COMMUNITY HEALTH SERVICES OF GA has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan GROUP LIFE AND HEALTH INSURANCE PLAN FOR EMPLOYEES OF COMMUNITY HEALTH SERVICES OF GEORGIA
401k plan membership statisitcs for GROUP LIFE AND HEALTH INSURANCE PLAN FOR EMPLOYEES OF COMMUNITY HEALTH SERVICES OF GEORGIA
| Measure | Date | Value |
|---|
| 2016 : GROUP LIFE AND HEALTH INSURANCE PLAN FOR EMPLOYEES OF COMMUNITY HEALTH SERVICES OF GEORGIA 2016 401k financial data |
|---|
| Total transfer of assets from this plan | 2016-12-31 | $536,027 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-12-31 | $0 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-12-31 | $1,008,252 |
| Total income from all sources (including contributions) | 2016-12-31 | $0 |
| Value of total assets at end of year | 2016-12-31 | $0 |
| Value of total assets at beginning of year | 2016-12-31 | $1,544,279 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2016-12-31 | No |
| Was this plan covered by a fidelity bond | 2016-12-31 | No |
| If this is an individual account plan, was there a blackout period | 2016-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2016-12-31 | No |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2016-12-31 | $1,006,291 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2016-12-31 | $101,303 |
| Total non interest bearing cash at beginning of year | 2016-12-31 | $537,988 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-12-31 | No |
| Value of net assets at end of year (total assets less liabilities) | 2016-12-31 | $0 |
| Value of net assets at beginning of year (total assets less liabilities) | 2016-12-31 | $536,027 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2016-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2016-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2016-12-31 | No |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2016-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2016-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2016-12-31 | No |
| Liabilities. Value of benefit claims payable at beginning of year | 2016-12-31 | $906,949 |
| Did the plan have assets held for investment | 2016-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2016-12-31 | No |
| 2015 : GROUP LIFE AND HEALTH INSURANCE PLAN FOR EMPLOYEES OF COMMUNITY HEALTH SERVICES OF GEORGIA 2015 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-12-31 | $3,678,280 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-12-31 | $3,490,975 |
| Total income from all sources (including contributions) | 2015-12-31 | $30,812,243 |
| Total of all expenses incurred | 2015-12-31 | $30,504,169 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2015-12-31 | $27,576,044 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2015-12-31 | $30,039,270 |
| Value of total assets at end of year | 2015-12-31 | $1,544,279 |
| Value of total assets at beginning of year | 2015-12-31 | $1,048,900 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2015-12-31 | $2,928,125 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2015-12-31 | No |
| Administrative expenses professional fees incurred | 2015-12-31 | $52,634 |
| Was this plan covered by a fidelity bond | 2015-12-31 | Yes |
| Value of fidelity bond cover | 2015-12-31 | $1,000,000 |
| If this is an individual account plan, was there a blackout period | 2015-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2015-12-31 | No |
| Contributions received from participants | 2015-12-31 | $9,716,843 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2015-12-31 | $1,006,291 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2015-12-31 | $396,203 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2015-12-31 | $328,673 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2015-12-31 | $864,052 |
| Other income not declared elsewhere | 2015-12-31 | $772,973 |
| Administrative expenses (other) incurred | 2015-12-31 | $980,558 |
| Total non interest bearing cash at end of year | 2015-12-31 | $537,988 |
| Total non interest bearing cash at beginning of year | 2015-12-31 | $652,697 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-12-31 | No |
| Value of net income/loss | 2015-12-31 | $308,074 |
| Value of net assets at end of year (total assets less liabilities) | 2015-12-31 | $-2,134,001 |
| Value of net assets at beginning of year (total assets less liabilities) | 2015-12-31 | $-2,442,075 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2015-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2015-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2015-12-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2015-12-31 | $2,853,317 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2015-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2015-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2015-12-31 | No |
| Contributions received in cash from employer | 2015-12-31 | $20,322,427 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2015-12-31 | $24,722,727 |
| Contract administrator fees | 2015-12-31 | $1,894,933 |
| Liabilities. Value of benefit claims payable at end of year | 2015-12-31 | $3,349,607 |
| Liabilities. Value of benefit claims payable at beginning of year | 2015-12-31 | $2,626,923 |
| Did the plan have assets held for investment | 2015-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2015-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2015-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2015-12-31 | Unqualified |
| Accountancy firm name | 2015-12-31 | MCNAIR,MCLEMORE,MIDDLEBROOKS & CO. |
| Accountancy firm EIN | 2015-12-31 | 581094351 |
| 2014 : GROUP LIFE AND HEALTH INSURANCE PLAN FOR EMPLOYEES OF COMMUNITY HEALTH SERVICES OF GEORGIA 2014 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-12-31 | $3,490,975 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-12-31 | $378,000 |
| Total income from all sources (including contributions) | 2014-12-31 | $26,579,922 |
| Total of all expenses incurred | 2014-12-31 | $29,021,997 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2014-12-31 | $26,541,871 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2014-12-31 | $26,568,039 |
| Value of total assets at end of year | 2014-12-31 | $1,048,900 |
