BAPTIST COMMUNITY SERVICES has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan HEALTH BENEFIT PLAN FOR THE EMPLOYEES OF BAPTIST COMMUNITY SERVICES
401k plan membership statisitcs for HEALTH BENEFIT PLAN FOR THE EMPLOYEES OF BAPTIST COMMUNITY SERVICES
| Measure | Date | Value |
|---|
| 2021: HEALTH BENEFIT PLAN FOR THE EMPLOYEES OF BAPTIST COMMUNITY SERVICES 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-12-01 | 347 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-12-01 | 352 |
| Number of retired or separated participants receiving benefits | 2021-12-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-12-01 | 0 |
| Total of all active and inactive participants | 2021-12-01 | 352 |
| 2020: HEALTH BENEFIT PLAN FOR THE EMPLOYEES OF BAPTIST COMMUNITY SERVICES 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-12-01 | 361 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-12-01 | 347 |
| Number of retired or separated participants receiving benefits | 2020-12-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2020-12-01 | 0 |
| Total of all active and inactive participants | 2020-12-01 | 347 |
| 2019: HEALTH BENEFIT PLAN FOR THE EMPLOYEES OF BAPTIST COMMUNITY SERVICES 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-12-01 | 361 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-12-01 | 361 |
| Number of retired or separated participants receiving benefits | 2019-12-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-12-01 | 0 |
| Total of all active and inactive participants | 2019-12-01 | 361 |
| 2018: HEALTH BENEFIT PLAN FOR THE EMPLOYEES OF BAPTIST COMMUNITY SERVICES 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-12-01 | 340 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-12-01 | 361 |
| Number of retired or separated participants receiving benefits | 2018-12-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-12-01 | 0 |
| Total of all active and inactive participants | 2018-12-01 | 361 |
| 2017: HEALTH BENEFIT PLAN FOR THE EMPLOYEES OF BAPTIST COMMUNITY SERVICES 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-12-01 | 355 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-12-01 | 340 |
| Number of retired or separated participants receiving benefits | 2017-12-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-12-01 | 0 |
| Total of all active and inactive participants | 2017-12-01 | 340 |
| 2016: HEALTH BENEFIT PLAN FOR THE EMPLOYEES OF BAPTIST COMMUNITY SERVICES 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-12-01 | 384 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-12-01 | 355 |
| Number of retired or separated participants receiving benefits | 2016-12-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2016-12-01 | 0 |
| Total of all active and inactive participants | 2016-12-01 | 355 |
| 2015: HEALTH BENEFIT PLAN FOR THE EMPLOYEES OF BAPTIST COMMUNITY SERVICES 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-12-01 | 409 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-12-01 | 384 |
| Number of retired or separated participants receiving benefits | 2015-12-01 | 0 |
| Total of all active and inactive participants | 2015-12-01 | 384 |
| 2014: HEALTH BENEFIT PLAN FOR THE EMPLOYEES OF BAPTIST COMMUNITY SERVICES 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-12-01 | 383 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-12-01 | 408 |
| Number of retired or separated participants receiving benefits | 2014-12-01 | 1 |
| Total of all active and inactive participants | 2014-12-01 | 409 |
| 2013: HEALTH BENEFIT PLAN FOR THE EMPLOYEES OF BAPTIST COMMUNITY SERVICES 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-12-01 | 357 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-12-01 | 381 |
| Number of retired or separated participants receiving benefits | 2013-12-01 | 2 |
| Total of all active and inactive participants | 2013-12-01 | 383 |
| Total participants, beginning-of-year | 2013-01-01 | 356 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 354 |
| Number of retired or separated participants receiving benefits | 2013-01-01 | 3 |
| Total of all active and inactive participants | 2013-01-01 | 357 |
| 2012: HEALTH BENEFIT PLAN FOR THE EMPLOYEES OF BAPTIST COMMUNITY SERVICES 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 363 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 352 |
| Number of retired or separated participants receiving benefits | 2012-01-01 | 4 |
| Total of all active and inactive participants | 2012-01-01 | 356 |
| 2011: HEALTH BENEFIT PLAN FOR THE EMPLOYEES OF BAPTIST COMMUNITY SERVICES 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-01-01 | 362 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 360 |
| Number of retired or separated participants receiving benefits | 2011-01-01 | 3 |
| Number of other retired or separated participants entitled to future benefits | 2011-01-01 | 0 |
| Total of all active and inactive participants | 2011-01-01 | 363 |
| Total participants | 2011-01-01 | 363 |
| 2010: HEALTH BENEFIT PLAN FOR THE EMPLOYEES OF BAPTIST COMMUNITY SERVICES 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-01-01 | 336 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-01-01 | 358 |
| Number of retired or separated participants receiving benefits | 2010-01-01 | 4 |
| Number of other retired or separated participants entitled to future benefits | 2010-01-01 | 0 |
| Total of all active and inactive participants | 2010-01-01 | 362 |
| Total participants | 2010-01-01 | 362 |
| 2009: HEALTH BENEFIT PLAN FOR THE EMPLOYEES OF BAPTIST COMMUNITY SERVICES 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-01-01 | 301 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 328 |
| Number of retired or separated participants receiving benefits | 2009-01-01 | 8 |
| Number of other retired or separated participants entitled to future benefits | 2009-01-01 | 0 |
