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FIRST COMMUNITY CREDIT UNION BENEFIT PLAN 401k Plan overview

Plan NameFIRST COMMUNITY CREDIT UNION BENEFIT PLAN
Plan identification number 501

FIRST COMMUNITY CREDIT UNION BENEFIT PLAN Benefits

401k Plan Type
Plan Features/Benefits

    401k Sponsoring company profile

    FIRST COMMUNITY CREDIT UNION has sponsored the creation of one or more 401k plans.

    Company Name:FIRST COMMUNITY CREDIT UNION
    Employer identification number (EIN):741212168
    NAIC Classification:522130
    NAIC Description:Credit Unions

    Form 5500 Filing Information

    Submission information for form 5500 for 401k plan FIRST COMMUNITY CREDIT UNION BENEFIT PLAN

    Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
    5012020-02-01CATHERINE EMILY RIGBY2021-08-30
    5012019-02-01KATIE RIGBY2020-08-12
    5012018-02-01CATHERINE RIGBY2019-08-28
    5012017-02-01
    5012016-02-01KATIE RIGBY
    5012015-02-01KATIE RIGBY KATIE RIGBY2016-09-26
    5012014-02-01KATIE RIGBY
    5012013-02-01RON DOWNING
    5012012-02-01AMY PUPO
    5012011-02-01AMY SADAUNE
    5012010-02-01AMY L SADAUNE
    5012009-02-01AMY SADAUNE
    5012009-02-01AMY SADAUNE