| Value of total assets at beginning of year | 2014-12-31 | $378,000 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2014-12-31 | $2,480,126 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2014-12-31 | No |
| Administrative expenses professional fees incurred | 2014-12-31 | $42,261 |
| Was this plan covered by a fidelity bond | 2014-12-31 | Yes |
| Value of fidelity bond cover | 2014-12-31 | $1,000,000 |
| If this is an individual account plan, was there a blackout period | 2014-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2014-12-31 | No |
| Contributions received from participants | 2014-12-31 | $7,903,594 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2014-12-31 | $396,203 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2014-12-31 | $864,052 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2014-12-31 | $378,000 |
| Other income not declared elsewhere | 2014-12-31 | $11,883 |
| Administrative expenses (other) incurred | 2014-12-31 | $1,043,524 |
| Total non interest bearing cash at end of year | 2014-12-31 | $652,697 |
| Total non interest bearing cash at beginning of year | 2014-12-31 | $378,000 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-12-31 | No |
| Value of net income/loss | 2014-12-31 | $-2,442,075 |
| Value of net assets at end of year (total assets less liabilities) | 2014-12-31 | $-2,442,075 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2014-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2014-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2014-12-31 | No |
| Value of interest in common/collective trusts at end of year | 2014-12-31 | $0 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2014-12-31 | $3,476,485 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2014-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2014-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2014-12-31 | No |
| Contributions received in cash from employer | 2014-12-31 | $18,664,445 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2014-12-31 | $23,065,386 |
| Contract administrator fees | 2014-12-31 | $1,394,341 |
| Liabilities. Value of benefit claims payable at end of year | 2014-12-31 | $2,626,923 |
| Did the plan have assets held for investment | 2014-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2014-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2014-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2014-12-31 | Unqualified |
| Accountancy firm name | 2014-12-31 | MCNAIR, MCLEMORE, MIDDLEBROOKS & CO |
| Accountancy firm EIN | 2014-12-31 | 581094351 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | G 162057 |
| Policy instance | 4 |
| Insurance contract or identification number | G 162057 | | Number of Individuals Covered | 3717 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $45,975 | | Other welfare benefits provided | WEEKLY INCOME | | Welfare Benefit Premiums Paid to Carrier | USD $459,747 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $45,975 | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VAR 204313 |
| Policy instance | 9 |
| Insurance contract or identification number | VAR 204313 | | Number of Individuals Covered | 745 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $5,589 | | Other welfare benefits provided | ACC. DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $55,893 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,589 | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VCI 800535 |
| Policy instance | 1 |
| Insurance contract or identification number | VCI 800535 | | Number of Individuals Covered | 1156 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $31,540 | | Other welfare benefits provided | VOLUNTARY CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $315,402 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $31,540 | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL 149348 |
| Policy instance | 2 |
| Insurance contract or identification number | GL 149348 | | Number of Individuals Covered | 3717 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $60,979 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | DEPENDENT LIFE,AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $609,794 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $60,979 | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | LTD 122653 |
| Policy instance | 3 |
| Insurance contract or identification number | LTD 122653 | | Number of Individuals Covered | 438 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $4,380 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $87,604 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,380 | | Insurance broker organization code? | 3 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 ) |
| Policy contract number | 30062826 |
| Policy instance | 5 |
| Insurance contract or identification number | 30062826 | | Number of Individuals Covered | 2420 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $5 | | Total amount of fees paid to insurance company | USD $73,581 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $387,265 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 73581 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE | | Commission paid to Insurance Broker | USD $5 | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 ) |
| Policy contract number | 18169 |
| Policy instance | 6 |
| Insurance contract or identification number | 18169 | | Number of Individuals Covered | 2570 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of fees paid to insurance company | USD $235,076 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,091,215 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 235076 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VPL 300200 |
| Policy instance | 7 |
| Insurance contract or identification number | VPL 300200 | | Number of Individuals Covered | 842 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $21,888 | | Other welfare benefits provided | VOLUNTARY LONG-TERM DISABILITY | | Welfare Benefit Premiums Paid to Carrier | USD $218,876 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $21,888 | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VPS 325193 |
| Policy instance | 8 |
| Insurance contract or identification number | VPS 325193 | | Number of Individuals Covered | 18 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $740 | | Other welfare benefits provided | VOLUNTARY SHORT-TERM DISABILITY | | Welfare Benefit Premiums Paid to Carrier | USD $7,404 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $740 | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VPS 325193 |