| Total of all active and inactive participants | 2009-01-01 | 336 |
| Total participants | 2009-01-01 | 336 |
| 2021: HEALTH BENEFIT PLAN FOR THE EMPLOYEES OF BAPTIST COMMUNITY SERVICES 2021 form 5500 responses |
|---|
| 2021-12-01 | Type of plan entity | Single employer plan |
| 2021-12-01 | Plan funding arrangement – Insurance | Yes |
| 2021-12-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-12-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: HEALTH BENEFIT PLAN FOR THE EMPLOYEES OF BAPTIST COMMUNITY SERVICES 2020 form 5500 responses |
|---|
| 2020-12-01 | Type of plan entity | Single employer plan |
| 2020-12-01 | Plan funding arrangement – Insurance | Yes |
| 2020-12-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-12-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: HEALTH BENEFIT PLAN FOR THE EMPLOYEES OF BAPTIST COMMUNITY SERVICES 2019 form 5500 responses |
|---|
| 2019-12-01 | Type of plan entity | Single employer plan |
| 2019-12-01 | Plan funding arrangement – Insurance | Yes |
| 2019-12-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-12-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: HEALTH BENEFIT PLAN FOR THE EMPLOYEES OF BAPTIST COMMUNITY SERVICES 2018 form 5500 responses |
|---|
| 2018-12-01 | Type of plan entity | Single employer plan |
| 2018-12-01 | Plan funding arrangement – Insurance | Yes |
| 2018-12-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-12-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: HEALTH BENEFIT PLAN FOR THE EMPLOYEES OF BAPTIST COMMUNITY SERVICES 2017 form 5500 responses |
|---|
| 2017-12-01 | Type of plan entity | Single employer plan |
| 2017-12-01 | Plan funding arrangement – Insurance | Yes |
| 2017-12-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-12-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: HEALTH BENEFIT PLAN FOR THE EMPLOYEES OF BAPTIST COMMUNITY SERVICES 2016 form 5500 responses |
|---|
| 2016-12-01 | Type of plan entity | Single employer plan |
| 2016-12-01 | Plan funding arrangement – Insurance | Yes |
| 2016-12-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-12-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: HEALTH BENEFIT PLAN FOR THE EMPLOYEES OF BAPTIST COMMUNITY SERVICES 2015 form 5500 responses |
|---|
| 2015-12-01 | Type of plan entity | Single employer plan |
| 2015-12-01 | Plan funding arrangement – Insurance | Yes |
| 2015-12-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-12-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: HEALTH BENEFIT PLAN FOR THE EMPLOYEES OF BAPTIST COMMUNITY SERVICES 2014 form 5500 responses |
|---|
| 2014-12-01 | Type of plan entity | Single employer plan |
| 2014-12-01 | Plan funding arrangement – Insurance | Yes |
| 2014-12-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-12-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: HEALTH BENEFIT PLAN FOR THE EMPLOYEES OF BAPTIST COMMUNITY SERVICES 2013 form 5500 responses |
|---|
| 2013-12-01 | Type of plan entity | Single employer plan |
| 2013-12-01 | Plan funding arrangement – Insurance | Yes |
| 2013-12-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-12-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013-01-01 | Type of plan entity | Single employer plan |
| 2013-01-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2013-01-01 | Plan funding arrangement – Insurance | Yes |
| 2013-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2012: HEALTH BENEFIT PLAN FOR THE EMPLOYEES OF BAPTIST COMMUNITY SERVICES 2012 form 5500 responses |
|---|
| 2012-01-01 | Type of plan entity | Single employer plan |
| 2012-01-01 | Plan funding arrangement – Insurance | Yes |
| 2012-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2011: HEALTH BENEFIT PLAN FOR THE EMPLOYEES OF BAPTIST COMMUNITY SERVICES 2011 form 5500 responses |
|---|
| 2011-01-01 | Type of plan entity | Single employer plan |
| 2011-01-01 | Submission has been amended | No |
| 2011-01-01 | This submission is the final filing | No |
| 2011-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-01-01 | Plan is a collectively bargained plan | No |
| 2011-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2011-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2010: HEALTH BENEFIT PLAN FOR THE EMPLOYEES OF BAPTIST COMMUNITY SERVICES 2010 form 5500 responses |
|---|
| 2010-01-01 | Type of plan entity | Single employer plan |
| 2010-01-01 | Submission has been amended | No |
| 2010-01-01 | This submission is the final filing | No |
| 2010-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2010-01-01 | Plan is a collectively bargained plan | No |
| 2010-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2010-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2009: HEALTH BENEFIT PLAN FOR THE EMPLOYEES OF BAPTIST COMMUNITY SERVICES 2009 form 5500 responses |
|---|
| 2009-01-01 | Type of plan entity | Single employer plan |
| 2009-01-01 | Submission has been amended | No |
| 2009-01-01 | This submission is the final filing | No |
| 2009-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-01-01 | Plan is a collectively bargained plan | No |
| 2009-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2009-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | S487200 |
| Policy instance | 2 |
| Insurance contract or identification number | S487200 | | Number of Individuals Covered | 352 | | Insurance policy start date | 2022-09-01 | | Insurance policy end date | 2022-11-30 | | Other welfare benefits provided | TRANSPLANT POLICY | | Welfare Benefit Premiums Paid to Carrier | USD $49,180 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 ) |
| Policy contract number | 203-14-S4477 |
| Policy instance | 7 |
| Insurance contract or identification number | 203-14-S4477 | | Number of Individuals Covered | 244 | | Insurance policy start date | 2021-12-01 | | Insurance policy end date | 2022-11-30 | | Total amount of commissions paid to insurance broker | USD $13,056 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $158,175 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,056 | | Insurance broker organization code? | 3 |
