CHANCELLOR HEALTH PARTNERS, LLC has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan CHANCELLOR HEALTH PARTNERS, LLC
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 934614 |
| Policy instance | 6 |
| Insurance contract or identification number | 934614 | | Number of Individuals Covered | 190 | | Insurance policy start date | 2021-10-01 | | Insurance policy end date | 2022-09-30 | | Total amount of commissions paid to insurance broker | USD $14,385 | | Total amount of fees paid to insurance company | USD $3,122 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $287,695 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $14,385 | | Amount paid for insurance broker fees | 1573 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 |
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| STARMOUNT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68985 ) |
| Policy contract number | 912132 |
| Policy instance | 5 |
| Insurance contract or identification number | 912132 | | Number of Individuals Covered | 231 | | Insurance policy start date | 2021-10-01 | | Insurance policy end date | 2022-09-30 | | Total amount of commissions paid to insurance broker | USD $10,299 | | Total amount of fees paid to insurance company | USD $1,909 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $87,410 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,875 | | Amount paid for insurance broker fees | 1909 | | Additional information about fees paid to insurance broker | ADDTIONAL COMPENSATION | | Insurance broker organization code? | 3 |
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| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 912109 |
| Policy instance | 4 |
| Insurance contract or identification number | 912109 | | Number of Individuals Covered | 109 | | Insurance policy start date | 2021-10-01 | | Insurance policy end date | 2022-09-30 | | Total amount of commissions paid to insurance broker | USD $3,254 | | Total amount of fees paid to insurance company | USD $411 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ADD | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $19,456 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,467 | | Amount paid for insurance broker fees | 411 | | Additional information about fees paid to insurance broker | ADDTIONAL COMPENSATION | | Insurance broker organization code? | 4 |
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| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 912108 |
| Policy instance | 3 |
| Insurance contract or identification number | 912108 | | Number of Individuals Covered | 69 | | Insurance policy start date | 2021-10-01 | | Insurance policy end date | 2022-09-30 | | Total amount of commissions paid to insurance broker | USD $3,306 | | Total amount of fees paid to insurance company | USD $551 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $28,008 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,306 | | Amount paid for insurance broker fees | 551 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 |
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| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 912107 |
| Policy instance | 2 |
| Insurance contract or identification number | 912107 | | Number of Individuals Covered | 401 | | Insurance policy start date | 2021-10-01 | | Insurance policy end date | 2022-09-30 | | Total amount of commissions paid to insurance broker | USD $13,185 | | Total amount of fees paid to insurance company | USD $1,641 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ADD | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $79,922 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,845 | | Amount paid for insurance broker fees | 1641 | | Additional information about fees paid to insurance broker | ADDTIONAL COMPENSATION | | Insurance broker organization code? | 3 |
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| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | 42510 |
| Policy instance | 1 |
| Insurance contract or identification number | 42510 | | Number of Individuals Covered | 13 | | Insurance policy start date | 2021-10-01 | | Insurance policy end date | 2022-09-30 | | Total amount of commissions paid to insurance broker | USD $1,413 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENT AND CRITICAL ILLNESS | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $2,284 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,413 | | Insurance broker organization code? | 3 |
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| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | 42510 |
| Policy instance | 2 |
| Insurance contract or identification number | 42510 | | Number of Individuals Covered | 13 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2021-10-01 | | Total amount of commissions paid to insurance broker | USD $1,413 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | ACCIDENT AND CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $2,284 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,413 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
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| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 912107 |
| Policy instance | 3 |
| Insurance contract or identification number | 912107 | | Number of Individuals Covered | 371 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2021-10-01 | | Total amount of commissions paid to insurance broker | USD $10,861 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $93,020 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,861 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
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| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 912108 |
| Policy instance | 4 |
| Insurance contract or identification number | 912108 | | Number of Individuals Covered | 69 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2021-10-01 | | Total amount of commissions paid to insurance broker | USD $3,306 | | Total amount of fees paid to insurance company | USD $0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $28,008 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,306 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
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| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 912109 |
| Policy instance | 5 |
| Insurance contract or identification number | 912109 | | Number of Individuals Covered | 132 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2021-10-01 | | Total amount of commissions paid to insurance broker | USD $3,048 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $25,944 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,048 | | Insurance broker organization code? | 4 | | Amount paid for insurance broker fees | 0 |
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| STARMOUNT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68985 ) |
| Policy contract number | 912132 |
| Policy instance | 6 |
| Insurance contract or identification number | 912132 | | Number of Individuals Covered | 231 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2021-10-01 | | Total amount of commissions paid to insurance broker | USD $5,678 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $99,400 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,678 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
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| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 934614 |
| Policy instance | 7 |