| Policy instance | 8 |
| Insurance contract or identification number | VPS 325193 | | Number of Individuals Covered | 19 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $807 | | Other welfare benefits provided | VOLUNTARY SHORT-TERM DISABILITY | | Welfare Benefit Premiums Paid to Carrier | USD $8,072 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $807 | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VCI 800535 |
| Policy instance | 1 |
| Insurance contract or identification number | VCI 800535 | | Number of Individuals Covered | 1232 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $36,205 | | Other welfare benefits provided | VOLUNTARY CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $362,048 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $36,205 | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL 149348 |
| Policy instance | 2 |
| Insurance contract or identification number | GL 149348 | | Number of Individuals Covered | 4239 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $70,267 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | DEPENDENT LIFE,AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $702,671 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $70,267 | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | LTD 122653 |
| Policy instance | 3 |
| Insurance contract or identification number | LTD 122653 | | Number of Individuals Covered | 539 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $5,506 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $110,116 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,506 | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | G 162057 |
| Policy instance | 4 |
| Insurance contract or identification number | G 162057 | | Number of Individuals Covered | 4238 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $52,874 | | Other welfare benefits provided | WEEKLY INCOME | | Welfare Benefit Premiums Paid to Carrier | USD $528,745 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $52,874 | | Insurance broker organization code? | 3 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 ) |
| Policy contract number | 30062826 |
| Policy instance | 5 |
| Insurance contract or identification number | 30062826 | | Number of Individuals Covered | 2652 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $31,755 | | Total amount of fees paid to insurance company | USD $130,838 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $475,773 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 130838 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE | | Insurance broker organization code? | 3 | | Commission paid to Insurance Broker | USD $31,755 |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 ) |
| Policy contract number | 18169 |
| Policy instance | 6 |
| Insurance contract or identification number | 18169 | | Number of Individuals Covered | 2767 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,129,158 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VAR 204313 |
| Policy instance | 9 |
| Insurance contract or identification number | VAR 204313 | | Number of Individuals Covered | 736 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $6,133 | | Other welfare benefits provided | VOL. ACC. DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $61,332 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,133 | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VPL 300200 |
| Policy instance | 7 |
| Insurance contract or identification number | VPL 300200 | | Number of Individuals Covered | 916 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $28,334 | | Other welfare benefits provided | VOLUNTARY LONG-TERM DISABILITY | | Welfare Benefit Premiums Paid to Carrier | USD $283,336 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $28,334 | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VCI 800535 |
| Policy instance | 1 |
| Insurance contract or identification number | VCI 800535 | | Number of Individuals Covered | 1386 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $39,225 | | Other welfare benefits provided | VOLUNTARY CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $376,136 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $37,614 | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL 149348 |
| Policy instance | 2 |
| Insurance contract or identification number | GL 149348 | | Number of Individuals Covered | 4902 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $75,587 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | DEPENDENT LIFE,AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $725,604 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $72,560 | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | LTD 122653 |
| Policy instance | 3 |
| Insurance contract or identification number | LTD 122653 | | Number of Individuals Covered | 667 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $7,746 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $142,233 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,112 | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | G 162057 |
| Policy instance | 4 |
| Insurance contract or identification number | G 162057 | | Number of Individuals Covered | 4899 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $64,492 | | Other welfare benefits provided | WEEKLY INCOME | | Welfare Benefit Premiums Paid to Carrier | USD $618,413 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $61,841 | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 ) |
| Policy contract number | 18169 |
| Policy instance | 6 |
| Insurance contract or identification number | 18169 | | Number of Individuals Covered | 3145 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,349,799 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VPL 300200 |
| Policy instance | 7 |
| Insurance contract or identification number | VPL 300200 | | Number of Individuals Covered | 969 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $30,884 | | Other welfare benefits provided | VOLUNTARY LONG-TERM DISABILITY | | Welfare Benefit Premiums Paid to Carrier | USD $297,593 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $29,759 | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VPS 325193 |