|
| COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 ) |
| Policy contract number | 203-14-S4477 |
| Policy instance | 6 |
| Insurance contract or identification number | 203-14-S4477 | | Number of Individuals Covered | 373 | | Insurance policy start date | 2021-12-01 | | Insurance policy end date | 2022-11-30 | | Total amount of commissions paid to insurance broker | USD $8,448 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $102,352 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,448 | | Insurance broker organization code? | 3 |
|
| COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 ) |
| Policy contract number | 203-14-S4477 |
| Policy instance | 5 |
| Insurance contract or identification number | 203-14-S4477 | | Number of Individuals Covered | 18 | | Insurance policy start date | 2021-12-01 | | Insurance policy end date | 2022-11-30 | | Total amount of commissions paid to insurance broker | USD $870 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,546 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $870 | | Insurance broker organization code? | 3 |
|
| COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 ) |
| Policy contract number | 203-14-S4477 |
| Policy instance | 4 |
| Insurance contract or identification number | 203-14-S4477 | | Number of Individuals Covered | 409 | | Insurance policy start date | 2021-12-01 | | Insurance policy end date | 2022-11-30 | | Total amount of commissions paid to insurance broker | USD $1,833 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $22,205 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,833 | | Insurance broker organization code? | 3 |
|
| COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 ) |
| Policy contract number | 203-14-S4477 |
| Policy instance | 3 |
| Insurance contract or identification number | 203-14-S4477 | | Number of Individuals Covered | 329 | | Insurance policy start date | 2021-12-01 | | Insurance policy end date | 2022-11-30 | | Total amount of commissions paid to insurance broker | USD $18,213 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $220,656 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $18,213 | | Insurance broker organization code? | 3 |
|
| COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | S487200 |
| Policy instance | 1 |
| Insurance contract or identification number | S487200 | | Number of Individuals Covered | 352 | | Insurance policy start date | 2021-12-01 | | Insurance policy end date | 2022-11-30 | | Total amount of fees paid to insurance company | USD $68,961 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $590,910 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 68961 | | Additional information about fees paid to insurance broker | REINSURANCE | | Insurance broker organization code? | 3 |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010-029893 |
| Policy instance | 8 |
| Insurance contract or identification number | 010-029893 | | Number of Individuals Covered | 679 | | Insurance policy start date | 2021-12-01 | | Insurance policy end date | 2022-11-30 | | Total amount of commissions paid to insurance broker | USD $7,350 | | Total amount of fees paid to insurance company | USD $642 | | Vision Insurance Welfare Benefit | Yes | | Other welfare benefits provided | LASIK | | Welfare Benefit Premiums Paid to Carrier | USD $73,498 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,350 | | Amount paid for insurance broker fees | 642 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 ) |
| Policy contract number | PD3-89046698001 |
| Policy instance | 6 |
| Insurance contract or identification number | PD3-89046698001 | | Number of Individuals Covered | 488 | | Insurance policy start date | 2020-04-01 | | Insurance policy end date | 2021-03-31 | | Other welfare benefits provided | LIBERTY MUTUAL LEAVE SERVICES | | Welfare Benefit Premiums Paid to Carrier | USD $17,826 | | 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 | SA3-89046698001 |
| Policy instance | 7 |
| Insurance contract or identification number | SA3-89046698001 | | Number of Individuals Covered | 404 | | Insurance policy start date | 2021-04-01 | | Insurance policy end date | 2021-06-30 | | Total amount of commissions paid to insurance broker | USD $6,493 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $43,286 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,493 | | Insurance broker organization code? | 3 |
|
| COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 ) |
| Policy contract number | 203-14-S4477 |
| Policy instance | 11 |
| Insurance contract or identification number | 203-14-S4477 | | Number of Individuals Covered | 319 | | Insurance policy start date | 2021-06-01 | | Insurance policy end date | 2021-11-30 | | Total amount of commissions paid to insurance broker | USD $11,605 | | Total amount of fees paid to insurance company | USD $52,310 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $182,668 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,605 | | Amount paid for insurance broker fees | 52310 | | Additional information about fees paid to insurance broker | REINSURANCE FEE | | Insurance broker organization code? | 3 |
|
| LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 ) |
| Policy contract number | GD3-89046698001 |
| Policy instance | 5 |
| Insurance contract or identification number | GD3-89046698001 | | Number of Individuals Covered | 398 | | Insurance policy start date | 2020-04-01 | | Insurance policy end date | 2021-03-31 | | Total amount of commissions paid to insurance broker | USD $19,364 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $129,094 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $19,364 | | Insurance broker organization code? | 3 |
|
| LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 ) |
| Policy contract number | GF3-89046698001 |
| Policy instance | 4 |
| Insurance contract or identification number | GF3-89046698001 | | Number of Individuals Covered | 23 | | Insurance policy start date | 2020-04-01 | | Insurance policy end date | 2021-03-31 | | Total amount of commissions paid to insurance broker | USD $2,034 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $13,561 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,034 | | Insurance broker organization code? | 3 |
|
| LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 ) |
| Policy contract number | SA3-89046698001 |
| Policy instance | 3 |
| Insurance contract or identification number | SA3-89046698001 | | Number of Individuals Covered | 429 | | Insurance policy start date | 2020-04-01 | | Insurance policy end date | 2021-03-31 | | Total amount of commissions paid to insurance broker | USD $23,925 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $159,496 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $23,925 | | Insurance broker organization code? | 3 |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010-029893 |
| Policy instance | 1 |
| Insurance contract or identification number | 010-029893 | | Number of Individuals Covered | 6 | | Insurance policy start date | 2020-12-01 | | Insurance policy end date | 2021-05-31 | | Total amount of commissions paid to insurance broker | USD $293 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,932 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $293 | | Insurance broker organization code? | 3 |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | HCCLOT40053 |
| Policy instance | 2 |
| Insurance contract or identification number | HCCLOT40053 | | Number of Individuals Covered | 340 | | Insurance policy start date | 2020-12-01 | | Insurance policy end date | 2021-11-30 | | Total amount of commissions paid to insurance broker | USD $2,593 | | Other welfare benefits provided | ORGAN TRANSPLANT | | Welfare Benefit Premiums Paid to Carrier | USD $49,428 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,593 | | Insurance broker organization code? | 3 |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | GF3-89046698001 |
| Policy instance | 8 |
| Insurance contract or identification number | GF3-89046698001 | | Number of Individuals Covered | 22 | | Insurance policy start date | 2021-04-01 | | Insurance policy end date | 2021-06-30 | | Total amount of commissions paid to insurance broker | USD $543 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,620 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $543 | | Insurance broker organization code? | 3 |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | GD3-89046698001 |
| Policy instance | 9 |
| Insurance contract or identification number | GD3-89046698001 | | Number of Individuals Covered | 375 | | Insurance policy start date | 2021-04-01 | | Insurance policy end date | 2021-06-30 | | Total amount of commissions paid to insurance broker | USD $5,427 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $36,180 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,427 | | Insurance broker organization code? | 3 |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010-029893 |
| Policy instance | 17 |
| Insurance contract or identification number | 010-029893 | | Number of Individuals Covered | 660 | | Insurance policy start date | 2020-12-01 | | Insurance policy end date | 2021-11-30 | | Total amount of commissions paid to insurance broker | USD $7,691 | | Total amount of fees paid to insurance company | USD $124 | | Vision Insurance Welfare Benefit | Yes | | Other welfare benefits provided | LASIK | | Welfare Benefit Premiums Paid to Carrier | USD $76,909 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,691 | | Amount paid for insurance broker fees | 124 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | S487200 |
| Policy instance | 16 |
| Insurance contract or identification number | S487200 | | Number of Individuals Covered | 359 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2021-11-30 | | Total amount of fees paid to insurance company | USD $16,360 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $137,476 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 16360 | | Additional information about fees paid to insurance broker | REINSURANCE FEE | | Insurance broker organization code? | 3 |
|
| COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 ) |
| Policy contract number | 203-14-S4477 |
| Policy instance | 15 |
| Insurance contract or identification number | 203-14-S4477 | | Number of Individuals Covered | 255 | | Insurance policy start date | 2021-06-01 | | Insurance policy end date | 2021-11-30 | | Total amount of commissions paid to insurance broker | USD $4,050 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $63,752 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,050 | | Insurance broker organization code? | 3 |
|
| COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 ) |
| Policy contract number | 203-14-S4477 |
| Policy instance | 14 |
| Insurance contract or identification number | 203-14-S4477 | | Number of Individuals Covered | 385 | | Insurance policy start date | 2021-06-01 | | Insurance policy end date | 2021-11-30 | | Total amount of commissions paid to insurance broker | USD $2,642 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $41,584 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,642 | | Insurance broker organization code? | 3 |
|
| COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 ) |
| Policy contract number | 203-14-S4477 |
| Policy instance | 13 |
| Insurance contract or identification number | 203-14-S4477 | | Number of Individuals Covered | 22 | | Insurance policy start date | 2021-06-01 | | Insurance policy end date | 2021-11-30 | | Total amount of commissions paid to insurance broker | USD $279 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,393 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $279 | | Insurance broker organization code? | 3 |
