SEVEN ACRES JEWISH SENIOR CARE SERVICES, INC. has sponsored the creation of one or more 401k plans.
Additional information about SEVEN ACRES JEWISH SENIOR CARE SERVICES, INC.
Submission information for form 5500 for 401k plan SEVEN ACRES JEWISH SENIOR CARE SERVICES INC CAFETERIA PLAN
401k plan membership statisitcs for SEVEN ACRES JEWISH SENIOR CARE SERVICES INC CAFETERIA PLAN
| Measure | Date | Value |
|---|
| 2021: SEVEN ACRES JEWISH SENIOR CARE SERVICES INC CAFETERIA PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-09-01 | 125 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-09-01 | 100 |
| Number of retired or separated participants receiving benefits | 2021-09-01 | 0 |
| 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 | 100 |
| Number of employers contributing to the scheme | 2021-09-01 | 0 |
| 2019: SEVEN ACRES JEWISH SENIOR CARE SERVICES INC CAFETERIA PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-09-01 | 152 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-09-01 | 157 |
| Number of retired or separated participants receiving benefits | 2019-09-01 | 0 |
| 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 | 157 |
| Number of employers contributing to the scheme | 2019-09-01 | 0 |
| 2018: SEVEN ACRES JEWISH SENIOR CARE SERVICES INC CAFETERIA PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-09-01 | 171 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-09-01 | 152 |
| Number of retired or separated participants receiving benefits | 2018-09-01 | 0 |
| 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 | 152 |
| Number of employers contributing to the scheme | 2018-09-01 | 0 |
| 2017: SEVEN ACRES JEWISH SENIOR CARE SERVICES INC CAFETERIA PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-09-01 | 240 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-09-01 | 171 |
| Number of retired or separated participants receiving benefits | 2017-09-01 | 0 |
| 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 | 171 |
| Number of employers contributing to the scheme | 2017-09-01 | 0 |
| 2016: SEVEN ACRES JEWISH SENIOR CARE SERVICES INC CAFETERIA PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-09-01 | 243 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-09-01 | 240 |
| Number of retired or separated participants receiving benefits | 2016-09-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2016-09-01 | 0 |
| Total of all active and inactive participants | 2016-09-01 | 240 |
| Number of employers contributing to the scheme | 2016-09-01 | 0 |
| 2015: SEVEN ACRES JEWISH SENIOR CARE SERVICES INC CAFETERIA PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-09-01 | 200 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-09-01 | 166 |
| Number of retired or separated participants receiving benefits | 2015-09-01 | 2 |
| Total of all active and inactive participants | 2015-09-01 | 168 |
| Total participants | 2015-09-01 | 168 |
| 2014: SEVEN ACRES JEWISH SENIOR CARE SERVICES INC CAFETERIA PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-09-01 | 123 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-09-01 | 121 |
| Number of retired or separated participants receiving benefits | 2014-09-01 | 10 |
| Total of all active and inactive participants | 2014-09-01 | 131 |
| Total participants | 2014-09-01 | 131 |
| 2013: SEVEN ACRES JEWISH SENIOR CARE SERVICES INC CAFETERIA PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-09-01 | 206 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-09-01 | 146 |
| Number of retired or separated participants receiving benefits | 2013-09-01 | 7 |
| Total of all active and inactive participants | 2013-09-01 | 153 |
| Total participants | 2013-09-01 | 153 |
| 2012: SEVEN ACRES JEWISH SENIOR CARE SERVICES INC CAFETERIA PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-09-01 | 184 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-09-01 | 174 |
| Number of retired or separated participants receiving benefits | 2012-09-01 | 10 |
| Total of all active and inactive participants | 2012-09-01 | 184 |
| Total participants | 2012-09-01 | 184 |
| 2011: SEVEN ACRES JEWISH SENIOR CARE SERVICES INC CAFETERIA PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-09-01 | 175 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-09-01 | 174 |
| Number of retired or separated participants receiving benefits | 2011-09-01 | 7 |
| Total of all active and inactive participants | 2011-09-01 | 181 |
| Total participants | 2011-09-01 | 181 |
| 2010: SEVEN ACRES JEWISH SENIOR CARE SERVICES INC CAFETERIA PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-09-01 | 190 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-09-01 | 234 |
| Number of retired or separated participants receiving benefits | 2010-09-01 | 5 |
| Number of other retired or separated participants entitled to future benefits | 2010-09-01 | 0 |
| Total of all active and inactive participants | 2010-09-01 | 239 |
| Number of employers contributing to the scheme | 2010-09-01 | 0 |
| Total participants, beginning-of-year | 2010-01-01 | 190 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-01-01 | 234 |