| Policy instance | 8 |
| Insurance contract or identification number | VPS 325193 | | Number of Individuals Covered | 39 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $1,114 | | Other welfare benefits provided | VOLUNTARY SHORT-TERM DISABILITY | | Welfare Benefit Premiums Paid to Carrier | USD $11,141 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,114 | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VAR 204313 |
| Policy instance | 9 |
| Insurance contract or identification number | VAR 204313 | | Number of Individuals Covered | 714 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $5,953 | | Other welfare benefits provided | VOL. ACC. DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $57,549 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,755 | | Insurance broker organization code? | 3 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 ) |
| Policy contract number | 30062826 |
| Policy instance | 5 |
| Insurance contract or identification number | 30062826 | | Number of Individuals Covered | 2916 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $45,518 | | Total amount of fees paid to insurance company | USD $148,036 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $538,310 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 148036 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE | | Insurance broker organization code? | 3 | | Commission paid to Insurance Broker | USD $45,518 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VPS 325193 |
| Policy instance | 9 |
| Insurance contract or identification number | VPS 325193 | | Number of Individuals Covered | 46 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $1,966 | | Other welfare benefits provided | VOLUNTARY SHORT-TERM DISABILITY | | Welfare Benefit Premiums Paid to Carrier | USD $16,408 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,749 | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VPL 300200 |
| Policy instance | 8 |
| Insurance contract or identification number | VPL 300200 | | Number of Individuals Covered | 947 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $49,913 | | Other welfare benefits provided | VOLUNTARY LONG-TERM DISABILITY | | Welfare Benefit Premiums Paid to Carrier | USD $304,461 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $32,568 | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VG 181123 |
| Policy instance | 7 |
| Insurance contract or identification number | VG 181123 | | Number of Individuals Covered | 1108 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $13,131 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $65,885 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,883 | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 ) |
| Policy contract number | 18169 |
| Policy instance | 6 |
| Insurance contract or identification number | 18169 | | Number of Individuals Covered | 3536 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,389,485 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 ) |
| Policy contract number | 30062826 |
| Policy instance | 5 |
| Insurance contract or identification number | 30062826 | | Number of Individuals Covered | 3299 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $43,993 | | Total amount of fees paid to insurance company | USD $154,111 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $581,553 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 154111 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE | | Insurance broker organization code? | 3 | | Commission paid to Insurance Broker | USD $43,993 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VCI 800535 |
| Policy instance | 1 |
| Insurance contract or identification number | VCI 800535 | | Number of Individuals Covered | 1322 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $69,815 | | Other welfare benefits provided | VOLUNTARY CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $396,821 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $44,828 | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL 149348 |
| Policy instance | 2 |
| Insurance contract or identification number | GL 149348 | | Number of Individuals Covered | 5127 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $107,985 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | DEPENDENT LIFE,AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $719,897 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $74,245 | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VAR 204313 |
| Policy instance | 10 |
| Insurance contract or identification number | VAR 204313 | | Number of Individuals Covered | 550 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $8,652 | | Other welfare benefits provided | VOL. ACC. DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $53,283 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,658 | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | G 162057 |
| Policy instance | 4 |
| Insurance contract or identification number | G 162057 | | Number of Individuals Covered | 5125 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $105,376 | | Other welfare benefits provided | WEEKLY INCOME | | Welfare Benefit Premiums Paid to Carrier | USD $702,504 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $75,660 | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | LTD 122653 |
| Policy instance | 3 |
| Insurance contract or identification number | LTD 122653 | | Number of Individuals Covered | 836 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $20,020 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $183,981 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $12,442 | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VCI 800535 |
| Policy instance | 1 |
| Insurance contract or identification number | VCI 800535 | | Number of Individuals Covered | 1556 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $110,391 | | Total amount of fees paid to insurance company | USD $7,646 | | Other welfare benefits provided | VOLUNTARY CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $315,401 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $77,258 | | Amount paid for insurance broker fees | 7646 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VAR 204313 |