|
| COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 ) |
| Policy contract number | 203-14-S4477 |
| Policy instance | 12 |
| Insurance contract or identification number | 203-14-S4477 | | Number of Individuals Covered | 411 | | Insurance policy start date | 2021-06-01 | | Insurance policy end date | 2021-11-30 | | Total amount of commissions paid to insurance broker | USD $572 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $9,004 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $572 | | Insurance broker organization code? | 3 |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | PD3-89046698001 |
| Policy instance | 10 |
| Insurance contract or identification number | PD3-89046698001 | | Number of Individuals Covered | 499 | | Insurance policy start date | 2021-04-01 | | Insurance policy end date | 2021-06-30 | | Other welfare benefits provided | LEAVE SERVICES | | Welfare Benefit Premiums Paid to Carrier | USD $4,036 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 ) |
| Policy contract number | PD3-89046698001 |
| Policy instance | 7 |
| Insurance contract or identification number | PD3-89046698001 | | Number of Individuals Covered | 538 | | Insurance policy start date | 2019-04-01 | | Insurance policy end date | 2020-03-31 | | Other welfare benefits provided | LIBERTY MUTUAL LEAVE SERVICES | | Welfare Benefit Premiums Paid to Carrier | USD $10,822 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 ) |
| Policy contract number | GD3-89046698001 |
| Policy instance | 6 |
| Insurance contract or identification number | GD3-89046698001 | | Number of Individuals Covered | 408 | | Insurance policy start date | 2019-04-01 | | Insurance policy end date | 2020-03-31 | | Total amount of commissions paid to insurance broker | USD $14,898 | | Total amount of fees paid to insurance company | USD $1,455 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $90,794 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $14,898 | | Amount paid for insurance broker fees | 1455 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 ) |
| Policy contract number | GF3-89046698001 |
| Policy instance | 5 |
| Insurance contract or identification number | GF3-89046698001 | | Number of Individuals Covered | 19 | | Insurance policy start date | 2019-04-01 | | Insurance policy end date | 2020-03-31 | | Total amount of commissions paid to insurance broker | USD $1,029 | | Total amount of fees paid to insurance company | USD $133 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,847 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,029 | | Amount paid for insurance broker fees | 133 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 ) |
| Policy contract number | SA3-89046698001 |
| Policy instance | 4 |
| Insurance contract or identification number | SA3-89046698001 | | Number of Individuals Covered | 435 | | Insurance policy start date | 2019-04-01 | | Insurance policy end date | 2020-03-31 | | Total amount of commissions paid to insurance broker | USD $16,309 | | Total amount of fees paid to insurance company | USD $1,746 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $101,716 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $16,309 | | Amount paid for insurance broker fees | 1746 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | HCCLOT40053 |
| Policy instance | 3 |
| Insurance contract or identification number | HCCLOT40053 | | Number of Individuals Covered | 360 | | Insurance policy start date | 2019-12-01 | | Insurance policy end date | 2020-11-30 | | Total amount of commissions paid to insurance broker | USD $4,302 | | Other welfare benefits provided | ORGAN TRANSPLANT | | Welfare Benefit Premiums Paid to Carrier | USD $48,860 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,302 | | Insurance broker organization code? | 3 |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010-029893 |
| Policy instance | 2 |
| Insurance contract or identification number | 010-029893 | | Number of Individuals Covered | 743 | | Insurance policy start date | 2019-12-01 | | Insurance policy end date | 2020-11-30 | | Total amount of commissions paid to insurance broker | USD $31,015 | | Total amount of fees paid to insurance company | USD $2,632 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $310,154 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $31,015 | | Amount paid for insurance broker fees | 2632 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| UNIMERICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 91529 ) |
| Policy contract number | UNI-202419 |
| Policy instance | 1 |
| Insurance contract or identification number | UNI-202419 | | Number of Individuals Covered | 360 | | Insurance policy start date | 2019-12-01 | | Insurance policy end date | 2020-11-30 | | Total amount of commissions paid to insurance broker | USD $65,899 | | Total amount of fees paid to insurance company | USD $69,768 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $549,158 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $38,441 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 69768 | | Additional information about fees paid to insurance broker | REINSURANCE FEE |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | HCCLOT40053 |
| Policy instance | 3 |
| Insurance contract or identification number | HCCLOT40053 | | Number of Individuals Covered | 354 | | Insurance policy start date | 2018-12-01 | | Insurance policy end date | 2019-11-30 | | Total amount of commissions paid to insurance broker | USD $2,486 | | Other welfare benefits provided | ORGAN TRANSPLANT | | Welfare Benefit Premiums Paid to Carrier | USD $49,667 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,486 | | Insurance broker organization code? | 3 |
|
| UNIMERICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 91529 ) |
| Policy contract number | UNI-202419 |
| Policy instance | 1 |
| Insurance contract or identification number | UNI-202419 | | Number of Individuals Covered | 354 | | Insurance policy start date | 2018-12-01 | | Insurance policy end date | 2019-11-30 | | Total amount of commissions paid to insurance broker | USD $67,997 | | Total amount of fees paid to insurance company | USD $68,751 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $566,795 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $39,657 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 68751 | | Additional information about fees paid to insurance broker | REINSURANCE FEE |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010-029893 |
| Policy instance | 2 |
| Insurance contract or identification number | 010-029893 | | Number of Individuals Covered | 776 | | Insurance policy start date | 2018-12-01 | | Insurance policy end date | 2019-11-30 | | Total amount of commissions paid to insurance broker | USD $32,808 | | Total amount of fees paid to insurance company | USD $2,300 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $328,084 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $32,808 | | Amount paid for insurance broker fees | 2300 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 ) |
| Policy contract number | SA3-89046698001 |
| Policy instance | 4 |
| Insurance contract or identification number | SA3-89046698001 | | Number of Individuals Covered | 412 | | Insurance policy start date | 2018-04-01 | | Insurance policy end date | 2019-03-31 | | Total amount of commissions paid to insurance broker | USD $16,216 | | Total amount of fees paid to insurance company | USD $3,883 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $141,314 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $16,216 | | Amount paid for insurance broker fees | 3883 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 ) |
| Policy contract number | GF3-89046698001 |
| Policy instance | 5 |
| Insurance contract or identification number | GF3-89046698001 | | Number of Individuals Covered | 21 | | Insurance policy start date | 2018-04-01 | | Insurance policy end date | 2019-03-31 | | Total amount of commissions paid to insurance broker | USD $1,248 | | Total amount of fees paid to insurance company | USD $299 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,936 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,248 | | Amount paid for insurance broker fees | 299 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 ) |
| Policy contract number | GD3-89046698001 |
| Policy instance | 6 |
| Insurance contract or identification number | GD3-89046698001 | | Number of Individuals Covered | 395 | | Insurance policy start date | 2018-04-01 | | Insurance policy end date | 2019-03-31 | | Total amount of commissions paid to insurance broker | USD $14,465 | | Total amount of fees paid to insurance company | USD $3,436 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $115,226 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $14,465 | | Amount paid for insurance broker fees | 3436 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 ) |
| Policy contract number | PD3-89046698001 |
| Policy instance | 7 |
| Insurance contract or identification number | PD3-89046698001 | | Number of Individuals Covered | 478 | | Insurance policy start date | 2018-04-01 | | Insurance policy end date | 2019-03-31 | | Total amount of fees paid to insurance company | USD $325 | | Other welfare benefits provided | LIBERTY MUTUAL LEAVE SERVICES | | Welfare Benefit Premiums Paid to Carrier | USD $12,922 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 325 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010-029893 |
| Policy instance | 2 |
| Insurance contract or identification number | 010-029893 | | Number of Individuals Covered | 748 | | Insurance policy start date | 2017-12-01 | | Insurance policy end date | 2018-11-30 | | Total amount of commissions paid to insurance broker | USD $32,829 | | Total amount of fees paid to insurance company | USD $4,701 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $328,294 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNIMERICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 91529 ) |
| Policy contract number | UNI-202419 |
| Policy instance | 1 |
| Insurance contract or identification number | UNI-202419 | | Number of Individuals Covered | 351 | | Insurance policy start date | 2017-12-01 | | Insurance policy end date | 2018-11-30 | | Total amount of commissions paid to insurance broker | USD $68,386 | | Total amount of fees paid to insurance company | USD $68,411 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $569,884 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
| Policy contract number | 9475515 |
| Policy instance | 3 |
| Insurance contract or identification number | 9475515 | | Number of Individuals Covered | 340 | | Insurance policy start date | 2017-12-01 | | Insurance policy end date | 2018-11-30 | | Total amount of commissions paid to insurance broker | USD $2,609 | | Other welfare benefits provided | ORGAN TRANSPLANT | | Welfare Benefit Premiums Paid to Carrier | USD $52,177 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 ) |
| Policy contract number | SA3-89046698001 |
| Policy instance | 4 |
| Insurance contract or identification number | SA3-89046698001 | | Number of Individuals Covered | 412 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2018-03-31 | | Total amount of commissions paid to insurance broker | USD $10,280 | | Total amount of fees paid to insurance company | USD $927 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $90,771 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 ) |
| Policy contract number | GF3-89046698001 |
| Policy instance | 5 |
