JACKSON ACADEMY, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan JACKSON ACADEMY INC FLEXIBLE BENEFITS CAFETERIA PLAN
401k plan membership statisitcs for JACKSON ACADEMY INC FLEXIBLE BENEFITS CAFETERIA PLAN
| Measure | Date | Value |
|---|
| 2021: JACKSON ACADEMY INC FLEXIBLE BENEFITS CAFETERIA PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-09-01 | 131 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-09-01 | 117 |
| Number of retired or separated participants receiving benefits | 2021-09-01 | 2 |
| Number of other retired or separated participants entitled to future benefits | 2021-09-01 | 0 |
| Total of all active and inactive participants | 2021-09-01 | 119 |
| 2020: JACKSON ACADEMY INC FLEXIBLE BENEFITS CAFETERIA PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-09-01 | 138 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-09-01 | 128 |
| Number of retired or separated participants receiving benefits | 2020-09-01 | 5 |
| Total of all active and inactive participants | 2020-09-01 | 133 |
| 2019: JACKSON ACADEMY INC FLEXIBLE BENEFITS CAFETERIA PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-09-01 | 142 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-09-01 | 130 |
| Number of retired or separated participants receiving benefits | 2019-09-01 | 3 |
| Number of other retired or separated participants entitled to future benefits | 2019-09-01 | 0 |
| Total of all active and inactive participants | 2019-09-01 | 133 |
| 2018: JACKSON ACADEMY INC FLEXIBLE BENEFITS CAFETERIA PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-09-01 | 169 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-09-01 | 183 |
| Number of retired or separated participants receiving benefits | 2018-09-01 | 1 |
| Number of other retired or separated participants entitled to future benefits | 2018-09-01 | 0 |
| Total of all active and inactive participants | 2018-09-01 | 184 |
| 2017: JACKSON ACADEMY INC FLEXIBLE BENEFITS CAFETERIA PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-09-01 | 138 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-09-01 | 140 |
| Number of retired or separated participants receiving benefits | 2017-09-01 | 3 |
| Number of other retired or separated participants entitled to future benefits | 2017-09-01 | 0 |
| Total of all active and inactive participants | 2017-09-01 | 143 |
| 2016: JACKSON ACADEMY INC FLEXIBLE BENEFITS CAFETERIA PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-09-01 | 140 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-09-01 | 128 |
| Number of retired or separated participants receiving benefits | 2016-09-01 | 0 |
| Total of all active and inactive participants | 2016-09-01 | 128 |
| 2015: JACKSON ACADEMY INC FLEXIBLE BENEFITS CAFETERIA PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-09-01 | 168 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-09-01 | 179 |
| Number of retired or separated participants receiving benefits | 2015-09-01 | 0 |
| Total of all active and inactive participants | 2015-09-01 | 179 |
| 2014: JACKSON ACADEMY INC FLEXIBLE BENEFITS CAFETERIA PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-09-01 | 139 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-09-01 | 129 |
| Number of retired or separated participants receiving benefits | 2014-09-01 | 2 |
| Number of other retired or separated participants entitled to future benefits | 2014-09-01 | 0 |
| Total of all active and inactive participants | 2014-09-01 | 131 |
| 2013: JACKSON ACADEMY INC FLEXIBLE BENEFITS CAFETERIA PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-09-01 | 183 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-09-01 | 183 |
| Number of retired or separated participants receiving benefits | 2013-09-01 | 18 |
| Total of all active and inactive participants | 2013-09-01 | 201 |
| 2012: JACKSON ACADEMY INC FLEXIBLE BENEFITS CAFETERIA PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-09-01 | 167 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-09-01 | 148 |
| Total of all active and inactive participants | 2012-09-01 | 148 |
| 2011: JACKSON ACADEMY INC FLEXIBLE BENEFITS CAFETERIA PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-09-01 | 145 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-09-01 | 129 |
| Number of retired or separated participants receiving benefits | 2011-09-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2011-09-01 | 0 |
| Total of all active and inactive participants | 2011-09-01 | 129 |
| 2009: JACKSON ACADEMY INC FLEXIBLE BENEFITS CAFETERIA PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-09-01 | 168 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-09-01 | 168 |
| Number of retired or separated participants receiving benefits | 2009-09-01 | 5 |
| Total of all active and inactive participants | 2009-09-01 | 173 |
| Total participants | 2009-09-01 | 173 |
| 2007: JACKSON ACADEMY INC FLEXIBLE BENEFITS CAFETERIA PLAN 2007 401k membership |
|---|
| Total participants, beginning-of-year | 2007-09-01 | 170 |
| Total number of active participants reported on line 7a of the Form 5500 | 2007-09-01 | 165 |
| Number of retired or separated participants receiving benefits | 2007-09-01 | 3 |
| Total of all active and inactive participants | 2007-09-01 | 168 |
| Total participants | 2007-09-01 | 168 |
| 2005: JACKSON ACADEMY INC FLEXIBLE BENEFITS CAFETERIA PLAN 2005 401k membership |
|---|
| Total participants, beginning-of-year | 2005-09-01 | 102 |
| Total number of active participants reported on line 7a of the Form 5500 | 2005-09-01 | 99 |
| Number of retired or separated participants receiving benefits | 2005-09-01 | 3 |
| Total of all active and inactive participants | 2005-09-01 | 102 |
| Total participants | 2005-09-01 | 102 |
| 2004: JACKSON ACADEMY INC FLEXIBLE BENEFITS CAFETERIA PLAN 2004 401k membership |
|---|
| Total participants, beginning-of-year | 2004-09-01 | 116 |
| Total number of active participants reported on line 7a of the Form 5500 | 2004-09-01 | 100 |
| Number of retired or separated participants receiving benefits | 2004-09-01 | 2 |
| Total of all active and inactive participants | 2004-09-01 | 102 |
| Total participants | 2004-09-01 | 102 |
