MG2 CORPORATION has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan MG2 CORPORATION BENEFITS AND 125 PLAN
Measure | Date | Value |
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2022: MG2 CORPORATION BENEFITS AND 125 PLAN 2022 401k membership |
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Total participants, beginning-of-year | 2022-05-01 | 386 |
Total number of active participants reported on line 7a of the Form 5500 | 2022-05-01 | 606 |
Number of retired or separated participants receiving benefits | 2022-05-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2022-05-01 | 0 |
Total of all active and inactive participants | 2022-05-01 | 606 |
2021: MG2 CORPORATION BENEFITS AND 125 PLAN 2021 401k membership |
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Total participants, beginning-of-year | 2021-05-01 | 318 |
Total number of active participants reported on line 7a of the Form 5500 | 2021-05-01 | 378 |
Number of retired or separated participants receiving benefits | 2021-05-01 | 8 |
Number of other retired or separated participants entitled to future benefits | 2021-05-01 | 0 |
Total of all active and inactive participants | 2021-05-01 | 386 |
Number of employers contributing to the scheme | 2021-05-01 | 0 |
2020: MG2 CORPORATION BENEFITS AND 125 PLAN 2020 401k membership |
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Total participants, beginning-of-year | 2020-05-01 | 316 |
Total number of active participants reported on line 7a of the Form 5500 | 2020-05-01 | 302 |
Number of retired or separated participants receiving benefits | 2020-05-01 | 4 |
Number of other retired or separated participants entitled to future benefits | 2020-05-01 | 0 |
Total of all active and inactive participants | 2020-05-01 | 306 |
Number of employers contributing to the scheme | 2020-05-01 | 0 |
2019: MG2 CORPORATION BENEFITS AND 125 PLAN 2019 401k membership |
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Total participants, beginning-of-year | 2019-05-01 | 288 |
Total number of active participants reported on line 7a of the Form 5500 | 2019-05-01 | 319 |
Number of retired or separated participants receiving benefits | 2019-05-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2019-05-01 | 0 |
Total of all active and inactive participants | 2019-05-01 | 319 |
Number of employers contributing to the scheme | 2019-05-01 | 0 |
2018: MG2 CORPORATION BENEFITS AND 125 PLAN 2018 401k membership |
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Total participants, beginning-of-year | 2018-05-01 | 258 |
Total number of active participants reported on line 7a of the Form 5500 | 2018-05-01 | 278 |
Number of retired or separated participants receiving benefits | 2018-05-01 | 10 |
Number of other retired or separated participants entitled to future benefits | 2018-05-01 | 0 |
Total of all active and inactive participants | 2018-05-01 | 288 |
Number of employers contributing to the scheme | 2018-05-01 | 0 |
2017: MG2 CORPORATION BENEFITS AND 125 PLAN 2017 401k membership |
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Total participants, beginning-of-year | 2017-05-01 | 250 |
Total number of active participants reported on line 7a of the Form 5500 | 2017-05-01 | 247 |
Number of retired or separated participants receiving benefits | 2017-05-01 | 10 |
Number of other retired or separated participants entitled to future benefits | 2017-05-01 | 0 |
Total of all active and inactive participants | 2017-05-01 | 257 |
2016: MG2 CORPORATION BENEFITS AND 125 PLAN 2016 401k membership |
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Total participants, beginning-of-year | 2016-05-01 | 240 |
Total number of active participants reported on line 7a of the Form 5500 | 2016-05-01 | 246 |
Number of retired or separated participants receiving benefits | 2016-05-01 | 4 |
Number of other retired or separated participants entitled to future benefits | 2016-05-01 | 0 |
Total of all active and inactive participants | 2016-05-01 | 250 |
2015: MG2 CORPORATION BENEFITS AND 125 PLAN 2015 401k membership |
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Total participants, beginning-of-year | 2015-05-01 | 254 |
Total number of active participants reported on line 7a of the Form 5500 | 2015-05-01 | 237 |
Number of retired or separated participants receiving benefits | 2015-05-01 | 3 |
Number of other retired or separated participants entitled to future benefits | 2015-05-01 | 0 |
Total of all active and inactive participants | 2015-05-01 | 240 |
2014: MG2 CORPORATION BENEFITS AND 125 PLAN 2014 401k membership |
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Total participants, beginning-of-year | 2014-05-01 | 291 |
Total number of active participants reported on line 7a of the Form 5500 | 2014-05-01 | 244 |
Number of retired or separated participants receiving benefits | 2014-05-01 | 15 |
Number of other retired or separated participants entitled to future benefits | 2014-05-01 | 0 |
Total of all active and inactive participants | 2014-05-01 | 259 |
2013: MG2 CORPORATION BENEFITS AND 125 PLAN 2013 401k membership |
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Total participants, beginning-of-year | 2013-05-01 | 325 |
Total number of active participants reported on line 7a of the Form 5500 | 2013-05-01 | 281 |
Number of retired or separated participants receiving benefits | 2013-05-01 | 4 |
Number of other retired or separated participants entitled to future benefits | 2013-05-01 | 0 |
Total of all active and inactive participants | 2013-05-01 | 285 |
2012: MG2 CORPORATION BENEFITS AND 125 PLAN 2012 401k membership |
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Total participants, beginning-of-year | 2012-05-01 | 290 |
Total number of active participants reported on line 7a of the Form 5500 | 2012-05-01 | 314 |
Number of retired or separated participants receiving benefits | 2012-05-01 | 4 |
Number of other retired or separated participants entitled to future benefits | 2012-05-01 | 0 |
Total of all active and inactive participants | 2012-05-01 | 318 |
2011: MG2 CORPORATION BENEFITS AND 125 PLAN 2011 401k membership |
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Total participants, beginning-of-year | 2011-05-01 | 253 |
Total number of active participants reported on line 7a of the Form 5500 | 2011-05-01 | 279 |
Number of retired or separated participants receiving benefits | 2011-05-01 | 4 |
Number of other retired or separated participants entitled to future benefits | 2011-05-01 | 0 |
Total of all active and inactive participants | 2011-05-01 | 283 |
2010: MG2 CORPORATION BENEFITS AND 125 PLAN 2010 401k membership |
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Total participants, beginning-of-year | 2010-05-01 | 280 |
Total number of active participants reported on line 7a of the Form 5500 | 2010-05-01 | 251 |
Number of retired or separated participants receiving benefits | 2010-05-01 | 14 |
Number of other retired or separated participants entitled to future benefits | 2010-05-01 | 0 |
Total of all active and inactive participants | 2010-05-01 | 265 |
2009: MG2 CORPORATION BENEFITS AND 125 PLAN 2009 401k membership |
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Total participants, beginning-of-year | 2009-05-01 | 339 |
Total number of active participants reported on line 7a of the Form 5500 | 2009-05-01 | 277 |
Number of retired or separated participants receiving benefits | 2009-05-01 | 47 |
Number of other retired or separated participants entitled to future benefits | 2009-05-01 | 1 |