| Policy instance | 10 |
| Insurance contract or identification number | VAR 204313 | | Number of Individuals Covered | 506 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $9,855 | | Total amount of fees paid to insurance company | USD $602 | | Other welfare benefits provided | VOL. ACC. DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $39,421 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,697 | | Amount paid for insurance broker fees | 602 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VPS 325193 |
| Policy instance | 9 |
| Insurance contract or identification number | VPS 325193 | | Number of Individuals Covered | 2022 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $125,019 | | Total amount of fees paid to insurance company | USD $7,500 | | Other welfare benefits provided | VOLUNTARY SHORT-TERM DISABILITY | | Welfare Benefit Premiums Paid to Carrier | USD $500,077 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $103,474 | | Amount paid for insurance broker fees | 7500 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE FEES | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VPL 300200 |
| Policy instance | 8 |
| Insurance contract or identification number | VPL 300200 | | Number of Individuals Covered | 992 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $66,397 | | Total amount of fees paid to insurance company | USD $4,407 | | Other welfare benefits provided | VOLUNTARY LONG-TERM DISABILITY | | Welfare Benefit Premiums Paid to Carrier | USD $265,585 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $45,356 | | Amount paid for insurance broker fees | 4407 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VG 181123 |
| Policy instance | 7 |
| Insurance contract or identification number | VG 181123 | | Number of Individuals Covered | 1147 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $101,588 | | Total amount of fees paid to insurance company | USD $6,248 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $406,349 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $68,585 | | Amount paid for insurance broker fees | 6248 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 ) |
| Policy contract number | 18169 |
| Policy instance | 6 |
| Insurance contract or identification number | 18169 | | Number of Individuals Covered | 4027 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,211,943 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 ) |
| Policy contract number | 30062826 |
| Policy instance | 5 |
| Insurance contract or identification number | 30062826 | | Number of Individuals Covered | 3519 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $43,244 | | Total amount of fees paid to insurance company | USD $160,178 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $604,444 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,358 | | Amount paid for insurance broker fees | 160178 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | LTD 122653 |
| Policy instance | 3 |
| Insurance contract or identification number | LTD 122653 | | Number of Individuals Covered | 833 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $24,329 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $162,192 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $24,329 | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL 149348 |
| Policy instance | 2 |
| Insurance contract or identification number | GL 149348 | | Number of Individuals Covered | 5324 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $35,929 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | DEPENDENT LIFE,AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $239,530 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $35,929 | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | G 162057 |
| Policy instance | 4 |
| Insurance contract or identification number | G 162057 | | Number of Individuals Covered | 349 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $39,871 | | Other welfare benefits provided | WEEKLY INCOME | | Welfare Benefit Premiums Paid to Carrier | USD $265,810 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $39,871 | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL 149348 |
| Policy instance | 2 |
| Insurance contract or identification number | GL 149348 | | Number of Individuals Covered | 5378 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $48,310 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | DEPENDENT LIFE,AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $317,639 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $48,310 | | Insurance broker organization code? | 3 | | Insurance broker name | THE BENEFIT COMPANY, INC. |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VCI 800535 |
| Policy instance | 1 |
| Insurance contract or identification number | VCI 800535 | | Number of Individuals Covered | 1521 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $135,785 | | Total amount of fees paid to insurance company | USD $14,255 | | Other welfare benefits provided | VOLUNTARY CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $387,957 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $135,785 | | Amount paid for insurance broker fees | 14255 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE | | Insurance broker organization code? | 3 | | Insurance broker name | FORESTER BENEFITS MANAGEMENT, LLC |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | LTD 122653 |
| Policy instance | 3 |
| Insurance contract or identification number | LTD 122653 | | Number of Individuals Covered | 813 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $30,178 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $200,650 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $30,178 | | Insurance broker organization code? | 3 | | Insurance broker name | THE BENEFIT COMPANY, INC. |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | G 162057 |
| Policy instance | 4 |
| Insurance contract or identification number | G 162057 | | Number of Individuals Covered | 353 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $15,978 | | Other welfare benefits provided | WEEKLY INCOME | | Welfare Benefit Premiums Paid to Carrier | USD $106,523 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $15,978 | | Insurance broker organization code? | 3 | | Insurance broker name | THE BENEFIT COMPANY, INC. |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 ) |