| 2021: JACKSON ACADEMY INC FLEXIBLE BENEFITS CAFETERIA PLAN 2021 form 5500 responses |
|---|
| 2021-09-01 | Type of plan entity | Single employer plan |
| 2021-09-01 | Submission has been amended | No |
| 2021-09-01 | This submission is the final filing | No |
| 2021-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2021-09-01 | Plan is a collectively bargained plan | No |
| 2021-09-01 | Plan funding arrangement – Insurance | Yes |
| 2021-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: JACKSON ACADEMY INC FLEXIBLE BENEFITS CAFETERIA PLAN 2020 form 5500 responses |
|---|
| 2020-09-01 | Type of plan entity | Single employer plan |
| 2020-09-01 | Submission has been amended | No |
| 2020-09-01 | This submission is the final filing | No |
| 2020-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2020-09-01 | Plan is a collectively bargained plan | No |
| 2020-09-01 | Plan funding arrangement – Insurance | Yes |
| 2020-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: JACKSON ACADEMY INC FLEXIBLE BENEFITS CAFETERIA PLAN 2019 form 5500 responses |
|---|
| 2019-09-01 | Type of plan entity | Single employer plan |
| 2019-09-01 | Submission has been amended | No |
| 2019-09-01 | This submission is the final filing | No |
| 2019-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2019-09-01 | Plan is a collectively bargained plan | No |
| 2019-09-01 | Plan funding arrangement – Insurance | Yes |
| 2019-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: JACKSON ACADEMY INC FLEXIBLE BENEFITS CAFETERIA PLAN 2018 form 5500 responses |
|---|
| 2018-09-01 | Type of plan entity | Single employer plan |
| 2018-09-01 | Submission has been amended | No |
| 2018-09-01 | This submission is the final filing | No |
| 2018-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2018-09-01 | Plan is a collectively bargained plan | No |
| 2018-09-01 | Plan funding arrangement – Insurance | Yes |
| 2018-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: JACKSON ACADEMY INC FLEXIBLE BENEFITS CAFETERIA PLAN 2017 form 5500 responses |
|---|
| 2017-09-01 | Type of plan entity | Single employer plan |
| 2017-09-01 | Submission has been amended | No |
| 2017-09-01 | This submission is the final filing | No |
| 2017-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-09-01 | Plan is a collectively bargained plan | No |
| 2017-09-01 | Plan funding arrangement – Insurance | Yes |
| 2017-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: JACKSON ACADEMY INC FLEXIBLE BENEFITS CAFETERIA PLAN 2016 form 5500 responses |
|---|
| 2016-09-01 | Type of plan entity | Single employer plan |
| 2016-09-01 | Submission has been amended | No |
| 2016-09-01 | This submission is the final filing | No |
| 2016-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-09-01 | Plan is a collectively bargained plan | No |
| 2016-09-01 | Plan funding arrangement – Insurance | Yes |
| 2016-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: JACKSON ACADEMY INC FLEXIBLE BENEFITS CAFETERIA PLAN 2015 form 5500 responses |
|---|
| 2015-09-01 | Type of plan entity | Single employer plan |
| 2015-09-01 | Submission has been amended | No |
| 2015-09-01 | This submission is the final filing | No |
| 2015-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-09-01 | Plan is a collectively bargained plan | No |
| 2015-09-01 | Plan funding arrangement – Insurance | Yes |
| 2015-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: JACKSON ACADEMY INC FLEXIBLE BENEFITS CAFETERIA PLAN 2014 form 5500 responses |
|---|
| 2014-09-01 | Type of plan entity | Single employer plan |
| 2014-09-01 | Submission has been amended | No |
| 2014-09-01 | This submission is the final filing | No |
| 2014-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-09-01 | Plan is a collectively bargained plan | No |
| 2014-09-01 | Plan funding arrangement – Insurance | Yes |
| 2014-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: JACKSON ACADEMY INC FLEXIBLE BENEFITS CAFETERIA PLAN 2013 form 5500 responses |
|---|
| 2013-09-01 | Type of plan entity | Single employer plan |
| 2013-09-01 | Submission has been amended | No |
| 2013-09-01 | This submission is the final filing | No |
| 2013-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-09-01 | Plan is a collectively bargained plan | No |
| 2013-09-01 | Plan funding arrangement – Insurance | Yes |
| 2013-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2012: JACKSON ACADEMY INC FLEXIBLE BENEFITS CAFETERIA PLAN 2012 form 5500 responses |
|---|
| 2012-09-01 | Type of plan entity | Single employer plan |
| 2012-09-01 | Submission has been amended | No |
| 2012-09-01 | This submission is the final filing | No |
| 2012-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-09-01 | Plan is a collectively bargained plan | No |
| 2012-09-01 | Plan funding arrangement – Insurance | Yes |
| 2012-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2012-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2011: JACKSON ACADEMY INC FLEXIBLE BENEFITS CAFETERIA PLAN 2011 form 5500 responses |
|---|
| 2011-09-01 | Type of plan entity | Single employer plan |
| 2011-09-01 | Submission has been amended | No |
| 2011-09-01 | This submission is the final filing | No |
| 2011-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-09-01 | Plan is a collectively bargained plan | No |
| 2011-09-01 | Plan funding arrangement – Insurance | Yes |
| 2011-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2011-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2009: JACKSON ACADEMY INC FLEXIBLE BENEFITS CAFETERIA PLAN 2009 form 5500 responses |
|---|
| 2009-09-01 | Type of plan entity | Single employer plan |
| 2009-09-01 | Submission has been amended | Yes |
| 2009-09-01 | This submission is the final filing | No |
| 2009-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-09-01 | Plan is a collectively bargained plan | No |
| 2009-09-01 | Plan funding arrangement – Insurance | Yes |
| 2009-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2009-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2007: JACKSON ACADEMY INC FLEXIBLE BENEFITS CAFETERIA PLAN 2007 form 5500 responses |
|---|
| 2007-09-01 | Type of plan entity | Single employer plan |