| Insurance contract or identification number | GF3-89046698001 | | Number of Individuals Covered | 21 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2018-03-31 | | Total amount of commissions paid to insurance broker | USD $705 | | Total amount of fees paid to insurance company | USD $248 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,194 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| US FIRE (National Association of Insurance Commissioners NAIC id number: 21113 ) |
| Policy contract number | #US200593 |
| Policy instance | 2 |
| Insurance contract or identification number | #US200593 | | Number of Individuals Covered | 757 | | Insurance policy start date | 2014-12-01 | | Insurance policy end date | 2015-11-30 | | Total amount of commissions paid to insurance broker | USD $4,229 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | ORGAN TRANSPLANT | | Welfare Benefit Premiums Paid to Carrier | USD $42,285 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,229 | | Insurance broker organization code? | 3 | | Insurance broker name | UPSHAW INSURANCE AGENCY |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010-029893 |
| Policy instance | 3 |
| Insurance contract or identification number | 010-029893 | | Number of Individuals Covered | 789 | | Insurance policy start date | 2014-12-01 | | Insurance policy end date | 2015-11-30 | | Total amount of commissions paid to insurance broker | USD $33,127 | | Total amount of fees paid to insurance company | USD $5,107 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $331,268 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $33,127 | | Amount paid for insurance broker fees | 5107 | | Insurance broker organization code? | 3 | | Insurance broker name | UPSHAW INSURANCE AGENCY |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL 146760 |
| Policy instance | 4 |
| Insurance contract or identification number | GL 146760 | | Number of Individuals Covered | 379 | | Insurance policy start date | 2014-12-01 | | Insurance policy end date | 2015-11-30 | | Total amount of commissions paid to insurance broker | USD $25,972 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $121,130 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $25,972 | | Insurance broker organization code? | 3 | | Insurance broker name | UPSHAW INSURANCE AGENCY |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | HCL30183 |
| Policy instance | 1 |
| Insurance contract or identification number | HCL30183 | | Number of Individuals Covered | 827 | | Insurance policy start date | 2014-12-01 | | Insurance policy end date | 2015-11-30 | | Total amount of commissions paid to insurance broker | USD $30,411 | | Total amount of fees paid to insurance company | USD $74,597 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $654,562 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,229 | | Amount paid for insurance broker fees | 74597 | | Additional information about fees paid to insurance broker | REINSURANCE FEE | | Insurance broker organization code? | 3 | | Insurance broker name | LOCKTON COMPANIES LLC |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | LTD 120423 |
| Policy instance | 5 |
| Insurance contract or identification number | LTD 120423 | | Number of Individuals Covered | 9 | | Insurance policy start date | 2014-12-01 | | Insurance policy end date | 2015-11-30 | | Total amount of commissions paid to insurance broker | USD $2,724 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $12,730 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,724 | | Insurance broker organization code? | 3 | | Insurance broker name | UPSHAW INSURANCE AGENCY |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | LTD 120423 |
| Policy instance | 6 |
| Insurance contract or identification number | LTD 120423 | | Number of Individuals Covered | 17 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $1,913 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $9,566 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,913 | | Insurance broker organization code? | 3 | | Insurance broker name | UPSHAW INSURANCE AGENCY |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | HCL30183 |
| Policy instance | 1 |
| Insurance contract or identification number | HCL30183 | | Number of Individuals Covered | 366 | | Insurance policy start date | 2013-12-01 | | Insurance policy end date | 2014-11-30 | | Total amount of commissions paid to insurance broker | USD $25,894 | | Total amount of fees paid to insurance company | USD $75,081 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $647,345 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 75081 | | Additional information about fees paid to insurance broker | REINSURANCE FEE | | Insurance broker organization code? | 3 | | Commission paid to Insurance Broker | USD $25,894 | | Insurance broker name | LOCKTON COMPANIES LLC |
|
| US FIRE (National Association of Insurance Commissioners NAIC id number: 21113 ) |
| Policy contract number | #US061031 |
| Policy instance | 2 |
| Insurance contract or identification number | #US061031 | | Number of Individuals Covered | 344 | | Insurance policy start date | 2013-12-01 | | Insurance policy end date | 2014-11-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | ORGAN TRANSPLANT | | Welfare Benefit Premiums Paid to Carrier | USD $40,910 | | 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 | 010-029893 |
| Policy instance | 3 |
| Insurance contract or identification number | 010-029893 | | Number of Individuals Covered | 323 | | Insurance policy start date | 2013-12-01 | | Insurance policy end date | 2014-11-30 | | Total amount of commissions paid to insurance broker | USD $29,434 | | Total amount of fees paid to insurance company | USD $4,013 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $294,339 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $29,434 | | Amount paid for insurance broker fees | 4013 | | Insurance broker organization code? | 3 | | Insurance broker name | UPSHAW INSURANCE AGENCY |