| Number of retired or separated participants receiving benefits | 2010-01-01 | 5 |
| 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 | 239 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2010-01-01 | 0 |
| Total participants | 2010-01-01 | 239 |
| Number of participants with account balances | 2010-01-01 | 0 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2010-01-01 | 0 |
| 2009: SEVEN ACRES JEWISH SENIOR CARE SERVICES INC CAFETERIA PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-09-01 | 157 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-09-01 | 177 |
| Number of retired or separated participants receiving benefits | 2009-09-01 | 13 |
| Number of other retired or separated participants entitled to future benefits | 2009-09-01 | 0 |
| Total of all active and inactive participants | 2009-09-01 | 190 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2009-09-01 | 0 |
| Total participants | 2009-09-01 | 190 |
| Number of participants with account balances | 2009-09-01 | 0 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2009-09-01 | 0 |
| Number of employers contributing to the scheme | 2009-09-01 | 190 |
| 2021: SEVEN ACRES JEWISH SENIOR CARE SERVICES INC CAFETERIA PLAN 2021 form 5500 responses |
|---|
| 2021-09-01 | Type of plan entity | Single employer plan |
| 2021-09-01 | Plan funding arrangement – Insurance | Yes |
| 2021-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: SEVEN ACRES JEWISH SENIOR CARE SERVICES INC CAFETERIA PLAN 2019 form 5500 responses |
|---|
| 2019-09-01 | Type of plan entity | Single employer plan |
| 2019-09-01 | Plan funding arrangement – Insurance | Yes |
| 2019-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: SEVEN ACRES JEWISH SENIOR CARE SERVICES INC CAFETERIA PLAN 2018 form 5500 responses |
|---|
| 2018-09-01 | Type of plan entity | Single employer plan |
| 2018-09-01 | Plan funding arrangement – Insurance | Yes |
| 2018-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: SEVEN ACRES JEWISH SENIOR CARE SERVICES INC CAFETERIA PLAN 2017 form 5500 responses |
|---|
| 2017-09-01 | Type of plan entity | Single employer plan |
| 2017-09-01 | Plan funding arrangement – Insurance | Yes |
| 2017-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: SEVEN ACRES JEWISH SENIOR CARE SERVICES INC CAFETERIA PLAN 2016 form 5500 responses |
|---|
| 2016-09-01 | Type of plan entity | Single employer plan |
| 2016-09-01 | Plan funding arrangement – Insurance | Yes |
| 2016-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: SEVEN ACRES JEWISH SENIOR CARE SERVICES INC 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 – General assets of the sponsor | Yes |
| 2015-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: SEVEN ACRES JEWISH SENIOR CARE SERVICES INC 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 – General assets of the sponsor | Yes |
| 2014-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: SEVEN ACRES JEWISH SENIOR CARE SERVICES INC 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 – General assets of the sponsor | Yes |
| 2013-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: SEVEN ACRES JEWISH SENIOR CARE SERVICES INC 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 – General assets of the sponsor | Yes |
| 2012-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: SEVEN ACRES JEWISH SENIOR CARE SERVICES INC 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 – General assets of the sponsor | Yes |
| 2011-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2010: SEVEN ACRES JEWISH SENIOR CARE SERVICES INC CAFETERIA PLAN 2010 form 5500 responses |
|---|
| 2010-09-01 | Type of plan entity | Single employer plan |
| 2010-09-01 | Submission has been amended | Yes |
| 2010-09-01 | Plan funding arrangement – Insurance | Yes |
| 2010-09-01 | Plan benefit arrangement – Insurance | Yes |
| 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 – General assets of the sponsor | Yes |
| 2010-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: SEVEN ACRES JEWISH SENIOR CARE SERVICES INC CAFETERIA PLAN 2009 form 5500 responses |
|---|
| 2009-09-01 | Type of plan entity | Single employer plan |
| 2009-09-01 | Submission has been amended | No |
| 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 – General assets of the sponsor | Yes |
| 2009-09-01 | Plan benefit arrangement – Insurance | Yes |
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E3144466 |
| Policy instance | 4 |
| Insurance contract or identification number | E3144466 | | Number of Individuals Covered | 41 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-08-31 | | Total amount of commissions paid to insurance broker | USD $7,490 | | Total amount of fees paid to insurance company | USD $472 | | Temporary Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | CRITICAL ILLNESS, HOSPITAL, CANCER | | Welfare Benefit Premiums Paid to Carrier | USD $45,643 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,067 | | Amount paid for insurance broker fees | 273 | | Additional information about fees paid to insurance broker | FEES | | Insurance broker organization code? | 3 |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 60268 |