Total of all active and inactive participants | 2009-05-01 | 325 |
2022: MG2 CORPORATION BENEFITS AND 125 PLAN 2022 form 5500 responses |
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2022-05-01 | Type of plan entity | Single employer plan |
2022-05-01 | Submission has been amended | No |
2022-05-01 | This submission is the final filing | No |
2022-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2022-05-01 | Plan is a collectively bargained plan | No |
2022-05-01 | Plan funding arrangement – Insurance | Yes |
2022-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2022-05-01 | Plan benefit arrangement – Insurance | Yes |
2022-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2021: MG2 CORPORATION BENEFITS AND 125 PLAN 2021 form 5500 responses |
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2021-05-01 | Type of plan entity | Single employer plan |
2021-05-01 | Plan funding arrangement – Insurance | Yes |
2021-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2021-05-01 | Plan benefit arrangement – Insurance | Yes |
2021-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2020: MG2 CORPORATION BENEFITS AND 125 PLAN 2020 form 5500 responses |
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2020-05-01 | Type of plan entity | Single employer plan |
2020-05-01 | Plan funding arrangement – Insurance | Yes |
2020-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2020-05-01 | Plan benefit arrangement – Insurance | Yes |
2020-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2019: MG2 CORPORATION BENEFITS AND 125 PLAN 2019 form 5500 responses |
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2019-05-01 | Type of plan entity | Single employer plan |
2019-05-01 | Plan funding arrangement – Insurance | Yes |
2019-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2019-05-01 | Plan benefit arrangement – Insurance | Yes |
2019-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2018: MG2 CORPORATION BENEFITS AND 125 PLAN 2018 form 5500 responses |
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2018-05-01 | Type of plan entity | Single employer plan |
2018-05-01 | Plan funding arrangement – Insurance | Yes |
2018-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2018-05-01 | Plan benefit arrangement – Insurance | Yes |
2018-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2017: MG2 CORPORATION BENEFITS AND 125 PLAN 2017 form 5500 responses |
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2017-05-01 | Type of plan entity | Single employer plan |
2017-05-01 | Plan funding arrangement – Insurance | Yes |
2017-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2017-05-01 | Plan benefit arrangement – Insurance | Yes |
2017-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2016: MG2 CORPORATION BENEFITS AND 125 PLAN 2016 form 5500 responses |
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2016-05-01 | Type of plan entity | Single employer plan |
2016-05-01 | Submission has been amended | No |
2016-05-01 | This submission is the final filing | No |
2016-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2016-05-01 | Plan is a collectively bargained plan | No |
2016-05-01 | Plan funding arrangement – Insurance | Yes |
2016-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2016-05-01 | Plan benefit arrangement – Insurance | Yes |
2016-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2015: MG2 CORPORATION BENEFITS AND 125 PLAN 2015 form 5500 responses |
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2015-05-01 | Type of plan entity | Single employer plan |
2015-05-01 | Submission has been amended | No |
2015-05-01 | This submission is the final filing | No |
2015-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2015-05-01 | Plan is a collectively bargained plan | No |
2015-05-01 | Plan funding arrangement – Insurance | Yes |
2015-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2015-05-01 | Plan benefit arrangement – Insurance | Yes |
2015-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2014: MG2 CORPORATION BENEFITS AND 125 PLAN 2014 form 5500 responses |
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2014-05-01 | Type of plan entity | Single employer plan |
2014-05-01 | Submission has been amended | No |
2014-05-01 | This submission is the final filing | No |
2014-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2014-05-01 | Plan is a collectively bargained plan | No |
2014-05-01 | Plan funding arrangement – Insurance | Yes |
2014-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2014-05-01 | Plan benefit arrangement – Insurance | Yes |
2014-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2013: MG2 CORPORATION BENEFITS AND 125 PLAN 2013 form 5500 responses |
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2013-05-01 | Type of plan entity | Single employer plan |
2013-05-01 | Submission has been amended | No |
2013-05-01 | This submission is the final filing | No |
2013-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2013-05-01 | Plan is a collectively bargained plan | No |
2013-05-01 | Plan funding arrangement – Insurance | Yes |
2013-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2013-05-01 | Plan benefit arrangement – Insurance | Yes |
2013-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2012: MG2 CORPORATION BENEFITS AND 125 PLAN 2012 form 5500 responses |
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2012-05-01 | Type of plan entity | Single employer plan |
2012-05-01 | Submission has been amended | No |
2012-05-01 | This submission is the final filing | No |
2012-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2012-05-01 | Plan is a collectively bargained plan | No |
2012-05-01 | Plan funding arrangement – Insurance | Yes |
2012-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2012-05-01 | Plan benefit arrangement – Insurance | Yes |
2012-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2011: MG2 CORPORATION BENEFITS AND 125 PLAN 2011 form 5500 responses |
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2011-05-01 | Type of plan entity | Single employer plan |
2011-05-01 | Submission has been amended | Yes |
2011-05-01 | This submission is the final filing | No |
2011-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2011-05-01 | Plan is a collectively bargained plan | No |
2011-05-01 | Plan funding arrangement – Insurance | Yes |
2011-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2011-05-01 | Plan benefit arrangement – Insurance | Yes |
2011-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2010: MG2 CORPORATION BENEFITS AND 125 PLAN 2010 form 5500 responses |
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2010-05-01 | Type of plan entity | Single employer plan |
2010-05-01 | Submission has been amended | No |
2010-05-01 | This submission is the final filing | No |
2010-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2010-05-01 | Plan is a collectively bargained plan | No |
2010-05-01 | Plan funding arrangement – Insurance | Yes |
2010-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2010-05-01 | Plan benefit arrangement – Insurance | Yes |
2010-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2009: MG2 CORPORATION BENEFITS AND 125 PLAN 2009 form 5500 responses |
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2009-05-01 | Type of plan entity | Single employer plan |
2009-05-01 | Submission has been amended | No |
2009-05-01 | This submission is the final filing | No |
2009-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2009-05-01 | Plan is a collectively bargained plan | No |
2009-05-01 | Plan funding arrangement – Insurance | Yes |