|
| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
| Policy contract number | 4052771 |
| Policy instance | 4 |
| Insurance contract or identification number | 4052771 | | Number of Individuals Covered | 102 | | Insurance policy start date | 2013-09-01 | | Insurance policy end date | 2014-08-31 | | Total amount of commissions paid to insurance broker | USD $6,216 | | Total amount of fees paid to insurance company | USD $903 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | CRITICAL ILLNESS INSURANCE | | Welfare Benefit Premiums Paid to Carrier | USD $42,096 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,875 | | Amount paid for insurance broker fees | 510 | | Insurance broker organization code? | 3 | | Insurance broker name | UPSHAW INSURANCE AGENCY |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL 146760 |
| Policy instance | 5 |
| Insurance contract or identification number | GL 146760 | | Number of Individuals Covered | 391 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $20,437 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $102,187 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $20,437 | | Insurance broker organization code? | 3 | | Insurance broker name | UPSHAW INSURANCE AGENCY |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | S488200 |
| Policy instance | 1 |
| Insurance contract or identification number | S488200 | | Number of Individuals Covered | 354 | | Insurance policy start date | 2012-12-01 | | Insurance policy end date | 2013-11-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $69,936 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $606,820 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 46624 | | Additional information about fees paid to insurance broker | REINSURANCE FEE | | Insurance broker organization code? | 3 | | Insurance broker name | INSURANCE MANAGEMENT SERVICES |
|
| US FIRE (National Association of Insurance Commissioners NAIC id number: 21113 ) |
| Policy contract number | #US060854 |
| Policy instance | 2 |
| Insurance contract or identification number | #US060854 | | Number of Individuals Covered | 333 | | Insurance policy start date | 2012-12-01 | | Insurance policy end date | 2013-11-30 | | Total amount of commissions paid to insurance broker | USD $3,670 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | ORGAN TRANSPLANT | | Welfare Benefit Premiums Paid to Carrier | USD $36,999 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,670 | | Insurance broker organization code? | 3 | | Insurance broker name | UPSHAW INSURANCE AGENCY |
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| ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 ) |
| Policy contract number | S488200 |
| Policy instance | 1 |
| Insurance contract or identification number | S488200 | | Number of Individuals Covered | 350 | | Insurance policy start date | 2011-12-01 | | Insurance policy end date | 2012-11-30 | | Total amount of commissions paid to insurance broker | USD $95,079 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $635,446 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $63,386 | | Insurance broker organization code? | 3 | | Insurance broker name | INSURANCE MANAGEMENT SERVICES |
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| US FIRE (National Association of Insurance Commissioners NAIC id number: 21113 ) |
| Policy contract number | #US060651 |
| Policy instance | 5 |
| Insurance contract or identification number | #US060651 | | Number of Individuals Covered | 352 | | Insurance policy start date | 2011-12-01 | | Insurance policy end date | 2012-11-30 | | Total amount of commissions paid to insurance broker | USD $3,534 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | ORGAN TRANSPLANT | | Welfare Benefit Premiums Paid to Carrier | USD $35,345 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,534 | | Insurance broker organization code? | 3 | | Insurance broker name | UPSHAW INSURANCE AGENCY |
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| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | LTD 120423 |
| Policy instance | 4 |
| Insurance contract or identification number | LTD 120423 | | Number of Individuals Covered | 17 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $1,935 | | Total amount of fees paid to insurance company | USD $190 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $9,676 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,935 | | Amount paid for insurance broker fees | 190 | | Insurance broker organization code? | 3 | | Insurance broker name | UPSHAW INSURANCE AGENCY |
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| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL 146760 |
| Policy instance | 3 |
| Insurance contract or identification number | GL 146760 | | Number of Individuals Covered | 387 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $17,069 | | Total amount of fees paid to insurance company | USD $1,479 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $85,344 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $17,069 | | Amount paid for insurance broker fees | 1479 | | Insurance broker organization code? | 3 | | Insurance broker name | UPSHAW INSURANCE AGENCY |
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| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | #010-029893 |
| Policy instance | 2 |
| Insurance contract or identification number | #010-029893 | | Number of Individuals Covered | 337 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $27,500 | | Total amount of fees paid to insurance company | USD $3,224 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $274,996 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $27,500 | | Amount paid for insurance broker fees | 3224 | | Insurance broker organization code? | 3 | | Insurance broker name | UPSHAW INSURANCE AGENCY |
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