| 2007-09-01 | Submission has been amended | No |
| 2007-09-01 | This submission is the final filing | No |
| 2007-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2007-09-01 | Plan is a collectively bargained plan | No |
| 2007-09-01 | Plan funding arrangement – Insurance | Yes |
| 2007-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2007-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2007-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2005: JACKSON ACADEMY INC FLEXIBLE BENEFITS CAFETERIA PLAN 2005 form 5500 responses |
|---|
| 2005-09-01 | Type of plan entity | Single employer plan |
| 2005-09-01 | Submission has been amended | No |
| 2005-09-01 | This submission is the final filing | No |
| 2005-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2005-09-01 | Plan is a collectively bargained plan | No |
| 2005-09-01 | Plan funding arrangement – Insurance | Yes |
| 2005-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2005-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2005-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2004: JACKSON ACADEMY INC FLEXIBLE BENEFITS CAFETERIA PLAN 2004 form 5500 responses |
|---|
| 2004-09-01 | Type of plan entity | Single employer plan |
| 2004-09-01 | Submission has been amended | No |
| 2004-09-01 | This submission is the final filing | No |
| 2004-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2004-09-01 | Plan is a collectively bargained plan | No |
| 2004-09-01 | Plan funding arrangement – Insurance | Yes |
| 2004-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2004-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2004-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 ) |
| Policy contract number | G00608731 |
| Policy instance | 4 |
| Insurance contract or identification number | G00608731 | | Number of Individuals Covered | 180 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-08-31 | | Total amount of commissions paid to insurance broker | USD $3,358 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $22,384 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,358 | | Insurance broker organization code? | 3 |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | 48345 |
| Policy instance | 3 |
| Insurance contract or identification number | 48345 | | Number of Individuals Covered | 28 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-08-31 | | Total amount of commissions paid to insurance broker | USD $1,922 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | CANCER | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $15,224 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $473 | | Insurance broker organization code? | 3 |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 40776 |
| Policy instance | 2 |
| Insurance contract or identification number | 40776 | | Number of Individuals Covered | 132 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-08-31 | | Total amount of commissions paid to insurance broker | USD $1,335 | | Total amount of fees paid to insurance company | USD $201 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | AD&D | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $8,901 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,335 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 201 | | Additional information about fees paid to insurance broker | BONUS |
|
| STARMOUNT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68985 ) |
| Policy contract number | 881298 |
| Policy instance | 1 |
| Insurance contract or identification number | 881298 | | Number of Individuals Covered | 72 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-08-31 | | Total amount of commissions paid to insurance broker | USD $1,462 | | Total amount of fees paid to insurance company | USD $243 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $12,208 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,462 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 243 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION PAID |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | 48345 |
| Policy instance | 1 |
| Insurance contract or identification number | 48345 | | Number of Individuals Covered | 34 | | Insurance policy start date | 2020-09-01 | | Insurance policy end date | 2021-08-31 | | Total amount of commissions paid to insurance broker | USD $2,457 | | Total amount of fees paid to insurance company | USD $75 | | Other welfare benefits provided | CANCER | | Welfare Benefit Premiums Paid to Carrier | USD $18,840 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $661 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 64 | | Additional information about fees paid to insurance broker | FEES PAID |
|
| STARMOUNT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68985 ) |
| Policy contract number | 881298 |
| Policy instance | 2 |
| Insurance contract or identification number | 881298 | | Number of Individuals Covered | 72 | | Insurance policy start date | 2020-09-01 | | Insurance policy end date | 2021-08-31 | | Total amount of commissions paid to insurance broker | USD $1,381 | | Total amount of fees paid to insurance company | USD $230 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $11,523 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,381 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 230 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION PAID |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 40776 |
| Policy instance | 3 |
| Insurance contract or identification number | 40776 | | Number of Individuals Covered | 128 | | Insurance policy start date | 2020-09-01 | | Insurance policy end date | 2021-08-31 | | Total amount of commissions paid to insurance broker | USD $1,360 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $9,067 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,360 | | Insurance broker organization code? | 3 |
|
| AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 ) |
| Policy contract number | G 00608731 |
| Policy instance | 4 |