2009-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2009-05-01 | Plan benefit arrangement – Insurance | Yes |
2009-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 ) |
Policy contract number | 09112 |
Policy instance | 6 |
Insurance contract or identification number | 09112 | Number of Individuals Covered | 521 | Insurance policy start date | 2022-05-01 | Insurance policy end date | 2023-04-30 | 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 | 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 $249,477 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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WILLAMETTE DENTAL OF WASHINGTON, INC. (National Association of Insurance Commissioners NAIC id number: 47050 ) |
Policy contract number | WA710 |
Policy instance | 5 |
Insurance contract or identification number | WA710 | Number of Individuals Covered | 52 | Insurance policy start date | 2022-05-01 | Insurance policy end date | 2023-04-30 | Total amount of commissions paid to insurance broker | USD $1,319 | 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 | Yes | 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 $26,380 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,198 | Amount paid for insurance broker fees | 0 | Additional information about fees paid to insurance broker | COMMISSION PAID | Insurance broker organization code? | 3 |
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PREMERA BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 47570 ) |
Policy contract number | 1036799 |
Policy instance | 4 |
Insurance contract or identification number | 1036799 | Number of Individuals Covered | 606 | Insurance policy start date | 2022-05-01 | Insurance policy end date | 2023-04-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $5,948 | 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 | Yes | 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 $283,325 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 5948 | Additional information about fees paid to insurance broker | PREFERRED PRODUCER PROGRAM | Insurance broker organization code? | 3 |
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HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
Policy contract number | ETB-200918 |
Policy instance | 3 |
Insurance contract or identification number | ETB-200918 | Number of Individuals Covered | 0 | Insurance policy start date | 2022-05-01 | Insurance policy end date | 2023-04-30 | Total amount of commissions paid to insurance broker | USD $763 | 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 | BUSINESS TRAVEL ACCIDENT | 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 $5,086 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $763 | Amount paid for insurance broker fees | 0 | Additional information about fees paid to insurance broker | COMMISSIONS | Insurance broker organization code? | 3 |
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SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
Policy contract number | 01-017256-00 |
Policy instance | 2 |
Insurance contract or identification number | 01-017256-00 | Number of Individuals Covered | 395 | Insurance policy start date | 2022-05-01 | Insurance policy end date | 2023-04-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $7,759 | 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 | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $199,155 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $0 | Amount paid for insurance broker fees | 7759 | Additional information about fees paid to insurance broker | GROUP SUPPLEMENTAL COMMISSIONS | 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 | 146539 |
Policy instance | 1 |
Insurance contract or identification number | 146539 | Number of Individuals Covered | 70 | Insurance policy start date | 2022-05-01 | Insurance policy end date | 2023-03-01 | Total amount of commissions paid to insurance broker | USD $7,548 | Total amount of fees paid to insurance company | USD $539 | 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 | LIFESTYLE LIFE | 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 $43,131 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,548 | Amount paid for insurance broker fees | 0 | Additional information about fees paid to insurance broker | COMMISSIONS | Insurance broker organization code? | 3 |
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LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | 3877A |
Policy instance | 1 |
Insurance contract or identification number | 3877A | Number of Individuals Covered | 4 | Insurance policy start date | 2020-06-01 | Insurance policy end date | 2021-05-31 | Total amount of commissions paid to insurance broker | USD $661 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $8,262 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $661 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
Policy contract number | 01-017256-00 |
Policy instance | 2 |
Insurance contract or identification number | 01-017256-00 | Number of Individuals Covered | 362 | Insurance policy start date | 2021-05-01 | Insurance policy end date | 2022-04-30 | Total amount of commissions paid to insurance broker | USD $36,030 | Total amount of fees paid to insurance company | USD $3,378 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | EMPLOYEE ASSISTANCE PROGRAM | Welfare Benefit Premiums Paid to Carrier | USD $187,202 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $26,669 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Additional information about fees paid to insurance broker | GROUP SUPPLEMENTAL COMMISSIONS |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 146539 |
Policy instance | 3 |
Insurance contract or identification number | 146539 | Number of Individuals Covered | 64 | Insurance policy start date | 2021-05-01 | Insurance policy end date | 2022-04-30 | Total amount of commissions paid to insurance broker | USD $9,321 | Total amount of fees paid to insurance company | USD $666 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $41,932 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $9,321 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION |
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STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
Policy contract number | 771021 |
Policy instance | 4 |
Insurance contract or identification number | 771021 | Number of Individuals Covered | 69 | Insurance policy start date | 2021-05-01 | Insurance policy end date | 2022-04-30 | Total amount of commissions paid to insurance broker | USD $998 | Total amount of fees paid to insurance company | USD $146 | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $3,994 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $998 | Amount paid for insurance broker fees | 49 | Additional information about fees paid to insurance broker | CONTINGENT COMPENSATION | Insurance broker organization code? | 3 |
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HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
Policy contract number | ETB-200918 |
Policy instance | 5 |
Insurance contract or identification number | ETB-200918 | Number of Individuals Covered | 378 | Insurance policy start date | 2021-05-01 | Insurance policy end date | 2022-04-30 | Total amount of commissions paid to insurance broker | USD $763 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | BUSINESS TRAVEL ACCIDENT | Welfare Benefit Premiums Paid to Carrier | USD $5,086 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $763 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