| Insurance contract or identification number | 934614 | | Number of Individuals Covered | 219 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2021-09-30 | | Total amount of commissions paid to insurance broker | USD $14,676 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $293,518 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $14,676 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 0 |
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| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 417003413582 |
| Policy instance | 1 |
| Insurance contract or identification number | 417003413582 | | Number of Individuals Covered | 256 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2021-10-01 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $292,978 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 934614 |
| Policy instance | 7 |
| Insurance contract or identification number | 934614 | | Number of Individuals Covered | 196 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-09-30 | | Total amount of commissions paid to insurance broker | USD $15,878 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $317,560 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $15,878 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
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| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 417003413582 |
| Policy instance | 1 |
| Insurance contract or identification number | 417003413582 | | Number of Individuals Covered | 199 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-10-01 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $317,039 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | R0686626 |
| Policy instance | 2 |
| Insurance contract or identification number | R0686626 | | Number of Individuals Covered | 160 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-10-01 | | Total amount of commissions paid to insurance broker | USD $5,448 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | GCIEE, GRPACCVO, GRPHSPVO | | Welfare Benefit Premiums Paid to Carrier | USD $37,294 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,448 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
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| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 912107 |
| Policy instance | 3 |
| Insurance contract or identification number | 912107 | | Number of Individuals Covered | 470 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-10-01 | | Total amount of commissions paid to insurance broker | USD $9,521 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $88,734 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,521 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
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| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 912108 |
| Policy instance | 4 |
| Insurance contract or identification number | 912108 | | Number of Individuals Covered | 92 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-10-01 | | Total amount of commissions paid to insurance broker | USD $3,251 | | Total amount of fees paid to insurance company | USD $0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $28,068 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,251 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
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| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 912109 |
| Policy instance | 5 |
| Insurance contract or identification number | 912109 | | Number of Individuals Covered | 171 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-10-01 | | Total amount of commissions paid to insurance broker | USD $3,483 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $29,794 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,483 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| STARMOUNT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68985 ) |
| Policy contract number | 912132 |
| Policy instance | 6 |
| Insurance contract or identification number | 912132 | | Number of Individuals Covered | 266 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-10-01 | | Total amount of commissions paid to insurance broker | USD $7,446 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $109,365 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,446 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
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| STARMOUNT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68985 ) |
| Policy contract number | 912132 |
| Policy instance | 6 |
| Insurance contract or identification number | 912132 | | Number of Individuals Covered | 291 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-10-01 | | Total amount of commissions paid to insurance broker | USD $6,751 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $124,473 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,751 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
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| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 912109 |
| Policy instance | 5 |
| Insurance contract or identification number | 912109 | | Number of Individuals Covered | 188 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-10-01 | | Total amount of commissions paid to insurance broker | USD $3,356 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $27,508 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,356 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
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| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 912108 |
| Policy instance | 4 |
| Insurance contract or identification number | 912108 | | Number of Individuals Covered | 81 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-10-01 | | Total amount of commissions paid to insurance broker | USD $2,634 | | Total amount of fees paid to insurance company | USD $0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $21,380 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,634 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
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| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 912107 |
| Policy instance | 3 |
| Insurance contract or identification number | 912107 | | Number of Individuals Covered | 427 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-10-01 | | Total amount of commissions paid to insurance broker | USD $10,427 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $78,558 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,427 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
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| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | R0686626 |
| Policy instance | 2 |
| Insurance contract or identification number | R0686626 | | Number of Individuals Covered | 230 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-10-01 | | Total amount of commissions paid to insurance broker | USD $19,295 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | GCIEE, GRPACCVO, GRPHSPVO | | Welfare Benefit Premiums Paid to Carrier | USD $46,417 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $19,295 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
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| UNIMERICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 91529 ) |
| Policy contract number | 417002413582 |
| Policy instance | 1 |
| Insurance contract or identification number | 417002413582 | | Number of Individuals Covered | 209 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-10-01 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $335,671 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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