    Plan Statistics for FIRST COMMUNITY CREDIT UNION BENEFIT PLAN

    401k plan membership statisitcs for FIRST COMMUNITY CREDIT UNION BENEFIT PLAN

    Measure Date Value
    2020: FIRST COMMUNITY CREDIT UNION BENEFIT PLAN 2020 401k membership
    Total participants, beginning-of-year2020-02-01285
    Total number of active participants reported on line 7a of the Form 55002020-02-01347
    Number of retired or separated participants receiving benefits2020-02-010
    Number of other retired or separated participants entitled to future benefits2020-02-010
    Total of all active and inactive participants2020-02-01347
    Number of employers contributing to the scheme2020-02-010
    2019: FIRST COMMUNITY CREDIT UNION BENEFIT PLAN 2019 401k membership
    Total participants, beginning-of-year2019-02-01279
    Total number of active participants reported on line 7a of the Form 55002019-02-01285
    Number of retired or separated participants receiving benefits2019-02-010
    Number of other retired or separated participants entitled to future benefits2019-02-010
    Total of all active and inactive participants2019-02-01285
    Number of employers contributing to the scheme2019-02-010
    2018: FIRST COMMUNITY CREDIT UNION BENEFIT PLAN 2018 401k membership
    Total participants, beginning-of-year2018-02-01222
    Total number of active participants reported on line 7a of the Form 55002018-02-01279
    Number of retired or separated participants receiving benefits2018-02-010
    Number of other retired or separated participants entitled to future benefits2018-02-010
    Total of all active and inactive participants2018-02-01279
    Number of employers contributing to the scheme2018-02-010
    2017: FIRST COMMUNITY CREDIT UNION BENEFIT PLAN 2017 401k membership
    Total participants, beginning-of-year2017-02-01202
    Total number of active participants reported on line 7a of the Form 55002017-02-01222
    Number of retired or separated participants receiving benefits2017-02-010
    Number of other retired or separated participants entitled to future benefits2017-02-010
    Total of all active and inactive participants2017-02-01222
    2016: FIRST COMMUNITY CREDIT UNION BENEFIT PLAN 2016 401k membership
    Total participants, beginning-of-year2016-02-01289
    Total number of active participants reported on line 7a of the Form 55002016-02-01267
    Number of retired or separated participants receiving benefits2016-02-010
    Number of other retired or separated participants entitled to future benefits2016-02-010
    Total of all active and inactive participants2016-02-01267
    2015: FIRST COMMUNITY CREDIT UNION BENEFIT PLAN 2015 401k membership
    Total participants, beginning-of-year2015-02-01254
    Total number of active participants reported on line 7a of the Form 55002015-02-01284
    Number of retired or separated participants receiving benefits2015-02-010
    Number of other retired or separated participants entitled to future benefits2015-02-010
    Total of all active and inactive participants2015-02-01284
    2014: FIRST COMMUNITY CREDIT UNION BENEFIT PLAN 2014 401k membership
    Total participants, beginning-of-year2014-02-01268
    Total number of active participants reported on line 7a of the Form 55002014-02-01254
    Number of retired or separated participants receiving benefits2014-02-010
    Number of other retired or separated participants entitled to future benefits2014-02-010
    Total of all active and inactive participants2014-02-01254
    2013: FIRST COMMUNITY CREDIT UNION BENEFIT PLAN 2013 401k membership
    Total participants, beginning-of-year2013-02-01238
    Total number of active participants reported on line 7a of the Form 55002013-02-01269
    Number of retired or separated participants receiving benefits2013-02-010
    Number of other retired or separated participants entitled to future benefits2013-02-010
    Total of all active and inactive participants2013-02-01269
    2012: FIRST COMMUNITY CREDIT UNION BENEFIT PLAN 2012 401k membership
    Total participants, beginning-of-year2012-02-01233
    Total number of active participants reported on line 7a of the Form 55002012-02-01238
    Number of retired or separated participants receiving benefits2012-02-010
    Number of other retired or separated participants entitled to future benefits2012-02-010
    Total of all active and inactive participants2012-02-01238
    2011: FIRST COMMUNITY CREDIT UNION BENEFIT PLAN 2011 401k membership
    Total participants, beginning-of-year2011-02-01225
    Total number of active participants reported on line 7a of the Form 55002011-02-01233
    Number of retired or separated participants receiving benefits2011-02-010
    Number of other retired or separated participants entitled to future benefits2011-02-010
    Total of all active and inactive participants2011-02-01233
    2010: FIRST COMMUNITY CREDIT UNION BENEFIT PLAN 2010 401k membership
    Total participants, beginning-of-year2010-02-01190
    Total number of active participants reported on line 7a of the Form 55002010-02-01225
    Number of retired or separated participants receiving benefits2010-02-010
    Number of other retired or separated participants entitled to future benefits2010-02-010
    Total of all active and inactive participants2010-02-01225
    2009: FIRST COMMUNITY CREDIT UNION BENEFIT PLAN 2009 401k membership
    Total participants, beginning-of-year2009-02-01169
    Total number of active participants reported on line 7a of the Form 55002009-02-01187
    Number of retired or separated participants receiving benefits2009-02-013
    Number of other retired or separated participants entitled to future benefits2009-02-010
    Total of all active and inactive participants2009-02-01190