Policy contract number | 3877A |
Policy instance | 6 |
Insurance contract or identification number | 3877A | Number of Individuals Covered | 4 | Insurance policy start date | 2020-06-01 | Insurance policy end date | 2021-05-31 | Total amount of commissions paid to insurance broker | USD $9,572 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $117,265 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $9,572 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
|
WILLAMETTE DENTAL OF WASHINGTON, INC. (National Association of Insurance Commissioners NAIC id number: 47050 ) |
Policy contract number | WA710 |
Policy instance | 7 |
Insurance contract or identification number | WA710 | Number of Individuals Covered | 49 | Insurance policy start date | 2021-05-01 | Insurance policy end date | 2022-04-30 | Total amount of commissions paid to insurance broker | USD $1,187 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,187 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
|
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
Policy contract number | 03877A0001 |
Policy instance | 1 |
Insurance contract or identification number | 03877A0001 | Number of Individuals Covered | 4 | Insurance policy start date | 2019-06-01 | Insurance policy end date | 2020-05-31 | Total amount of commissions paid to insurance broker | USD $142 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $1,772 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $142 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
|
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
Policy contract number | 01-017256-00 |
Policy instance | 2 |
Insurance contract or identification number | 01-017256-00 | Number of Individuals Covered | 303 | Insurance policy start date | 2020-05-01 | Insurance policy end date | 2021-04-30 | Total amount of commissions paid to insurance broker | USD $28,811 | Total amount of fees paid to insurance company | USD $5,818 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | EMPLOYEE ASSISTANCE PROGRAM | Welfare Benefit Premiums Paid to Carrier | USD $171,745 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $20,224 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Additional information about fees paid to insurance broker | GROUP SUPPLEMENTAL COMMISSIONS |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 146539 |
Policy instance | 3 |
Insurance contract or identification number | 146539 | Number of Individuals Covered | 27 | Insurance policy start date | 2020-05-01 | Insurance policy end date | 2021-04-30 | Total amount of commissions paid to insurance broker | USD $4,053 | Total amount of fees paid to insurance company | USD $289 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $34,489 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,053 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION |
|
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
Policy contract number | 771021 |
Policy instance | 4 |
Insurance contract or identification number | 771021 | Number of Individuals Covered | 18 | Insurance policy start date | 2020-05-01 | Insurance policy end date | 2021-04-30 | Total amount of commissions paid to insurance broker | USD $284 | Total amount of fees paid to insurance company | USD $23 | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $1,138 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $284 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Additional information about fees paid to insurance broker | CONTINGENT COMPENSATION |
|
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
Policy contract number | ETB-200918 |
Policy instance | 5 |
Insurance contract or identification number | ETB-200918 | Number of Individuals Covered | 302 | Insurance policy start date | 2020-05-01 | Insurance policy end date | 2021-04-30 | Total amount of commissions paid to insurance broker | USD $763 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | BUSINESS TRAVEL ACCIDENT | Welfare Benefit Premiums Paid to Carrier | USD $5,086 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $763 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
|
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
Policy contract number | 3877A |
Policy instance | 6 |
Insurance contract or identification number | 3877A | Number of Individuals Covered | 4 | Insurance policy start date | 2019-06-01 | Insurance policy end date | 2020-05-31 | Total amount of commissions paid to insurance broker | USD $9,664 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $120,546 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $9,664 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
|
WILLAMETTE DENTAL OF WASHINGTON, INC. (National Association of Insurance Commissioners NAIC id number: 47050 ) |
Policy contract number | WA710 |
Policy instance | 7 |
Insurance contract or identification number | WA710 | Number of Individuals Covered | 21 | Insurance policy start date | 2020-05-01 | Insurance policy end date | 2021-04-30 | Total amount of commissions paid to insurance broker | USD $495 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $495 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
|
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
Policy contract number | 3877A |
Policy instance | 6 |
Insurance contract or identification number | 3877A | Number of Individuals Covered | 2 | Insurance policy start date | 2018-06-01 | Insurance policy end date | 2019-05-31 | Total amount of commissions paid to insurance broker | USD $5,695 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $71,185 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $5,695 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
|
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
Policy contract number | ETB-200918 |
Policy instance | 5 |
Insurance contract or identification number | ETB-200918 | Number of Individuals Covered | 319 | Insurance policy start date | 2019-05-01 | Insurance policy end date | 2020-04-30 | Total amount of commissions paid to insurance broker | USD $763 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | BUSINESS TRAVEL ACCIDENT | Welfare Benefit Premiums Paid to Carrier | USD $5,086 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $763 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
|
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
Policy contract number | 771021 |
Policy instance | 4 |
Insurance contract or identification number | 771021 | Number of Individuals Covered | 16 | Insurance policy start date | 2019-05-01 | Insurance policy end date | 2020-04-30 | Total amount of commissions paid to insurance broker | USD $274 | Total amount of fees paid to insurance company | USD $57 | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $274 | Amount paid for insurance broker fees | 14 | Additional information about fees paid to insurance broker | CONTINGENT COMPENSATION | Insurance broker organization code? | 3 |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 146539 |
Policy instance | 3 |
Insurance contract or identification number | 146539 | Number of Individuals Covered | 28 | Insurance policy start date | 2019-05-01 | Insurance policy end date | 2020-04-30 | Total amount of commissions paid to insurance broker | USD $6,061 | Total amount of fees paid to insurance company | USD $433 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $34,634 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,061 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION |
|