| Policy contract number | 30062826 |
| Policy instance | 5 |
| Insurance contract or identification number | 30062826 | | Number of Individuals Covered | 3628 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $48,720 | | Total amount of fees paid to insurance company | USD $157,820 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $595,546 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $48,720 | | Amount paid for insurance broker fees | 157820 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE | | Insurance broker organization code? | 3 | | Insurance broker name | FORESTER BENEFITS MANAGEMENT |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 ) |
| Policy contract number | 18169 |
| Policy instance | 6 |
| Insurance contract or identification number | 18169 | | Number of Individuals Covered | 4112 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,149,482 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VG 181123 |
| Policy instance | 7 |
| Insurance contract or identification number | VG 181123 | | Number of Individuals Covered | 1125 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $104,139 | | Total amount of fees paid to insurance company | USD $5,519 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $416,555 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $104,139 | | Amount paid for insurance broker fees | 5519 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE | | Insurance broker organization code? | 3 | | Insurance broker name | THE BENEFIT COMPANY, INC. |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VPL 300200 |
| Policy instance | 8 |
| Insurance contract or identification number | VPL 300200 | | Number of Individuals Covered | 930 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $73,456 | | Total amount of fees paid to insurance company | USD $3,740 | | Other welfare benefits provided | VOLUNTARY LONG-TERM DISABILITY | | Welfare Benefit Premiums Paid to Carrier | USD $293,824 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $73,456 | | Amount paid for insurance broker fees | 3740 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE | | Insurance broker organization code? | 3 | | Insurance broker name | THE BENEFIT COMPANY, INC. |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VPS 325193 |
| Policy instance | 9 |
| Insurance contract or identification number | VPS 325193 | | Number of Individuals Covered | 1982 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $232,791 | | Total amount of fees paid to insurance company | USD $7,500 | | Other welfare benefits provided | VOLUNTARY SHORT-TERM DISABILITY | | Welfare Benefit Premiums Paid to Carrier | USD $931,165 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $232,791 | | Amount paid for insurance broker fees | 7500 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE | | Insurance broker organization code? | 3 | | Insurance broker name | THE BENEFIT COMPANY, INC. |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VAR 204313 |
| Policy instance | 10 |
| Insurance contract or identification number | VAR 204313 | | Number of Individuals Covered | 454 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $10,040 | | Total amount of fees paid to insurance company | USD $613 | | Other welfare benefits provided | VOL. ACC. DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $40,159 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,040 | | Amount paid for insurance broker fees | 613 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE | | Insurance broker organization code? | 3 | | Insurance broker name | THE BENEFIT COMPANY, INC. |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL 149348 |
| Policy instance | 2 |
| Insurance contract or identification number | GL 149348 | | Number of Individuals Covered | 5460 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $48,415 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | DEPENDENT LIFE,AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $322,658 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $48,415 | | Insurance broker organization code? | 3 | | Insurance broker name | THE BENEFIT COMPANY, INC. |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 232361 |
| Policy instance | 5 |
| Insurance contract or identification number | 232361 | | Number of Individuals Covered | 4070 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $43,466 | | Welfare Benefit Premiums Paid to Carrier | USD $1,818,154 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $43,466 | | Insurance broker organization code? | 3 | | Insurance broker name | STOP LOSS COALITION SERVICES, LLC |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | LTD 122653 |
| Policy instance | 3 |
| Insurance contract or identification number | LTD 122653 | | Number of Individuals Covered | 725 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $22,970 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $118,802 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $22,970 | | Insurance broker organization code? | 3 | | Insurance broker name | THE BENEFIT COMPANY, INC. |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | G 162057 |
| Policy instance | 4 |
| Insurance contract or identification number | G 162057 | | Number of Individuals Covered | 285 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $13,711 | | Other welfare benefits provided | WEEKLY INCOME | | Welfare Benefit Premiums Paid to Carrier | USD $91,403 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,711 | | Insurance broker organization code? | 3 | | Insurance broker name | THE BENEFIT COMPANY, INC. |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010-350687 |
| Policy instance | 1 |
| Insurance contract or identification number | 010-350687 | | Number of Individuals Covered | 6135 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $48,827 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $488,275 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $48,827 | | Insurance broker organization code? | 3 | | Insurance broker name | FORESTER BENEFITS MANAGEMENT LLC |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | G 162057 |
| Policy instance | 4 |