    Form 5500 Responses for FIRST COMMUNITY CREDIT UNION BENEFIT PLAN

    2020: FIRST COMMUNITY CREDIT UNION BENEFIT PLAN 2020 form 5500 responses
    2020-02-01Type of plan entitySingle employer plan
    2020-02-01Plan funding arrangement – InsuranceYes
    2020-02-01Plan funding arrangement – General assets of the sponsorYes
    2020-02-01Plan benefit arrangement – InsuranceYes
    2020-02-01Plan benefit arrangement – General assets of the sponsorYes
    2019: FIRST COMMUNITY CREDIT UNION BENEFIT PLAN 2019 form 5500 responses
    2019-02-01Type of plan entitySingle employer plan
    2019-02-01Plan funding arrangement – InsuranceYes
    2019-02-01Plan funding arrangement – General assets of the sponsorYes
    2019-02-01Plan benefit arrangement – InsuranceYes
    2019-02-01Plan benefit arrangement – General assets of the sponsorYes
    2018: FIRST COMMUNITY CREDIT UNION BENEFIT PLAN 2018 form 5500 responses
    2018-02-01Type of plan entitySingle employer plan
    2018-02-01Plan funding arrangement – InsuranceYes
    2018-02-01Plan funding arrangement – General assets of the sponsorYes
    2018-02-01Plan benefit arrangement – InsuranceYes
    2018-02-01Plan benefit arrangement – General assets of the sponsorYes
    2017: FIRST COMMUNITY CREDIT UNION BENEFIT PLAN 2017 form 5500 responses
    2017-02-01Type of plan entitySingle employer plan
    2017-02-01Plan funding arrangement – InsuranceYes
    2017-02-01Plan funding arrangement – General assets of the sponsorYes
    2017-02-01Plan benefit arrangement – InsuranceYes
    2017-02-01Plan benefit arrangement – General assets of the sponsorYes
    2016: FIRST COMMUNITY CREDIT UNION BENEFIT PLAN 2016 form 5500 responses
    2016-02-01Type of plan entitySingle employer plan
    2016-02-01Submission has been amendedNo
    2016-02-01This submission is the final filingNo
    2016-02-01This return/report is a short plan year return/report (less than 12 months)No
    2016-02-01Plan is a collectively bargained planNo
    2016-02-01Plan funding arrangement – InsuranceYes
    2016-02-01Plan funding arrangement – General assets of the sponsorYes
    2016-02-01Plan benefit arrangement – InsuranceYes
    2016-02-01Plan benefit arrangement – General assets of the sponsorYes
    2015: FIRST COMMUNITY CREDIT UNION BENEFIT PLAN 2015 form 5500 responses
    2015-02-01Type of plan entitySingle employer plan
    2015-02-01Submission has been amendedNo
    2015-02-01This submission is the final filingNo
    2015-02-01This return/report is a short plan year return/report (less than 12 months)No
    2015-02-01Plan is a collectively bargained planNo
    2015-02-01Plan funding arrangement – InsuranceYes
    2015-02-01Plan funding arrangement – General assets of the sponsorYes
    2015-02-01Plan benefit arrangement – InsuranceYes
    2015-02-01Plan benefit arrangement – General assets of the sponsorYes
    2014: FIRST COMMUNITY CREDIT UNION BENEFIT PLAN 2014 form 5500 responses
    2014-02-01Type of plan entitySingle employer plan
    2014-02-01Submission has been amendedNo
    2014-02-01This submission is the final filingNo
    2014-02-01This return/report is a short plan year return/report (less than 12 months)No
    2014-02-01Plan is a collectively bargained planNo