| Insurance contract or identification number | G 00608731 | | Number of Individuals Covered | 193 | | Insurance policy start date | 2020-09-01 | | Insurance policy end date | 2021-08-31 | | Total amount of commissions paid to insurance broker | USD $3,335 | | Total amount of fees paid to insurance company | USD $0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $22,234 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,335 | | Insurance broker organization code? | 3 |
|
| STARMOUNT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68985 ) |
| Policy contract number | 881298 |
| Policy instance | 2 |
| Insurance contract or identification number | 881298 | | Number of Individuals Covered | 72 | | Insurance policy start date | 2019-09-01 | | Insurance policy end date | 2020-08-31 | | Total amount of commissions paid to insurance broker | USD $1,389 | | Total amount of fees paid to insurance company | USD $579 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $12,533 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,389 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 579 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION PAID |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 40776 |
| Policy instance | 3 |
| Insurance contract or identification number | 40776 | | Number of Individuals Covered | 134 | | Insurance policy start date | 2019-09-01 | | Insurance policy end date | 2020-08-31 | | Total amount of commissions paid to insurance broker | USD $1,420 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,420 | | Insurance broker organization code? | 3 |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | 48345 |
| Policy instance | 1 |
| Insurance contract or identification number | 48345 | | Number of Individuals Covered | 39 | | Insurance policy start date | 2019-09-01 | | Insurance policy end date | 2020-08-31 | | Total amount of commissions paid to insurance broker | USD $3,077 | | Total amount of fees paid to insurance company | USD $50 | | Other welfare benefits provided | CANCER | | Welfare Benefit Premiums Paid to Carrier | USD $19,657 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $801 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 43 | | Additional information about fees paid to insurance broker | FEES PAID |
|
| AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 ) |
| Policy contract number | G 00608731 |
| Policy instance | 4 |
| Insurance contract or identification number | G 00608731 | | Number of Individuals Covered | 176 | | Insurance policy start date | 2019-09-01 | | Insurance policy end date | 2020-08-31 | | Total amount of commissions paid to insurance broker | USD $3,363 | | Total amount of fees paid to insurance company | USD $0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $22,417 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,363 | | Insurance broker organization code? | 3 |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | 48345 |
| Policy instance | 2 |
| Insurance contract or identification number | 48345 | | Number of Individuals Covered | 40 | | Insurance policy start date | 2018-09-01 | | Insurance policy end date | 2019-08-31 | | Total amount of commissions paid to insurance broker | USD $2,509 | | Total amount of fees paid to insurance company | USD $55 | | Other welfare benefits provided | CANCER | | Welfare Benefit Premiums Paid to Carrier | USD $16,894 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $653 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 31 | | Additional information about fees paid to insurance broker | FEES PAID |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 40776 |
| Policy instance | 3 |
| Insurance contract or identification number | 40776 | | Number of Individuals Covered | 134 | | Insurance policy start date | 2018-09-01 | | Insurance policy end date | 2019-08-31 | | Total amount of commissions paid to insurance broker | USD $1,383 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $9,218 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,383 | | Insurance broker organization code? | 3 |
|
| AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 ) |
| Policy contract number | G 00608731 |
| Policy instance | 4 |
| Insurance contract or identification number | G 00608731 | | Number of Individuals Covered | 183 | | Insurance policy start date | 2018-09-01 | | Insurance policy end date | 2019-08-31 | | Total amount of commissions paid to insurance broker | USD $3,358 | | Total amount of fees paid to insurance company | USD $0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $22,384 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,358 | | Insurance broker organization code? | 3 |
|
| SPECTERA, INC. (National Association of Insurance Commissioners NAIC id number: 74950 ) |
| Policy contract number | MW121224-02-1 |
| Policy instance | 1 |
| Insurance contract or identification number | MW121224-02-1 | | Number of Individuals Covered | 66 | | Insurance policy start date | 2018-09-01 | | Insurance policy end date | 2019-08-31 | | Total amount of commissions paid to insurance broker | USD $2,536 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $8,458 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,521 | | Insurance broker organization code? | 3 |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 40776 |
| Policy instance | 3 |
| Insurance contract or identification number | 40776 | | Number of Individuals Covered | 138 | | Insurance policy start date | 2017-09-01 | | Insurance policy end date | 2018-08-31 | | Total amount of commissions paid to insurance broker | USD $1,386 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $9,242 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | 48345 |
| Policy instance | 2 |
| Insurance contract or identification number | 48345 | | Number of Individuals Covered | 39 | | Insurance policy start date | 2017-09-01 | | Insurance policy end date | 2018-08-31 | | Total amount of commissions paid to insurance broker | USD $3,610 | | Total amount of fees paid to insurance company | USD $23 | | Other welfare benefits provided | CANCER | | Welfare Benefit Premiums Paid to Carrier | USD $22,798 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SPECTERA, INC. (National Association of Insurance Commissioners NAIC id number: 74950 ) |