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
Policy contract number | 01-017256-00 |
Policy instance | 2 |
Insurance contract or identification number | 01-017256-00 | Number of Individuals Covered | 319 | Insurance policy start date | 2019-05-01 | Insurance policy end date | 2020-04-30 | Total amount of commissions paid to insurance broker | USD $36,448 | Total amount of fees paid to insurance company | USD $1,199 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | EMPLOYEE ASSISTANCE PROGRAM | Welfare Benefit Premiums Paid to Carrier | USD $181,558 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $27,791 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Additional information about fees paid to insurance broker | GROUP SUPPLEMENTAL COMMISSIONS |
|
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | 3877A |
Policy instance | 1 |
Insurance contract or identification number | 3877A | Number of Individuals Covered | 2 | Insurance policy start date | 2018-06-01 | Insurance policy end date | 2019-05-31 | Total amount of commissions paid to insurance broker | USD $80 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $1,003 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $80 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
|
WILLAMETTE DENTAL OF WASHINGTON, INC. (National Association of Insurance Commissioners NAIC id number: 47050 ) |
Policy contract number | WA710 |
Policy instance | 7 |
Insurance contract or identification number | WA710 | Number of Individuals Covered | 23 | Insurance policy start date | 2019-05-01 | Insurance policy end date | 2020-04-30 | Total amount of commissions paid to insurance broker | USD $410 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $410 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
|
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | 3877A |
Policy instance | 1 |
Insurance contract or identification number | 3877A | Number of Individuals Covered | 2 | Insurance policy start date | 2017-06-01 | Insurance policy end date | 2018-05-31 | Total amount of commissions paid to insurance broker | USD $36 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $456 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
Policy contract number | 01-017256-00 |
Policy instance | 2 |
Insurance contract or identification number | 01-017256-00 | Number of Individuals Covered | 282 | Insurance policy start date | 2018-05-01 | Insurance policy end date | 2019-04-30 | Total amount of commissions paid to insurance broker | USD $34,680 | Total amount of fees paid to insurance company | USD $2,338 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | EMPLOYEE ASSISTANCE PROGRAM | Welfare Benefit Premiums Paid to Carrier | USD $175,182 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $27,120 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Additional information about fees paid to insurance broker | GROUP SUPPLEMENTAL COMMISSIONS |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 146539 |
Policy instance | 3 |
Insurance contract or identification number | 146539 | Number of Individuals Covered | 30 | Insurance policy start date | 2018-05-01 | Insurance policy end date | 2019-04-30 | Total amount of commissions paid to insurance broker | USD $5,377 | Total amount of fees paid to insurance company | USD $384 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $30,727 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,377 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION |
|
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
Policy contract number | 771021 |
Policy instance | 4 |
Insurance contract or identification number | 771021 | Number of Individuals Covered | 17 | Insurance policy start date | 2018-05-01 | Insurance policy end date | 2019-04-30 | Total amount of commissions paid to insurance broker | USD $256 | Total amount of fees paid to insurance company | USD $31 | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $1,026 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $256 | Amount paid for insurance broker fees | 12 | Additional information about fees paid to insurance broker | CONTINGENT COMPENSATION | Insurance broker organization code? | 3 |
|
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
Policy contract number | ETB200918 |
Policy instance | 5 |
Insurance contract or identification number | ETB200918 | Number of Individuals Covered | 278 | Insurance policy start date | 2018-05-01 | Insurance policy end date | 2019-04-30 | Total amount of commissions paid to insurance broker | USD $763 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | BUSINESS TRAVEL ACCIDENT | Welfare Benefit Premiums Paid to Carrier | USD $5,086 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $763 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
|
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
Policy contract number | 3877A |
Policy instance | 6 |
Insurance contract or identification number | 3877A | Number of Individuals Covered | 2 | Insurance policy start date | 2017-06-01 | Insurance policy end date | 2018-05-31 | Total amount of commissions paid to insurance broker | USD $2,627 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $32,836 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $2,627 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
|
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
Policy contract number | 3877A |
Policy instance | 6 |
Insurance contract or identification number | 3877A | Number of Individuals Covered | 2 | Insurance policy start date | 2016-06-01 | Insurance policy end date | 2017-05-31 | Total amount of commissions paid to insurance broker | USD $2,741 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $34,259 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $2,741 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Insurance broker name | GALLAGHER BENEFIT SERVICES, INC. |
|
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
Policy contract number | ETB200918 |
Policy instance | 5 |
Insurance contract or identification number | ETB200918 | Number of Individuals Covered | 247 | Insurance policy start date | 2017-05-01 | Insurance policy end date | 2018-04-30 | Total amount of commissions paid to insurance broker | USD $487 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | BUSINESS TRAVEL ACCIDENT | Welfare Benefit Premiums Paid to Carrier | USD $3,245 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $487 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Insurance broker name | GALLAGHER BENEFIT SERVICES, INC. |
|
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
Policy contract number | 771021 |
Policy instance | 4 |
Insurance contract or identification number | 771021 | Number of Individuals Covered | 14 | Insurance policy start date | 2017-05-01 | Insurance policy end date | 2018-04-30 | Total amount of commissions paid to insurance broker | USD $219 | Total amount of fees paid to insurance company | USD $81 | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $875 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $219 | Amount paid for insurance broker fees | 81 | Additional information about fees paid to insurance broker | CONTINGENT COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | GALLAGHER BENEFIT SERVICES, INC. |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 146539 |
Policy instance | 3 |