    2014-02-01Plan funding arrangement – InsuranceYes
    2014-02-01Plan funding arrangement – General assets of the sponsorYes
    2014-02-01Plan benefit arrangement – InsuranceYes
    2014-02-01Plan benefit arrangement – General assets of the sponsorYes
    2013: FIRST COMMUNITY CREDIT UNION BENEFIT PLAN 2013 form 5500 responses
    2013-02-01Type of plan entitySingle employer plan
    2013-02-01Submission has been amendedNo
    2013-02-01This submission is the final filingNo
    2013-02-01This return/report is a short plan year return/report (less than 12 months)No
    2013-02-01Plan is a collectively bargained planNo
    2013-02-01Plan funding arrangement – InsuranceYes
    2013-02-01Plan funding arrangement – General assets of the sponsorYes
    2013-02-01Plan benefit arrangement – InsuranceYes
    2013-02-01Plan benefit arrangement – General assets of the sponsorYes
    2012: FIRST COMMUNITY CREDIT UNION BENEFIT PLAN 2012 form 5500 responses
    2012-02-01Type of plan entitySingle employer plan
    2012-02-01Submission has been amendedNo
    2012-02-01This submission is the final filingNo
    2012-02-01This return/report is a short plan year return/report (less than 12 months)No
    2012-02-01Plan is a collectively bargained planNo
    2012-02-01Plan funding arrangement – InsuranceYes
    2012-02-01Plan funding arrangement – General assets of the sponsorYes
    2012-02-01Plan benefit arrangement – InsuranceYes
    2012-02-01Plan benefit arrangement – General assets of the sponsorYes
    2011: FIRST COMMUNITY CREDIT UNION BENEFIT PLAN 2011 form 5500 responses
    2011-02-01Type of plan entitySingle employer plan
    2011-02-01Submission has been amendedNo
    2011-02-01This submission is the final filingNo
    2011-02-01This return/report is a short plan year return/report (less than 12 months)No
    2011-02-01Plan is a collectively bargained planNo
    2011-02-01Plan funding arrangement – InsuranceYes
    2011-02-01Plan funding arrangement – General assets of the sponsorYes
    2011-02-01Plan benefit arrangement – InsuranceYes
    2011-02-01Plan benefit arrangement – General assets of the sponsorYes
    2010: FIRST COMMUNITY CREDIT UNION BENEFIT PLAN 2010 form 5500 responses
    2010-02-01Type of plan entitySingle employer plan
    2010-02-01Submission has been amendedNo
    2010-02-01This submission is the final filingNo
    2010-02-01This return/report is a short plan year return/report (less than 12 months)No
    2010-02-01Plan is a collectively bargained planNo
    2010-02-01Plan funding arrangement – InsuranceYes
    2010-02-01Plan benefit arrangement – InsuranceYes
    2009: FIRST COMMUNITY CREDIT UNION BENEFIT PLAN 2009 form 5500 responses
    2009-02-01Type of plan entitySingle employer plan
    2009-02-01Submission has been amendedYes
    2009-02-01This submission is the final filingNo
    2009-02-01This return/report is a short plan year return/report (less than 12 months)No
    2009-02-01Plan is a collectively bargained planNo
    2009-02-01Plan funding arrangement – InsuranceYes
    2009-02-01Plan funding arrangement – General assets of the sponsorYes
    2009-02-01Plan benefit arrangement – InsuranceYes
    2009-02-01Plan benefit arrangement – General assets of the sponsorYes

