | | 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 | VOLUNTARY LIFE INSURANCE, VOLUNTARY 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 $38,004 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,701 | | Amount paid for insurance broker fees | 285 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | JOHNSTON STERLING PAUL & COMPANY |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 597383 |
| Policy instance | 4 |
| Insurance contract or identification number | 597383 | | Number of Individuals Covered | 36 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $7,977 | | Total amount of fees paid to insurance company | USD $399 | | 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 | GROUP LONG TERM CARE | | 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 $53,262 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,977 | | Amount paid for insurance broker fees | 399 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | THOMAS S. JOHNSON |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 597383 |
| Policy instance | 1 |
| Insurance contract or identification number | 597383 | | Number of Individuals Covered | 36 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $8,416 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | LONG TERM CARE | | Welfare Benefit Premiums Paid to Carrier | USD $51,791 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 505743 |
| Policy instance | 2 |
| Insurance contract or identification number | 505743 | | Number of Individuals Covered | 58 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $6,709 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | VOLUNTARY LIFE INSURANCE, VOLUNTARY ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $41,286 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 767400G |
| Policy instance | 5 |
| Insurance contract or identification number | 767400G | | Number of Individuals Covered | 180 | | Insurance policy start date | 2011-02-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $15,277 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $101,843 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 ) |
| Policy contract number | 16576 |
| Policy instance | 4 |
| Insurance contract or identification number | 16576 | | Number of Individuals Covered | 397 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | EXPANDED PSYCHIATRIC SERVICES, BABY YOURSELF, AIR MEDICAL SERVICES | | Welfare Benefit Premiums Paid to Carrier | USD $17,638 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
| Policy contract number | 5339924 |
| Policy instance | 3 |
| Insurance contract or identification number | 5339924 | | Number of Individuals Covered | 199 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-01-31 | | Total amount of commissions paid to insurance broker | USD $1,782 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $11,792 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 ) |
| Policy contract number | 16576 |
| Policy instance | 4 |
| Insurance contract or identification number | 16576 | | Number of Individuals Covered | 166 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | EXPANDED PSYCHIATRIC SERVICES, BABY YOURSELF, AIR MEDICAL SERVICES | | Welfare Benefit Premiums Paid to Carrier | USD $18,975 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 505743 |
| Policy instance | 2 |
| Insurance contract or identification number | 505743 | | Number of Individuals Covered | 64 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $6,868 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | VOLUNTARY LIFE INSURANCE, VOLUNTARY ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $42,269 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 597383 |
| Policy instance | 1 |
| Insurance contract or identification number | 597383 | | Number of Individuals Covered | 35 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $9,199 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | LONG TERM CARE | | Welfare Benefit Premiums Paid to Carrier | USD $56,609 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
| Policy contract number | 5339924 |
| Policy instance | 3 |
| Insurance contract or identification number | 5339924 | | Number of Individuals Covered | 206 | | Total amount of commissions paid to insurance broker | USD $17,391 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $115,941 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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