| Policy instance | 3 |
| Insurance contract or identification number | 60268 | | Number of Individuals Covered | 100 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-08-31 | | Total amount of commissions paid to insurance broker | USD $2,787 | | Total amount of fees paid to insurance company | USD $17 | | 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 $20,848 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,216 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Additional information about fees paid to insurance broker | THIRD PARTY ADMINISTRATION |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 5391364 |
| Policy instance | 2 |
| Insurance contract or identification number | 5391364 | | Number of Individuals Covered | 136 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-08-31 | | Total amount of commissions paid to insurance broker | USD $2,258 | | Total amount of fees paid to insurance company | USD $621 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $26,894 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,258 | | Amount paid for insurance broker fees | 621 | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 801245 |
| Policy instance | 1 |
| Insurance contract or identification number | 801245 | | 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 $375 | | Total amount of fees paid to insurance company | USD $11,912 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $864,497 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $375 | | Amount paid for insurance broker fees | 11912 | | Additional information about fees paid to insurance broker | DIRECT AND INDIRECT COMPENSATION | | Insurance broker organization code? | 3 |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 60268 |
| Policy instance | 3 |
| Insurance contract or identification number | 60268 | | Number of Individuals Covered | 157 | | Insurance policy start date | 2019-09-01 | | Insurance policy end date | 2020-08-31 | | Total amount of commissions paid to insurance broker | USD $2,460 | | Total amount of fees paid to insurance company | USD $910 | | 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 $22,945 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,281 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMMISSIONS |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E3144466 |
| Policy instance | 2 |
| Insurance contract or identification number | E3144466 | | Number of Individuals Covered | 53 | | Insurance policy start date | 2019-09-01 | | Insurance policy end date | 2020-08-31 | | Total amount of commissions paid to insurance broker | USD $5,553 | | Total amount of fees paid to insurance company | USD $328 | | Temporary Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | CRITICAL ILLNESS, HOSPITAL, CANCER | | Welfare Benefit Premiums Paid to Carrier | USD $60,282 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,589 | | Amount paid for insurance broker fees | 268 | | Additional information about fees paid to insurance broker | FEES | | Insurance broker organization code? | 3 |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 801245 |
| Policy instance | 1 |
| Insurance contract or identification number | 801245 | | 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 $4,953 | | Total amount of fees paid to insurance company | USD $18,444 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,132,232 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,953 | | Amount paid for insurance broker fees | 18444 | | Additional information about fees paid to insurance broker | 2019 RETENTION, INDIRECT AND DIRECT COMPENSATION | | Insurance broker organization code? | 3 |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 60268 |
| Policy instance | 3 |
| Insurance contract or identification number | 60268 | | Number of Individuals Covered | 152 | | Insurance policy start date | 2018-09-01 | | Insurance policy end date | 2019-08-31 | | Total amount of commissions paid to insurance broker | USD $2,473 | | Total amount of fees paid to insurance company | USD $55 | | 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 $20,105 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,473 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Additional information about fees paid to insurance broker | THIRD PARTY ADMINISTRATION |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E3144466 |
| Policy instance | 2 |
| Insurance contract or identification number | E3144466 | | Number of Individuals Covered | 57 | | Insurance policy start date | 2018-09-01 | | Insurance policy end date | 2019-08-31 | | Total amount of commissions paid to insurance broker | USD $9,084 | | Total amount of fees paid to insurance company | USD $425 | | Temporary Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | CRITICAL ILLNESS, HOSPITAL, CANCER | | Welfare Benefit Premiums Paid to Carrier | USD $63,767 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,062 | | Amount paid for insurance broker fees | 365 | | Additional information about fees paid to insurance broker | FEES | | Insurance broker organization code? | 3 |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 801245 |