    Insurance Providers Used on plan

    STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
    Policy contract number166888
    Policy instance 3
    Insurance contract or identification number166888
    Number of Individuals Covered289
    Insurance policy start date2020-02-01
    Insurance policy end date2021-01-31
    Total amount of commissions paid to insurance brokerUSD $24,964
    Total amount of fees paid to insurance companyUSD $5,000
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $24,964
    Amount paid for insurance broker fees0
    Insurance broker organization code?3
    Additional information about fees paid to insurance brokerADMINISTRATION
    UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
    Policy contract number913832
    Policy instance 2
    Insurance contract or identification number913832
    Number of Individuals Covered432
    Insurance policy start date2020-02-01
    Insurance policy end date2021-01-31
    Total amount of commissions paid to insurance brokerUSD $18,846
    Total amount of fees paid to insurance companyUSD $5,200
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $165,356
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $18,846
    Amount paid for insurance broker fees704
    Additional information about fees paid to insurance brokerSERVICE FEE AGREEMENT
    Insurance broker organization code?3
    CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
    Policy contract number628466
    Policy instance 1
    Insurance contract or identification number628466
    Number of Individuals Covered296
    Insurance policy start date2020-02-01
    Insurance policy end date2021-01-31
    Total amount of commissions paid to insurance brokerUSD $0
    Total amount of fees paid to insurance companyUSD $74,294
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $1,983,598
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $0
    Amount paid for insurance broker fees74294
    Additional information about fees paid to insurance brokerBENEFIT ADVISOR FEE
    Insurance broker organization code?3
    THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
    Policy contract number10033686
    Policy instance 2
    Insurance contract or identification number10033686
    Number of Individuals Covered286
    Insurance policy start date2019-02-01
    Insurance policy end date2020-01-31
    Total amount of commissions paid to insurance brokerUSD $22,029
    Total amount of fees paid to insurance companyUSD $5,337
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
    Welfare Benefit Premiums Paid to CarrierUSD $158,318
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $22,029
    Amount paid for insurance broker fees5337
    Additional information about fees paid to insurance brokerBROKER BONUS
    Insurance broker organization code?3
    UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
    Policy contract number913832
    Policy instance 1
    Insurance contract or identification number913832
    Number of Individuals Covered498
    Insurance policy start date2019-02-01
    Insurance policy end date2020-01-31
    Total amount of commissions paid to insurance brokerUSD $14,986
    Total amount of fees paid to insurance companyUSD $70,262
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $2,033,551
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $14,986
    Amount paid for insurance broker fees70262
    Additional information about fees paid to insurance brokerSERVICE FEE AGREEMENT
    Insurance broker organization code?3
    THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
    Policy contract number10033686
    Policy instance 3
    Insurance contract or identification number10033686
    Number of Individuals Covered271
    Insurance policy start date2018-02-01
    Insurance policy end date2019-01-31
    Total amount of commissions paid to insurance brokerUSD $32,483
    Total amount of fees paid to insurance companyUSD $9,915
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
    Welfare Benefit Premiums Paid to CarrierUSD $264,710
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $32,483
    Amount paid for insurance broker fees9915
    Additional information about fees paid to insurance brokerBROKER BONUS
    Insurance broker organization code?3
    UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
    Policy contract number913832
    Policy instance 2
    Insurance contract or identification number913832
    Number of Individuals Covered330
    Insurance policy start date2018-02-01
    Insurance policy end date2019-01-31
    Total amount of commissions paid to insurance brokerUSD $0
    Total amount of fees paid to insurance companyUSD $74,759
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $2,000,084
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $0
    Amount paid for insurance broker fees74603
    Additional information about fees paid to insurance brokerSERVICE FEE AGREEMENT
    Insurance broker organization code?3
    NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
    Policy contract number27002
    Policy instance 1
    Insurance contract or identification number27002
    Number of Individuals Covered279
    Insurance policy start date2018-02-01
    Insurance policy end date2019-01-31
    Total amount of commissions paid to insurance brokerUSD $1,556
    Total amount of fees paid to insurance companyUSD $0
    Vision Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $25,928
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
    Commission paid to Insurance BrokerUSD $1,556
    Amount paid for insurance broker fees0
    Insurance broker organization code?3
    THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
    Policy contract number10033686
    Policy instance 4
    Insurance contract or identification number10033686
    Number of Individuals Covered264
    Insurance policy start date2017-02-01
    Insurance policy end date2018-01-31
    Total amount of commissions paid to insurance brokerUSD $22,298
    Total amount of fees paid to insurance companyUSD $3,977
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
    Welfare Benefit Premiums Paid to CarrierUSD $198,298
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $16,769
    Amount paid for insurance broker fees3977
    Additional information about fees paid to insurance brokerBROKER BONUS
    Insurance broker organization code?3
    Insurance broker nameTHE BENEFITS TEAM, INC.
    AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
    Policy contract number212125
    Policy instance 3
    Insurance contract or identification number212125
    Number of Individuals Covered350
    Insurance policy start date2017-02-01
    Insurance policy end date2018-01-31
    Total amount of commissions paid to insurance brokerUSD $0
    Total amount of fees paid to insurance companyUSD $66,125
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $1,952,435
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $0
    Amount paid for insurance broker fees66125
    Additional information about fees paid to insurance brokerDIRECT COMPENSATION