Insurance contract or identification number | 146539 | Number of Individuals Covered | 33 | Insurance policy start date | 2017-05-01 | Insurance policy end date | 2018-04-30 | Total amount of commissions paid to insurance broker | USD $5,205 | Total amount of fees paid to insurance company | USD $372 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $29,743 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,205 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | Insurance broker name | GALLAGHER BENEFIT SERVICES, INC. |
|
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
Policy contract number | 01-017256-00 |
Policy instance | 2 |
Insurance contract or identification number | 01-017256-00 | Number of Individuals Covered | 248 | Insurance policy start date | 2017-05-01 | Insurance policy end date | 2018-04-30 | Total amount of commissions paid to insurance broker | USD $26,933 | Total amount of fees paid to insurance company | USD $1,739 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | EMPLOYEE ASSISTANCE PROGRAM | Welfare Benefit Premiums Paid to Carrier | USD $151,293 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $21,394 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Additional information about fees paid to insurance broker | GROUP SUPPLEMENTAL COMMISSIONS | Insurance broker name | GALLAGHER BENEFIT SERVICES, INC. |
|
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | 3877A |
Policy instance | 1 |
Insurance contract or identification number | 3877A | Number of Individuals Covered | 2 | Insurance policy start date | 2016-06-01 | Insurance policy end date | 2017-05-31 | Total amount of commissions paid to insurance broker | USD $31 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $363 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $31 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Insurance broker name | GALLAGHER BENEFIT SERVICES, INC. |
|
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | OK964012 |
Policy instance | 3 |
Insurance contract or identification number | OK964012 | Number of Individuals Covered | 237 | Insurance policy start date | 2015-05-01 | Insurance policy end date | 2016-04-30 | Total amount of commissions paid to insurance broker | USD $17,950 | Total amount of fees paid to insurance company | USD $5,185 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating 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 | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $119,975 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $17,950 | Amount paid for insurance broker fees | 5185 | Additional information about fees paid to insurance broker | OVERRIDE | Insurance broker organization code? | 3 | Insurance broker name | GALLAGHER BENEFIT SERVICES, INC. |
|
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
Policy contract number | ETB200918 |
Policy instance | 4 |
Insurance contract or identification number | ETB200918 | Number of Individuals Covered | 237 | Insurance policy start date | 2015-05-01 | Insurance policy end date | 2016-04-30 | Total amount of commissions paid to insurance broker | USD $487 | Total amount of fees paid to insurance company | USD $76 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating 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 | BUSINESS TRAVEL ACCIDENT | 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 $3,245 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $487 | Amount paid for insurance broker fees | 76 | Additional information about fees paid to insurance broker | BONUS | Insurance broker organization code? | 3 | Insurance broker name | GALLAGHER BENEFIT SERVICES, INC. |
|
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | 3877A |
Policy instance | 5 |
Insurance contract or identification number | 3877A | Number of Individuals Covered | 4 | Insurance policy start date | 2014-06-01 | Insurance policy end date | 2015-05-31 | Total amount of commissions paid to insurance broker | USD $185 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating 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 | ACCIDENTAL DEATH AND DISMEMBERMENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $2,109 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $185 | Insurance broker organization code? | 3 | Insurance broker name | GALLAGHER BENEFIT SERVICES, INC. |
|
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
Policy contract number | 3877A |
Policy instance | 1 |
Insurance contract or identification number | 3877A | Number of Individuals Covered | 4 | Insurance policy start date | 2014-06-01 | Insurance policy end date | 2015-05-31 | Total amount of commissions paid to insurance broker | USD $7,308 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating 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 | Yes | Dental Insurance Welfare Benefit | Yes | 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 $79,870 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $7,308 | Insurance broker organization code? | 3 | Insurance broker name | GALLAGHER BENEFIT SERVICES, INC. |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 146539 |
Policy instance | 2 |
Insurance contract or identification number | 146539 | Number of Individuals Covered | 37 | Insurance policy start date | 2015-05-01 | Insurance policy end date | 2016-04-30 | Total amount of commissions paid to insurance broker | USD $9,128 | Total amount of fees paid to insurance company | USD $571 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating 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 | 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 $45,641 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $9,128 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 571 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | Insurance broker name | GALLAGHER BENEFIT SERVICES, INC. |
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LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | OK964012 |
Policy instance | 6 |
Insurance contract or identification number | OK964012 | Number of Individuals Covered | 244 | Insurance policy start date | 2014-05-01 | Insurance policy end date | 2015-04-30 | Total amount of commissions paid to insurance broker | USD $17,711 | Total amount of fees paid to insurance company | USD $16 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating 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 | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $120,424 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $17,432 | Amount paid for insurance broker fees | 16 | Additional information about fees paid to insurance broker | OVERRIDE | Insurance broker organization code? | 3 | Insurance broker name | GALLAGHER BENEFIT SERVICES, INC. |
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CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
Policy contract number | 3877A |
Policy instance | 7 |
Insurance contract or identification number | 3877A | Number of Individuals Covered | 13 | Insurance policy start date | 2013-06-01 | Insurance policy end date | 2014-05-31 | Total amount of commissions paid to insurance broker | USD $15,777 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating 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 | Yes | Dental Insurance Welfare Benefit | Yes | 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 $211,346 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $15,777 | Insurance broker organization code? | 3 | Insurance broker name | GALLAGHER BENEFIT SERVICES, INC. |
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FREE AND CLEAR (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | MULVANNY |
Policy instance | 4 |