| Policy contract number | MW121224-02-1 |
| Policy instance | 1 |
| Insurance contract or identification number | MW121224-02-1 | | Number of Individuals Covered | 67 | | Insurance policy start date | 2017-09-01 | | Insurance policy end date | 2018-08-31 | | Total amount of commissions paid to insurance broker | USD $2,410 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $8,037 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 ) |
| Policy contract number | G 00608731 |
| Policy instance | 4 |
| Insurance contract or identification number | G 00608731 | | Number of Individuals Covered | 167 | | Insurance policy start date | 2017-09-01 | | Insurance policy end date | 2018-08-31 | | Total amount of commissions paid to insurance broker | USD $3,364 | | Total amount of fees paid to insurance company | USD $0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $22,427 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 40776 |
| Policy instance | 3 |
| Insurance contract or identification number | 40776 | | Number of Individuals Covered | 132 | | Insurance policy start date | 2015-09-01 | | Insurance policy end date | 2016-08-31 | | Total amount of commissions paid to insurance broker | USD $1,538 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $10,251 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,307 | | Insurance broker organization code? | 3 | | Insurance broker name | HUB INTERNATIONAL MIDWEST LIMITED |
|
| AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 ) |
| Policy contract number | G 00608731 |
| Policy instance | 4 |
| Insurance contract or identification number | G 00608731 | | Number of Individuals Covered | 179 | | Insurance policy start date | 2015-09-01 | | Insurance policy end date | 2016-08-31 | | Total amount of commissions paid to insurance broker | USD $3,386 | | Total amount of fees paid to insurance company | USD $0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $22,577 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,386 | | Insurance broker organization code? | 3 | | Insurance broker name | GATHINGS INSURANCE SERVICES LLC |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | 48345 |
| Policy instance | 2 |
| Insurance contract or identification number | 48345 | | Number of Individuals Covered | 42 | | Insurance policy start date | 2015-09-01 | | Insurance policy end date | 2016-08-31 | | Total amount of commissions paid to insurance broker | USD $4,873 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | CANCER | | Welfare Benefit Premiums Paid to Carrier | USD $23,945 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,346 | | Insurance broker organization code? | 3 | | Insurance broker name | WILLIAM A. BRIGGS |
|
| SPECTERA, INC. (National Association of Insurance Commissioners NAIC id number: 74950 ) |
| Policy contract number | MW121224-02-1 |
| Policy instance | 1 |
| Insurance contract or identification number | MW121224-02-1 | | Number of Individuals Covered | 54 | | Insurance policy start date | 2015-09-01 | | Insurance policy end date | 2016-08-31 | | Total amount of commissions paid to insurance broker | USD $2,499 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $8,332 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,499 | | Insurance broker organization code? | 3 | | Insurance broker name | JAMES GATHINGS |
|
| AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 ) |
| Policy contract number | G 00608731 |
| Policy instance | 4 |
| Insurance contract or identification number | G 00608731 | | Number of Individuals Covered | 166 | | Insurance policy start date | 2014-09-01 | | Insurance policy end date | 2015-08-31 | | Total amount of commissions paid to insurance broker | USD $3,174 | | Total amount of fees paid to insurance company | USD $0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $21,159 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,174 | | Insurance broker organization code? | 3 | | Insurance broker name | GATHINGS INSURANCE SERVICES LLC |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 40776 |
| Policy instance | 3 |
| Insurance contract or identification number | 40776 | | Number of Individuals Covered | 128 | | Insurance policy start date | 2014-09-01 | | Insurance policy end date | 2015-08-31 | | Total amount of commissions paid to insurance broker | USD $1,539 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $10,261 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,539 | | Insurance broker organization code? | 3 | | Insurance broker name | GATHINGS INSURANCE SERVICES LLC |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | 48345 |
| Policy instance | 2 |
| Insurance contract or identification number | 48345 | | Number of Individuals Covered | 39 | | Insurance policy start date | 2014-09-01 | | Insurance policy end date | 2015-08-31 | | Total amount of commissions paid to insurance broker | USD $2,703 | | Total amount of fees paid to insurance company | USD $97 | | Other welfare benefits provided | CANCER | | Welfare Benefit Premiums Paid to Carrier | USD $20,230 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,319 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 33 | | Additional information about fees paid to insurance broker | FEES PAID | | Insurance broker name | GREGORY WEEKS |
|
| SPECTERA, INC. (National Association of Insurance Commissioners NAIC id number: 74950 ) |
| Policy contract number | MW121224-02-1 |
| Policy instance | 1 |
| Insurance contract or identification number | MW121224-02-1 | | Number of Individuals Covered | 61 | | Insurance policy start date | 2014-09-01 | | Insurance policy end date | 2015-08-31 | | Total amount of commissions paid to insurance broker | USD $2,364 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $7,883 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,418 | | Insurance broker organization code? | 3 | | Insurance broker name | GATHINGS INSURANCE SERVICES LLC |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 040776 |
| Policy instance | 5 |