    Insurance broker organization code?3
    Insurance broker nameUSI SOUTHWEST, INC.
    NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
    Policy contract number27002
    Policy instance 2
    Insurance contract or identification number27002
    Number of Individuals Covered356
    Insurance policy start date2017-02-01
    Insurance policy end date2018-01-31
    Total amount of commissions paid to insurance brokerUSD $1,597
    Total amount of fees paid to insurance companyUSD $0
    Vision Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $24,531
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
    Commission paid to Insurance BrokerUSD $1,597
    Amount paid for insurance broker fees0
    Insurance broker organization code?3
    Insurance broker nameUSI SOUTHWEST, INC.
    THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
    Policy contract number40L00100000009
    Policy instance 1
    Insurance contract or identification number40L00100000009
    Number of Individuals Covered152
    Insurance policy start date2017-02-01
    Insurance policy end date2018-01-31
    Total amount of commissions paid to insurance brokerUSD $10,197
    Total amount of fees paid to insurance companyUSD $2,793
    Life Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $67,977
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $10,197
    Amount paid for insurance broker fees2793
    Additional information about fees paid to insurance brokerBROKER BONUS
    Insurance broker organization code?3
    Insurance broker nameUSI INSURANCE SERVICES LLC
    UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
    Policy contract number753787
    Policy instance 1
    Insurance contract or identification number753787
    Number of Individuals Covered439
    Insurance policy start date2015-02-01
    Insurance policy end date2016-01-31
    Total amount of commissions paid to insurance brokerUSD $0
    Total amount of fees paid to insurance companyUSD $95,940
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    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 BenefitYes
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    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 CarrierUSD $2,103,018
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Amount paid for insurance broker fees95940
    Additional information about fees paid to insurance brokerBONUS SERVICE FEE AGREEMENT
    Insurance broker organization code?3
    Insurance broker nameUSI INSURANCE SERVICES, LLC
    NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
    Policy contract number27002
    Policy instance 2
    Insurance contract or identification number27002
    Number of Individuals Covered369
    Insurance policy start date2015-02-01
    Insurance policy end date2016-01-31
    Total amount of commissions paid to insurance brokerUSD $1,637
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    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 BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitYes
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    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 CarrierUSD $25,341
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,637
    Insurance broker organization code?3
    Insurance broker nameUSI INSURANCE SERVICES, LLC
    AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: )
    Policy contract number44387
    Policy instance 4
    Insurance contract or identification number44387
    Number of Individuals Covered6
    Insurance policy start date2015-02-01
    Insurance policy end date2016-01-31
    Total amount of commissions paid to insurance brokerUSD $121
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    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 BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedCANCER
    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 CarrierUSD $933
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $121
    Insurance broker organization code?3
    Insurance broker nameTHE BENEFITS TEAM, INC.
    THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
    Policy contract number10033685
    Policy instance 3
    Insurance contract or identification number10033685
    Number of Individuals Covered284
    Insurance policy start date2015-02-01
    Insurance policy end date2016-01-31
    Total amount of commissions paid to insurance brokerUSD $18,234
    Total amount of fees paid to insurance companyUSD $2,264
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    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 BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $132,836
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $14,301
    Amount paid for insurance broker fees2264
    Additional information about fees paid to insurance brokerBROKER BONUS
    Insurance broker organization code?3
    Insurance broker nameTHE BENEFITS TEAM, INC.
    CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
    Policy contract number3333015
    Policy instance 4
    Insurance contract or identification number3333015
    Number of Individuals Covered208
    Insurance policy start date2014-02-01
    Insurance policy end date2015-01-31
    Total amount of commissions paid to insurance brokerUSD $11,395
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    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 BenefitNo
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    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 CarrierUSD $115,002
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $11,395
    Insurance broker organization code?3
    Insurance broker nameUSI INSURANCE SERVICES, LLC
    AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: )
    Policy contract number44387
    Policy instance 5
    Insurance contract or identification number44387
    Number of Individuals Covered7
    Insurance policy start date2014-02-01
    Insurance policy end date2015-01-31
    Total amount of commissions paid to insurance brokerUSD $149
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    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 BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedCANCER
    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 CarrierUSD $1,149
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $149
    Insurance broker organization code?3
    Insurance broker nameTHE BENEFITS TEAM, INC.
    UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
    Policy contract number753787
    Policy instance 3
    Insurance contract or identification number753787
    Number of Individuals Covered337
    Insurance policy start date2014-02-01
    Insurance policy end date2015-01-31
    Total amount of commissions paid to insurance brokerUSD $0
    Total amount of fees paid to insurance companyUSD $90,706
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    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 BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    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 CarrierUSD $1,756,810
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Amount paid for insurance broker fees90706