Insurance contract or identification number | MULVANNY | Number of Individuals Covered | 0 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating 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 | SMOKING CESSATION PROGRAM | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 ) |
Policy contract number | 3877A |
Policy instance | 3 |
Insurance contract or identification number | 3877A | Number of Individuals Covered | 13 | Insurance policy start date | 2013-06-01 | Insurance policy end date | 2014-05-31 | Total amount of commissions paid to insurance broker | USD $1,104 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating 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 | Yes | Dental Insurance Welfare Benefit | Yes | 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 | ACCIDENTAL DEATH AND DISMEMBERMENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $13,803 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $1,104 | Insurance broker organization code? | 3 | Insurance broker name | GALLAGHER BENEFIT SERVICES, INC. |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 146539 |
Policy instance | 2 |
Insurance contract or identification number | 146539 | Number of Individuals Covered | 47 | Insurance policy start date | 2014-05-01 | Insurance policy end date | 2015-04-30 | Total amount of commissions paid to insurance broker | USD $10,011 | Total amount of fees paid to insurance company | USD $626 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating 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 | 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 $46,766 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $10,011 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 626 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | Insurance broker name | GALLAGHER BENEFIT SERVICES, INC. |
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HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
Policy contract number | ETB200918 |
Policy instance | 1 |
Insurance contract or identification number | ETB200918 | Number of Individuals Covered | 244 | Insurance policy start date | 2014-05-01 | Insurance policy end date | 2015-04-30 | Total amount of commissions paid to insurance broker | USD $505 | Total amount of fees paid to insurance company | USD $76 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating 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 | BUSINESS TRAVEL ACCIDENT | 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 $3,365 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $505 | Amount paid for insurance broker fees | 76 | Additional information about fees paid to insurance broker | BONUS | Insurance broker organization code? | 3 | Insurance broker name | GALLAGHER BENEFIT SERVICES, INC. |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 ) |
Policy contract number | 30040033 |
Policy instance | 5 |
Insurance contract or identification number | 30040033 | Number of Individuals Covered | 210 | Insurance policy start date | 2014-05-01 | Insurance policy end date | 2015-04-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating 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 | 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 $24,655 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47317 ) |
Policy contract number | 30040033 |
Policy instance | 5 |
Insurance contract or identification number | 30040033 | Number of Individuals Covered | 236 | Insurance policy start date | 2013-05-01 | Insurance policy end date | 2014-04-30 | Total amount of commissions paid to insurance broker | USD $1,363 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating 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 | 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 $28,564 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,363 | Insurance broker organization code? | 3 | Insurance broker name | GALLAGHER BENEFIT SERVICES, INC. |
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HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
Policy contract number | ETB200918 |
Policy instance | 1 |
Insurance contract or identification number | ETB200918 | Number of Individuals Covered | 281 | Insurance policy start date | 2013-05-01 | Insurance policy end date | 2014-04-30 | Total amount of commissions paid to insurance broker | USD $505 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating 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 | BUSINESS TRAVEL ACCIDENT | 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 $3,365 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $505 | Insurance broker organization code? | 3 | Insurance broker name | GALLAGHER BENEFIT SERVICES, INC. |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 146538/146539 |
Policy instance | 2 |
Insurance contract or identification number | 146538/146539 | Number of Individuals Covered | 300 | Insurance policy start date | 2013-05-01 | Insurance policy end date | 2014-04-30 | Total amount of commissions paid to insurance broker | USD $20,453 | Total amount of fees paid to insurance company | USD $2,315 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating 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 | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $188,445 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $20,453 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 2315 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | Insurance broker name | GALLAGHER BENEFIT SERVICES, INC. |
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CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 ) |
Policy contract number | 3877A |
Policy instance | 3 |
Insurance contract or identification number | 3877A | Number of Individuals Covered | 11 | Insurance policy start date | 2012-06-01 | Insurance policy end date | 2013-05-31 | Total amount of commissions paid to insurance broker | USD $9,917 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating 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 | Yes | Dental Insurance Welfare Benefit | Yes | 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 | ACCIDENTAL DEATH AND DISMEMBERMENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $123,963 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $9,917 | Insurance broker organization code? | 3 | Insurance broker name | GALLAGHER BENEFIT SERVICES, INC. |
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FREE AND CLEAR (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | MULVANNY |
Policy instance | 4 |
Insurance contract or identification number | MULVANNY | Number of Individuals Covered | 0 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating 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 | SMOKING CESSATION PROGRAM | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | OK964012 |
Policy instance | 6 |
Insurance contract or identification number | OK964012 | Number of Individuals Covered | 281 | Insurance policy start date | 2013-05-01 | Insurance policy end date | 2014-04-30 | Total amount of commissions paid to insurance broker | USD $540 | Total amount of fees paid to insurance company | USD $27 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating 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 | ACCIDENTAL DEATH AND DISMEMBERMENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $2,160 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $540 | Amount paid for insurance broker fees | 27 | Additional information about fees paid to insurance broker | OVERRIDE | Insurance broker organization code? | 3 | Insurance broker name | GALLAGHER BENEFIT SERVICES, INC. |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 146538 |