| Insurance contract or identification number | 040776 | | Number of Individuals Covered | 126 | | Insurance policy start date | 2013-09-01 | | Insurance policy end date | 2014-08-31 | | Total amount of commissions paid to insurance broker | USD $1,388 | | Health Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,061 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 1388 | | Insurance broker organization code? | 3 | | Insurance broker name | GATHINGS INSURANCE SERVICES LLC |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 13892 |
| Policy instance | 1 |
| Insurance contract or identification number | 13892 | | Number of Individuals Covered | 266 | | Insurance policy start date | 2013-09-01 | | Insurance policy end date | 2014-08-31 | | Total amount of commissions paid to insurance broker | USD $4 | | Welfare Benefit Premiums Paid to Carrier | USD $370,372 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 ) |
| Policy contract number | G00608731 |
| Policy instance | 6 |
| Insurance contract or identification number | G00608731 | | Number of Individuals Covered | 161 | | Insurance policy start date | 2013-09-01 | | Insurance policy end date | 2014-08-31 | | Total amount of commissions paid to insurance broker | USD $3,269 | | Total amount of fees paid to insurance company | USD $0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $21,797 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 3118 | | Additional information about fees paid to insurance broker | SALES AND SERVICE | | Insurance broker organization code? | 3 | | Insurance broker name | JAN L KLING |
|
| SPECTERA, INC. (National Association of Insurance Commissioners NAIC id number: 74950 ) |
| Policy contract number | MW121224-02-01 |
| Policy instance | 3 |
| Insurance contract or identification number | MW121224-02-01 | | Number of Individuals Covered | 59 | | Insurance policy start date | 2013-09-01 | | Insurance policy end date | 2014-08-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $1,987 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,075 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 1191 | | Additional information about fees paid to insurance broker | SALES AND SERVICE | | Insurance broker organization code? | 3 | | Insurance broker name | GATHINGS INSURANCE SERVICES, LLC |
|
| BLUE CROSS BLUE SHIELD OF MS, INC. (National Association of Insurance Commissioners NAIC id number: 60111 ) |
| Policy contract number | 042261 |
| Policy instance | 2 |
| Insurance contract or identification number | 042261 | | Number of Individuals Covered | 127 | | Insurance policy start date | 2013-09-01 | | Insurance policy end date | 2014-08-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $764,538 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Additional information about fees paid to insurance broker | SERVICE | | Insurance broker organization code? | 3 | | Insurance broker name | GATHINGS INSURANCE SERVICES LLC |
|
| BLUE CROSS BLUE SHIELD OF MS, INC. (National Association of Insurance Commissioners NAIC id number: 60111 ) |
| Policy contract number | 042261 |
| Policy instance | 2 |
| Insurance contract or identification number | 042261 | | Number of Individuals Covered | 113 | | Insurance policy start date | 2012-09-01 | | Insurance policy end date | 2013-08-31 | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $266,028 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $0 | | Insurance broker name | JAMES GATHINGS |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 013892 |
| Policy instance | 1 |
| Insurance contract or identification number | 013892 | | Number of Individuals Covered | 113 | | Insurance policy start date | 2012-09-01 | | Insurance policy end date | 2013-08-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $279,193 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker name | GATHINGS INSURANCE SERVICES |
|
| SPECTERA, INC. (National Association of Insurance Commissioners NAIC id number: 74950 ) |
| Policy contract number | MW121224-02-1 |
| Policy instance | 3 |
| Insurance contract or identification number | MW121224-02-1 | | Number of Individuals Covered | 47 | | Insurance policy start date | 2013-09-01 | | Insurance policy end date | 2013-08-31 | | Total amount of commissions paid to insurance broker | USD $1,751 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,839 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,050 | | Insurance broker organization code? | 3 | | Insurance broker name | JAN KLING |
|
| AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 ) |
| Policy contract number | G00608731 |
| Policy instance | 4 |
| Insurance contract or identification number | G00608731 | | Number of Individuals Covered | 227 | | Insurance policy start date | 2012-09-01 | | Insurance policy end date | 2013-08-31 | | Total amount of commissions paid to insurance broker | USD $2,400 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $16,003 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,400 | | Insurance broker organization code? | 3 | | Insurance broker name | JAN KLING |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 040776 |
| Policy instance | 5 |
| Insurance contract or identification number | 040776 | | Number of Individuals Covered | 114 | | Insurance policy start date | 2012-09-01 | | Insurance policy end date | 2013-08-31 | | Total amount of commissions paid to insurance broker | USD $1,403 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $9,354 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,403 | | Insurance broker organization code? | 3 | | Insurance broker name | GATHINGS INSURANCE SERVICES |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | 48345 |
| Policy instance | 5 |
| Insurance contract or identification number | 48345 | | Number of Individuals Covered | 38 | | Insurance policy start date | 2011-09-01 | | Insurance policy end date | 2012-08-31 | | Total amount of commissions paid to insurance broker | USD $2,481 | | Total amount of fees paid to insurance company | USD $15 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $17,664 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 ) |
| Policy contract number | G00608731 |
| Policy instance | 4 |