    Additional information about fees paid to insurance brokerBONUS SERVICE FEE AGREEMENT
    Insurance broker organization code?3
    Insurance broker nameUSI INSURANCE SERVICES, LLC
    THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
    Policy contract number10033685
    Policy instance 1
    Insurance contract or identification number10033685
    Number of Individuals Covered285
    Insurance policy start date2014-02-01
    Insurance policy end date2015-01-31
    Total amount of commissions paid to insurance brokerUSD $15,394
    Total amount of fees paid to insurance companyUSD $3,820
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    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 BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $111,557
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $12,048
    Amount paid for insurance broker fees3820
    Additional information about fees paid to insurance brokerBROKER BONUS
    Insurance broker organization code?3
    Insurance broker nameTHE BENEFITS TEAM, INC.
    NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
    Policy contract number27002
    Policy instance 2
    Insurance contract or identification number27002
    Number of Individuals Covered335
    Insurance policy start date2014-02-01
    Insurance policy end date2015-01-31
    Total amount of commissions paid to insurance brokerUSD $1,610
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    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 BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitYes
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    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 CarrierUSD $28,761
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,610
    Insurance broker organization code?3
    Insurance broker nameANCO INSURANCE SERVICES CORPORATION
    CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
    Policy contract number3333015
    Policy instance 3
    Insurance contract or identification number3333015
    Number of Individuals Covered199
    Insurance policy start date2013-02-01
    Insurance policy end date2014-01-31
    Total amount of commissions paid to insurance brokerUSD $10,423
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    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 BenefitYes
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    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 CarrierUSD $231,673
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $10,423
    Insurance broker organization code?3
    Insurance broker nameANCO INSURANCE SERVICES CORPORATION
    NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
    Policy contract number27002
    Policy instance 2
    Insurance contract or identification number27002
    Number of Individuals Covered388
    Insurance policy start date2013-02-01
    Insurance policy end date2014-01-31
    Total amount of commissions paid to insurance brokerUSD $1,401
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    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 BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitYes
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    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 CarrierUSD $30,256
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,401
    Insurance broker organization code?3
    Insurance broker nameANCO INSURANCE SERVICES CORPORATION
    THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
    Policy contract number10033685
    Policy instance 1
    Insurance contract or identification number10033685
    Number of Individuals Covered269
    Insurance policy start date2013-02-01
    Insurance policy end date2014-01-31
    Total amount of commissions paid to insurance brokerUSD $16,476
    Total amount of fees paid to insurance companyUSD $1,000
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    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 BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $117,799
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $12,396
    Amount paid for insurance broker fees1000
    Additional information about fees paid to insurance brokerBROKER BONUS
    Insurance broker organization code?3
    Insurance broker nameTHE BENEIFTS TEAM, INC.
    THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
    Policy contract number10033685
    Policy instance 1
    Insurance contract or identification number10033685
    Number of Individuals Covered238
    Insurance policy start date2012-02-01
    Insurance policy end date2013-01-31
    Total amount of commissions paid to insurance brokerUSD $12,736
    Total amount of fees paid to insurance companyUSD $3,365
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    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 BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $91,382
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $9,436
    Amount paid for insurance broker fees3365
    Additional information about fees paid to insurance brokerBROKER BONUS
    Insurance broker organization code?3
    Insurance broker nameUSI INSURANCE SERVICES, LLC
    NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
    Policy contract number27002
    Policy instance 2
    Insurance contract or identification number27002
    Number of Individuals Covered373
    Insurance policy start date2012-02-01
    Insurance policy end date2013-01-31
    Total amount of commissions paid to insurance brokerUSD $1,567
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    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 BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitYes
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    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 CarrierUSD $24,047
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,567
    Insurance broker organization code?3
    Insurance broker nameUSI INSURANCE SERVICES, LLC
    CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )
    Policy contract number3333015
    Policy instance 3
    Insurance contract or identification number3333015
    Number of Individuals Covered195
    Insurance policy start date2012-02-01
    Insurance policy end date2013-01-31
    Total amount of commissions paid to insurance brokerUSD $79,602
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    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 BenefitYes
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    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 CarrierUSD $1,499,138
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $79,602
    Insurance broker organization code?3
    Insurance broker nameUSI INSURANCE SERVICES, LLC
    CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )
    Policy contract number3333015
    Policy instance 5
    Insurance contract or identification number3333015
    Number of Individuals Covered181
    Insurance policy start date2011-02-01
    Insurance policy end date2012-01-31
    Total amount of commissions paid to insurance brokerUSD $66,444