Policy instance | 2 |
Insurance contract or identification number | 146538 | Number of Individuals Covered | 319 | Insurance policy start date | 2012-05-01 | Insurance policy end date | 2013-04-30 | Total amount of commissions paid to insurance broker | USD $12,568 | Total amount of fees paid to insurance company | USD $1,776 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating 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 | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $142,104 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $12,568 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 1776 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | Insurance broker name | GALLAGHER BENEFIT SERVICES, INC. |
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CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 ) |
Policy contract number | 3877A |
Policy instance | 3 |
Insurance contract or identification number | 3877A | Number of Individuals Covered | 10 | Insurance policy start date | 2011-06-01 | Insurance policy end date | 2012-05-31 | Total amount of commissions paid to insurance broker | USD $7,465 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating 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 | Yes | Dental Insurance Welfare Benefit | Yes | 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 | ACCIDENTAL DEATH AND DISMEMBERMENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $93,316 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $7,465 | Insurance broker organization code? | 3 | Insurance broker name | GALLAGHER BENEFIT SERVICES, INC. |
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FREE AND CLEAR (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | MULVANNY |
Policy instance | 4 |
Insurance contract or identification number | MULVANNY | Number of Individuals Covered | 0 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating 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 | SMOKING CESSATION PROGRAM | 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 $375 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
Policy contract number | ETB200918 |
Policy instance | 1 |
Insurance contract or identification number | ETB200918 | Number of Individuals Covered | 319 | Insurance policy start date | 2012-05-01 | Insurance policy end date | 2013-04-30 | Total amount of commissions paid to insurance broker | USD $505 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating 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 | BUSINESS TRAVEL ACCIDENT | 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 $3,365 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $505 | Insurance broker organization code? | 3 | Insurance broker name | GALLAGHER BENEFIT SERVICES, INC. |
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FREE AND CLEAR (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | MULVANNY |
Policy instance | 4 |
Insurance contract or identification number | MULVANNY | Number of Individuals Covered | 1 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating 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 | SMOKING CESSATION PROGRAM | 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 $375 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
Policy contract number | ETB200918 |
Policy instance | 3 |
Insurance contract or identification number | ETB200918 | Number of Individuals Covered | 279 | Insurance policy start date | 2011-05-01 | Insurance policy end date | 2012-04-30 | Total amount of commissions paid to insurance broker | USD $623 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating 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 | BUSINESS TRAVEL ACCIDENT | 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 $4,153 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 146538 |
Policy instance | 2 |
Insurance contract or identification number | 146538 | Number of Individuals Covered | 279 | Insurance policy start date | 2011-05-01 | Insurance policy end date | 2012-04-30 | Total amount of commissions paid to insurance broker | USD $10,312 | Total amount of fees paid to insurance company | USD $1,358 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating 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 | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $108,635 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 ) |
Policy contract number | 03877A |
Policy instance | 1 |
Insurance contract or identification number | 03877A | Number of Individuals Covered | 8 | Insurance policy start date | 2011-05-01 | Insurance policy end date | 2012-04-30 | Total amount of commissions paid to insurance broker | USD $8,205 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating 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 | Yes | Dental Insurance Welfare Benefit | Yes | 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 | ACCIDENTAL DEATH AND DISMEMBERMENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $102,556 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
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FREE AND CLEAR (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | MULVANNY |
Policy instance | 4 |
Insurance contract or identification number | MULVANNY | Number of Individuals Covered | 3 | Insurance policy start date | 2010-01-01 | Insurance policy end date | 2010-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating 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 | SMOKING CESSATION PROGRAM | 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 $1,125 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
Policy contract number | ETB200918 |
Policy instance | 3 |
Insurance contract or identification number | ETB200918 | Number of Individuals Covered | 251 | Insurance policy start date | 2010-05-01 | Insurance policy end date | 2011-04-30 | Total amount of commissions paid to insurance broker | USD $623 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating 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 | BUSINESS TRAVEL ACCIDENT | 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 $4,153 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 146538 |
Policy instance | 2 |
Insurance contract or identification number | 146538 | Number of Individuals Covered | 253 | Insurance policy start date | 2010-05-01 | Insurance policy end date | 2011-04-30 | Total amount of commissions paid to insurance broker | USD $11,532 | Total amount of fees paid to insurance company | USD $1,556 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating 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 | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $114,576 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 ) |
Policy contract number | 03877A |
Policy instance | 1 |
Insurance contract or identification number | 03877A | Number of Individuals Covered | 7 | Insurance policy start date | 2010-05-01 | Insurance policy end date | 2011-04-30 | Total amount of commissions paid to insurance broker | USD $6,007 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating 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 | Yes | Dental Insurance Welfare Benefit | Yes | 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 | ACCIDENTAL DEATH AND DISMEMBERMENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $75,088 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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