| Insurance contract or identification number | G00608731 | | Number of Individuals Covered | 254 | | Insurance policy start date | 2011-09-01 | | Insurance policy end date | 2012-08-31 | | Total amount of commissions paid to insurance broker | USD $1,293 | | Total amount of fees paid to insurance company | USD $0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $17,243 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 040776 |
| Policy instance | 2 |
| Insurance contract or identification number | 040776 | | Number of Individuals Covered | 112 | | Insurance policy start date | 2011-09-01 | | Insurance policy end date | 2012-08-31 | | Total amount of commissions paid to insurance broker | USD $1,221 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $8,137 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SPECTERA, INC. (National Association of Insurance Commissioners NAIC id number: 74950 ) |
| Policy contract number | MW121224-02-1 |
| Policy instance | 1 |
| Insurance contract or identification number | MW121224-02-1 | | Number of Individuals Covered | 32 | | Insurance policy start date | 2011-09-01 | | Insurance policy end date | 2012-08-31 | | Total amount of commissions paid to insurance broker | USD $1,392 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,641 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 ) |
| Policy contract number | G00608731 |
| Policy instance | 4 |
| Insurance contract or identification number | G00608731 | | Number of Individuals Covered | 164 | | Insurance policy start date | 2010-09-01 | | Insurance policy end date | 2011-08-31 | | Total amount of commissions paid to insurance broker | USD $2,599 | | Total amount of fees paid to insurance company | USD $0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $17,323 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SPECTERA, INC. (National Association of Insurance Commissioners NAIC id number: 74950 ) |
| Policy contract number | 121224-02-01 |
| Policy instance | 3 |
| Insurance contract or identification number | 121224-02-01 | | Number of Individuals Covered | 29 | | Insurance policy start date | 2010-09-01 | | Insurance policy end date | 2011-08-31 | | Total amount of commissions paid to insurance broker | USD $1,359 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,529 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 040776 |
| Policy instance | 1 |
| Insurance contract or identification number | 040776 | | Number of Individuals Covered | 108 | | Insurance policy start date | 2010-09-01 | | Insurance policy end date | 2011-08-31 | | Total amount of commissions paid to insurance broker | USD $1,187 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $7,912 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | 48345 |
| Policy instance | 5 |
| Insurance contract or identification number | 48345 | | Number of Individuals Covered | 38 | | Insurance policy start date | 2010-09-01 | | Insurance policy end date | 2011-08-31 | | Total amount of commissions paid to insurance broker | USD $2,299 | | Total amount of fees paid to insurance company | USD $0 |
|
| SPECTERA, INC. (National Association of Insurance Commissioners NAIC id number: 74950 ) |
| Policy contract number | 121224-02-1 |
| Policy instance | 2 |
| Insurance contract or identification number | 121224-02-1 | | Number of Individuals Covered | 32 | | Insurance policy start date | 2008-09-01 | | Insurance policy end date | 2009-08-31 | | Total amount of commissions paid to insurance broker | USD $1,615 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,401 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 ) |
| Policy contract number | G00608731 |
| Policy instance | 5 |
| Insurance contract or identification number | G00608731 | | Number of Individuals Covered | 164 | | Insurance policy start date | 2008-12-01 | | Insurance policy end date | 2009-08-31 | | Total amount of commissions paid to insurance broker | USD $1,914 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $12,765 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE LAFAYETTE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65242 ) |
| Policy contract number | G009791 |
| Policy instance | 4 |
| Insurance contract or identification number | G009791 | | Number of Individuals Covered | 164 | | Insurance policy start date | 2008-09-01 | | Insurance policy end date | 2008-11-30 | | Total amount of commissions paid to insurance broker | USD $669 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $17,375 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | 48345 |
| Policy instance | 1 |
| Insurance contract or identification number | 48345 | | Number of Individuals Covered | 34 | | Insurance policy start date | 2008-09-01 | | Insurance policy end date | 2009-08-31 | | Total amount of commissions paid to insurance broker | USD $3,134 | | Total amount of fees paid to insurance company | USD $38 | | Other welfare benefits provided | CANCER & INTENSIVE CARE | | Welfare Benefit Premiums Paid to Carrier | USD $17,626 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 040776 |
| Policy instance | 3 |
| Insurance contract or identification number | 040776 | | Number of Individuals Covered | 109 | | Insurance policy start date | 2008-09-01 | | Insurance policy end date | 2009-08-31 | | Total amount of commissions paid to insurance broker | USD $1,182 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $7,880 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 040776 |
| Policy instance | 3 |
| Insurance contract or identification number | 040776 | | Number of Individuals Covered | 110 | | Insurance policy start date | 2007-09-01 | | Insurance policy end date | 2008-08-31 | | Total amount of commissions paid to insurance broker | USD $1,201 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $8,006 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE LAFAYETTE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65242 ) |
| Policy contract number | G009791 |
| Policy instance | 4 |
| Insurance contract or identification number | G009791 | | Number of Individuals Covered | 165 | | Insurance policy start date | 2007-09-01 | | Insurance policy end date | 2008-08-31 | | Total amount of commissions paid to insurance broker | USD $2,606 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $17,375 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SPECTERA, INC. (National Association of Insurance Commissioners NAIC id number: 74950 ) |