| Insurance contract or identification number | G 162057 | | Number of Individuals Covered | 254 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $12,142 | | Other welfare benefits provided | WEEKLY INCOME | | Welfare Benefit Premiums Paid to Carrier | USD $80,950 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $12,142 | | Insurance broker organization code? | 3 | | Insurance broker name | THE BENEFIT COMPANY, LLC |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | LTD 122653 |
| Policy instance | 3 |
| Insurance contract or identification number | LTD 122653 | | Number of Individuals Covered | 666 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $13,716 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $91,443 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,716 | | Insurance broker organization code? | 3 | | Insurance broker name | THE BENEFIT COMPANY, INC. |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL 149348 |
| Policy instance | 2 |
| Insurance contract or identification number | GL 149348 | | Number of Individuals Covered | 4610 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $42,860 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | DEPENDENT LIFE, AD & D | | Welfare Benefit Premiums Paid to Carrier | USD $285,734 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $42,860 | | Insurance broker organization code? | 3 | | Insurance broker name | THE BENEFIT COMPANY, INC. |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010-350687 |
| Policy instance | 1 |
| Insurance contract or identification number | 010-350687 | | Number of Individuals Covered | 6426 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $60,122 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $400,816 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $60,122 | | Insurance broker organization code? | 3 | | Insurance broker name | FORESTER BENEFITS MANAGEMENT, LLC |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 232361 |
| Policy instance | 5 |
| Insurance contract or identification number | 232361 | | Number of Individuals Covered | 4099 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $59,828 | | Welfare Benefit Premiums Paid to Carrier | USD $2,617,543 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $59,828 | | Insurance broker organization code? | 3 | | Insurance broker name | STOP LOSS COALITION SERVICES, LLC |
|
| BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 ) |
| Policy contract number | G0385,0386 |
| Policy instance | 1 |
| Insurance contract or identification number | G0385,0386 | | Number of Individuals Covered | 5310 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $287,801 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | POS CONTRACT | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $287,801 | | Insurance broker organization code? | 3 | | Insurance broker name | THE BENEFIT COMPANY, LLC |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | G 162057 |
| Policy instance | 6 |
| Insurance contract or identification number | G 162057 | | Number of Individuals Covered | 252 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $15,202 | | Other welfare benefits provided | WEEKLY INCOME | | Welfare Benefit Premiums Paid to Carrier | USD $101,345 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $15,202 | | Insurance broker organization code? | 3 | | Insurance broker name | THE BENEFIT COMPANY, LLC |
|
| CONSULT A DOCTOR (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 858 |
| Policy instance | 5 |
| Insurance contract or identification number | 858 | | Number of Individuals Covered | 3475 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $11,455 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $62,547 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,455 | | Insurance broker organization code? | 3 | | Insurance broker name | THE BENEFIT COMPANY, INC. |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | LTD 122653 |
| Policy instance | 4 |
| Insurance contract or identification number | LTD 122653 | | Number of Individuals Covered | 645 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $17,116 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $114,109 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $17,116 | | Insurance broker organization code? | 3 | | Insurance broker name | THE BENEFIT COMPANY, INC. |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL 149348 |
| Policy instance | 3 |
| Insurance contract or identification number | GL 149348 | | Number of Individuals Covered | 4265 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $49,725 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | DEPENDENT LIFE, AD & D | | Welfare Benefit Premiums Paid to Carrier | USD $331,500 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $49,725 | | Insurance broker organization code? | 3 | | Insurance broker name | THE BENEFIT COMPANY, INC. |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010-350687 |
| Policy instance | 2 |
| Insurance contract or identification number | 010-350687 | | Number of Individuals Covered | 4446 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $47,257 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $315,047 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $47,257 | | Insurance broker organization code? | 3 | | Insurance broker name | FORESTER BENEFITS MANAGEMENT, LLC |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | G 162057 |
| Policy instance | 1 |
| Insurance contract or identification number | G 162057 | | Number of Individuals Covered | 228 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $9,921 | | Other welfare benefits provided | WEEKLY INCOME | | Welfare Benefit Premiums Paid to Carrier | USD $66,141 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,921 | | Insurance broker organization code? | 3 | | Insurance broker name | THE BENEFIT COMPANY, INC. |
|
| CONSULT A DOCTOR (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 858 |
| Policy instance | 2 |
| Insurance contract or identification number | 858 | | Number of Individuals Covered | 3280 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $8,673 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $57,818 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,673 | | Insurance broker organization code? | 3 | | Insurance broker name | THE BENEFIT COMPANY, LLC |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL 149348 |