| Policy instance | 1 |
| Insurance contract or identification number | 801245 | | Number of Individuals Covered | 189 | | Insurance policy start date | 2018-09-01 | | Insurance policy end date | 2019-08-31 | | Total amount of commissions paid to insurance broker | USD $5,397 | | Total amount of fees paid to insurance company | USD $22,149 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,696,078 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,397 | | Amount paid for insurance broker fees | 22149 | | Additional information about fees paid to insurance broker | DIRECT AND INDIRECT COMPENSATION | | Insurance broker organization code? | 3 |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 60268 |
| Policy instance | 3 |
| Insurance contract or identification number | 60268 | | Number of Individuals Covered | 171 | | Insurance policy start date | 2017-09-01 | | Insurance policy end date | 2018-08-31 | | Total amount of commissions paid to insurance broker | USD $2,951 | | Total amount of fees paid to insurance company | USD $86 | | 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 $27,845 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,951 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Additional information about fees paid to insurance broker | THIRD PARTY ADMINISTRATION |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E3144466 |
| Policy instance | 2 |
| Insurance contract or identification number | E3144466 | | Number of Individuals Covered | 65 | | Insurance policy start date | 2017-09-01 | | Insurance policy end date | 2018-08-31 | | Total amount of commissions paid to insurance broker | USD $10,671 | | Total amount of fees paid to insurance company | USD $866 | | Temporary Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | CRITICAL ILLNESS, HOSPITAL, CANCER | | Welfare Benefit Premiums Paid to Carrier | USD $73,054 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,154 | | Amount paid for insurance broker fees | 605 | | Additional information about fees paid to insurance broker | FEES | | Insurance broker organization code? | 3 |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 801245 |
| Policy instance | 1 |
| Insurance contract or identification number | 801245 | | Number of Individuals Covered | 210 | | Insurance policy start date | 2017-09-01 | | Insurance policy end date | 2018-08-31 | | Total amount of commissions paid to insurance broker | USD $10,262 | | Total amount of fees paid to insurance company | USD $34,734 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,872,341 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,262 | | Amount paid for insurance broker fees | 34734 | | Additional information about fees paid to insurance broker | DIRECT COMPENSATION | | Insurance broker organization code? | 3 |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E3144466 |
| Policy instance | 2 |
| Insurance contract or identification number | E3144466 | | Number of Individuals Covered | 79 | | Insurance policy start date | 2016-09-01 | | Insurance policy end date | 2017-08-31 | | Total amount of commissions paid to insurance broker | USD $9,443 | | Total amount of fees paid to insurance company | USD $604 | | Temporary Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | CRITICAL ILLNESS, HOSPITAL, CANCER | | Welfare Benefit Premiums Paid to Carrier | USD $68,805 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,169 | | Amount paid for insurance broker fees | 402 | | Additional information about fees paid to insurance broker | FEES | | Insurance broker organization code? | 3 |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 801245 |
| Policy instance | 1 |
| Insurance contract or identification number | 801245 | | Number of Individuals Covered | 306 | | Insurance policy start date | 2016-09-01 | | Insurance policy end date | 2017-08-31 | | Total amount of commissions paid to insurance broker | USD $13,088 | | Total amount of fees paid to insurance company | USD $34,081 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | 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 $2,138,813 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,530 | | Amount paid for insurance broker fees | 23906 | | Additional information about fees paid to insurance broker | DIRECT COMPENSATION | | Insurance broker organization code? | 3 |
|
| UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | VS4666 |
| Policy instance | 2 |
| Insurance contract or identification number | VS4666 | | Number of Individuals Covered | 234 | | Insurance policy start date | 2010-09-01 | | Insurance policy end date | 2011-08-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| AETNA HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: 95490 ) |
| Policy contract number | 801245 |
| Policy instance | 1 |
| Insurance contract or identification number | 801245 | | Number of Individuals Covered | 234 | | Insurance policy start date | 2010-09-01 | | Insurance policy end date | 2011-08-31 | | 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 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
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