| Policy contract number | 121224-02-1 |
| Policy instance | 1 |
| Insurance contract or identification number | 121224-02-1 | | Number of Individuals Covered | 32 | | Insurance policy start date | 2007-09-01 | | Insurance policy end date | 2008-08-31 | | Total amount of commissions paid to insurance broker | USD $1,425 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,311 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | 48345 |
| Policy instance | 2 |
| Insurance contract or identification number | 48345 | | Number of Individuals Covered | 38 | | Insurance policy start date | 2007-09-01 | | Insurance policy end date | 2008-08-31 | | Total amount of commissions paid to insurance broker | USD $2,792 | | Total amount of fees paid to insurance company | USD $60 | | Other welfare benefits provided | CANCER; INTENSIVE CARE | | Welfare Benefit Premiums Paid to Carrier | USD $16,588 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SPECTERA, INC. (National Association of Insurance Commissioners NAIC id number: 74950 ) |
| Policy contract number | 121224-02-1 |
| Policy instance | 2 |
| Insurance contract or identification number | 121224-02-1 | | Number of Individuals Covered | 32 | | Insurance policy start date | 2006-09-01 | | Insurance policy end date | 2007-08-31 | | Total amount of commissions paid to insurance broker | USD $1,475 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,932 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | 48345 |
| Policy instance | 1 |
| Insurance contract or identification number | 48345 | | Number of Individuals Covered | 35 | | Insurance policy start date | 2005-09-01 | | Insurance policy end date | 2006-08-31 | | Total amount of commissions paid to insurance broker | USD $3,233 | | Total amount of fees paid to insurance company | USD $48 | | Other welfare benefits provided | CANCER AND INTENSIVE CARE | | Welfare Benefit Premiums Paid to Carrier | USD $15,097 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE LAFAYETTE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65242 ) |
| Policy contract number | G009791 |
| Policy instance | 4 |
| Insurance contract or identification number | G009791 | | Number of Individuals Covered | 168 | | Insurance policy start date | 2006-09-01 | | Insurance policy end date | 2007-08-31 | | Total amount of commissions paid to insurance broker | USD $2,483 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $16,551 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 040776 |
| Policy instance | 3 |
| Insurance contract or identification number | 040776 | | Number of Individuals Covered | 106 | | Insurance policy start date | 2006-09-01 | | Insurance policy end date | 2076-08-31 | | Total amount of commissions paid to insurance broker | USD $1,074 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $7,160 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | 48345 |
| Policy instance | 3 |
| Insurance contract or identification number | 48345 | | Insurance policy start date | 2005-09-01 | | Insurance policy end date | 2006-08-31 | | Total amount of commissions paid to insurance broker | USD $2,803 | | Total amount of fees paid to insurance company | USD $21 | | Other welfare benefits provided | CANCER AND INTENSIVE CARE | | Welfare Benefit Premiums Paid to Carrier | USD $14,510 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| SPECTERA, INC. (National Association of Insurance Commissioners NAIC id number: 74950 ) |
| Policy contract number | 121224-02-1 |
| Policy instance | 2 |
| Insurance contract or identification number | 121224-02-1 | | Number of Individuals Covered | 40 | | Insurance policy start date | 2005-09-01 | | Insurance policy end date | 2006-08-31 | | Total amount of commissions paid to insurance broker | USD $1,735 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,785 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 040776 |
| Policy instance | 1 |
| Insurance contract or identification number | 040776 | | Number of Individuals Covered | 95 | | Insurance policy start date | 2005-09-01 | | Insurance policy end date | 2006-08-31 | | Total amount of commissions paid to insurance broker | USD $1,034 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,890 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE LAFAYETTE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65242 ) |
| Policy contract number | G007159 |
| Policy instance | 1 |
| Insurance contract or identification number | G007159 | | Number of Individuals Covered | 93 | | Insurance policy start date | 2004-09-01 | | Insurance policy end date | 2005-08-31 | | Total amount of commissions paid to insurance broker | USD $1,173 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $7,819 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,173 | | Additional information about fees paid to insurance broker | SALES&SERVICE | | Insurance broker organization code? | 3 | | Insurance broker name | TOM BROWN |
|
| SPECTERA VISION CARE (National Association of Insurance Commissioners NAIC id number: 74950 ) |
| Policy contract number | 121224-02-1 |
| Policy instance | 2 |
| Insurance contract or identification number | 121224-02-1 | | Number of Individuals Covered | 37 | | Insurance policy start date | 2004-09-01 | | Insurance policy end date | 2005-08-31 | | Total amount of commissions paid to insurance broker | USD $1,619 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,391 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $972 | | Additional information about fees paid to insurance broker | SALES & SERVICE | | Insurance broker organization code? | 3 | | Insurance broker name | JAN KLING |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | 48345 |
| Policy instance | 3 |
| Insurance contract or identification number | 48345 | | Insurance policy start date | 2004-09-01 | | Insurance policy end date | 2005-08-31 | | Other welfare benefits provided | CANCER, INTENSIVE CARE | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
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