    Total amount of fees paid to insurance companyUSD $4,131
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    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 BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    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 CarrierUSD $1,328,881
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    HUMANA (National Association of Insurance Commissioners NAIC id number: 70580 )
    Policy contract number597593
    Policy instance 1
    Insurance contract or identification number597593
    Number of Individuals Covered88
    Insurance policy start date2011-02-01
    Insurance policy end date2012-01-31
    Total amount of commissions paid to insurance brokerUSD $5,952
    Total amount of fees paid to insurance companyUSD $1,334
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    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 BenefitNo
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    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 CarrierUSD $59,655
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 95161 )
    Policy contract number96386
    Policy instance 2
    Insurance contract or identification number96386
    Number of Individuals Covered98
    Insurance policy start date2011-02-01
    Insurance policy end date2012-01-31
    Total amount of commissions paid to insurance brokerUSD $1,876
    Total amount of fees paid to insurance companyUSD $493
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    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 BenefitNo
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    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 CarrierUSD $20,863
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
    Policy contract number27002
    Policy instance 3
    Insurance contract or identification number27002
    Number of Individuals Covered349
    Insurance policy start date2011-02-01
    Insurance policy end date2012-01-31
    Total amount of commissions paid to insurance brokerUSD $1,512
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    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 BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitYes
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    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 CarrierUSD $27,267
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
    Policy contract number40L00200000004
    Policy instance 4
    Insurance contract or identification number40L00200000004
    Number of Individuals Covered233
    Insurance policy start date2011-02-01
    Insurance policy end date2012-01-31
    Total amount of commissions paid to insurance brokerUSD $13,538
    Total amount of fees paid to insurance companyUSD $2,002
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    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 BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $96,055
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )
    Policy contract number3333015
    Policy instance 5
    Insurance contract or identification number3333015
    Number of Individuals Covered179
    Insurance policy start date2010-02-01
    Insurance policy end date2011-01-31
    Total amount of commissions paid to insurance brokerUSD $58,803
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    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 BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    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 CarrierUSD $1,176,066
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $58,803
    Insurance broker organization code?3
    Insurance broker nameUSI INSURANCE SERVICES, LLC
    NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
    Policy contract number27002
    Policy instance 3
    Insurance contract or identification number27002
    Number of Individuals Covered335
    Insurance policy start date2010-02-01
    Insurance policy end date2011-01-31
    Total amount of commissions paid to insurance brokerUSD $1,418
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    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 BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitYes
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    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 CarrierUSD $23,474
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,418
    Insurance broker organization code?3
    Insurance broker nameUSI INSURANCE SERVICES, LLC
    COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 95161 )
    Policy contract number96386
    Policy instance 2
    Insurance contract or identification number96386
    Number of Individuals Covered97
    Insurance policy start date2010-02-01
    Insurance policy end date2011-01-31
    Total amount of commissions paid to insurance brokerUSD $2,087
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    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 BenefitNo
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    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 CarrierUSD $19,640
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $2,087
    Insurance broker organization code?3
    Insurance broker nameUSI INSURANCE SERVICES, LLC
    HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
    Policy contract number597593
    Policy instance 1
    Insurance contract or identification number597593
    Number of Individuals Covered76
    Insurance policy start date2010-02-01
    Insurance policy end date2011-01-31
    Total amount of commissions paid to insurance brokerUSD $5,190
    Total amount of fees paid to insurance companyUSD $910
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    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 BenefitNo
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    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 CarrierUSD $50,231
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $5,190
    Amount paid for insurance broker fees910
    Additional information about fees paid to insurance brokerVOLUME INCENTIVE AND NON-MONETARY
    Insurance broker organization code?3
    Insurance broker nameUSI INSURANCE SERVICES, LLC
    THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
    Policy contract number10033685
    Policy instance 4
    Insurance contract or identification number10033685
    Number of Individuals Covered225
    Insurance policy start date2010-02-01
    Insurance policy end date2011-01-31
    Total amount of commissions paid to insurance brokerUSD $11,045
    Total amount of fees paid to insurance companyUSD $2,097
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    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 BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $79,236
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $8,049
    Amount paid for insurance broker fees2097
    Additional information about fees paid to insurance brokerBROKER BONUS
    Insurance broker organization code?3
    Insurance broker nameTHE BENEFITS TEAM, INC.

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