| Policy instance | 4 |
| Insurance contract or identification number | GL 149348 | | Number of Individuals Covered | 5021 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $28,439 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | DEPENDENT LIFE, AD & D | | Welfare Benefit Premiums Paid to Carrier | USD $189,594 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $28,439 | | Insurance broker organization code? | 3 | | Insurance broker name | THE BENEFIT COMPANY, INC. |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | LTD 122653 |
| Policy instance | 3 |
| Insurance contract or identification number | LTD 122653 | | Number of Individuals Covered | 605 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $11,214 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $74,756 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,214 | | Insurance broker organization code? | 3 | | Insurance broker name | THE BENEFIT COMPANY, INC. |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010-350687 |
| Policy instance | 5 |
| Insurance contract or identification number | 010-350687 | | Number of Individuals Covered | 4375 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $48,691 | | Total amount of fees paid to insurance company | USD $7,511 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $324,605 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $48,691 | | Amount paid for insurance broker fees | 7511 | | Insurance broker organization code? | 3 | | Insurance broker name | FORESTER BENEFITS MANAGEMENT, LLC |
|
| BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 ) |
| Policy contract number | G0385,0386 |
| Policy instance | 6 |
| Insurance contract or identification number | G0385,0386 | | Number of Individuals Covered | 5264 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $300,000 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | POS CONTRACT | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $300,000 | | Insurance broker organization code? | 3 | | Insurance broker name | THE BENEFIT COMPANY, LLC |
|
| BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 ) |
| Policy contract number | 1019031104 |
| Policy instance | 6 |
| Insurance contract or identification number | 1019031104 | | Number of Individuals Covered | 5373 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $281,250 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Were dividends or retroactive rate refunds paid in cash? | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010-350687 |
| Policy instance | 1 |
| Insurance contract or identification number | 010-350687 | | Number of Individuals Covered | 2554 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $22,340 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $148,264 | | 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: 65676 ) |
| Policy contract number | 10085887 |
| Policy instance | 2 |
| Insurance contract or identification number | 10085887 | | Number of Individuals Covered | 154 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $1,413 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD & D | | Welfare Benefit Premiums Paid to Carrier | USD $9,421 | | 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: 65676 ) |
| Policy contract number | 10106598 |
| Policy instance | 3 |
| Insurance contract or identification number | 10106598 | | Number of Individuals Covered | 222 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $6,830 | | Other welfare benefits provided | WEEKLY INCOME | | Welfare Benefit Premiums Paid to Carrier | USD $45,532 | | 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: 65676 ) |
| Policy contract number | 10106599 |
| Policy instance | 4 |
| Insurance contract or identification number | 10106599 | | Number of Individuals Covered | 492 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $19,904 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $132,692 | | 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: 65676 ) |
| Policy contract number | 10106470 |
| Policy instance | 5 |
| Insurance contract or identification number | 10106470 | | Number of Individuals Covered | 2691 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $58,073 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD & D | | Welfare Benefit Premiums Paid to Carrier | USD $232,279 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 ) |
| Policy contract number | 1019031104 |
| Policy instance | 5 |
| Insurance contract or identification number | 1019031104 | | Number of Individuals Covered | 5373 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $300,000 | | 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? | No |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 10106470 |
| Policy instance | 4 |
| Insurance contract or identification number | 10106470 | | Number of Individuals Covered | 3554 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $58,982 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD & D, DEPENDENT LIFE, LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $236,917 | | 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: 65676 ) |
| Policy contract number | 10106599 |
| Policy instance | 3 |
| Insurance contract or identification number | 10106599 | | Number of Individuals Covered | 518 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $17,092 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $113,942 | | 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: 65676 ) |
| Policy contract number | 10106598 |
| Policy instance | 2 |
| Insurance contract or identification number | 10106598 | | Number of Individuals Covered | 198 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $8,896 | | Other welfare benefits provided | WEEKLY INCOME | | Welfare Benefit Premiums Paid to Carrier | USD $59,301 | | 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: 65676 ) |
| Policy contract number | 10085887 |
| Policy instance | 1 |
| Insurance contract or identification number | 10085887 | | Number of Individuals Covered | 252 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $1,826 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD & D, DEPENDENT LIFE, LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $12,173 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
