SMITH FROZEN FOODS, INC. has sponsored the creation of one or more 401k plans.
Additional information about SMITH FROZEN FOODS, INC.
Submission information for form 5500 for 401k plan SMITH FROZEN FOODS GROUP MEDICAL BENEFIT PLAN
401k plan membership statisitcs for SMITH FROZEN FOODS GROUP MEDICAL BENEFIT PLAN
| Measure | Date | Value |
|---|
| 2022: SMITH FROZEN FOODS GROUP MEDICAL BENEFIT PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 251 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 251 |
| Number of retired or separated participants receiving benefits | 2022-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2022-01-01 | 0 |
| Total of all active and inactive participants | 2022-01-01 | 251 |
| 2021: SMITH FROZEN FOODS GROUP MEDICAL BENEFIT PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 251 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 251 |
| Number of retired or separated participants receiving benefits | 2021-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-01-01 | 0 |
| Total of all active and inactive participants | 2021-01-01 | 251 |
| 2020: SMITH FROZEN FOODS GROUP MEDICAL BENEFIT PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 272 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 251 |
| Number of retired or separated participants receiving benefits | 2020-01-01 | 2 |
| Number of other retired or separated participants entitled to future benefits | 2020-01-01 | 24 |
| Total of all active and inactive participants | 2020-01-01 | 277 |
| 2019: SMITH FROZEN FOODS GROUP MEDICAL BENEFIT PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 272 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 263 |
| Number of retired or separated participants receiving benefits | 2019-01-01 | 9 |
| Number of other retired or separated participants entitled to future benefits | 2019-01-01 | 0 |
| Total of all active and inactive participants | 2019-01-01 | 272 |
| 2018: SMITH FROZEN FOODS GROUP MEDICAL BENEFIT PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 253 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 257 |
| Number of retired or separated participants receiving benefits | 2018-01-01 | 15 |
| Number of other retired or separated participants entitled to future benefits | 2018-01-01 | 0 |
| Total of all active and inactive participants | 2018-01-01 | 272 |
| 2017: SMITH FROZEN FOODS GROUP MEDICAL BENEFIT PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 230 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 249 |
| Number of retired or separated participants receiving benefits | 2017-01-01 | 2 |
| Number of other retired or separated participants entitled to future benefits | 2017-01-01 | 2 |
| Total of all active and inactive participants | 2017-01-01 | 253 |
| 2016: SMITH FROZEN FOODS GROUP MEDICAL BENEFIT PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 211 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 226 |
| Number of retired or separated participants receiving benefits | 2016-01-01 | 4 |
| Number of other retired or separated participants entitled to future benefits | 2016-01-01 | 0 |
| Total of all active and inactive participants | 2016-01-01 | 230 |
| 2015: SMITH FROZEN FOODS GROUP MEDICAL BENEFIT PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 188 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 203 |
| Number of retired or separated participants receiving benefits | 2015-01-01 | 2 |
| Number of other retired or separated participants entitled to future benefits | 2015-01-01 | 0 |
| Total of all active and inactive participants | 2015-01-01 | 205 |
| 2014: SMITH FROZEN FOODS GROUP MEDICAL BENEFIT PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-08-01 | 200 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-08-01 | 188 |
| Number of retired or separated participants receiving benefits | 2014-08-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2014-08-01 | 0 |
| Total of all active and inactive participants | 2014-08-01 | 188 |
| 2013: SMITH FROZEN FOODS GROUP MEDICAL BENEFIT PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-08-01 | 203 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-08-01 | 194 |
| Number of retired or separated participants receiving benefits | 2013-08-01 | 6 |
| Total of all active and inactive participants | 2013-08-01 | 200 |
| 2012: SMITH FROZEN FOODS GROUP MEDICAL BENEFIT PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-08-01 | 219 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-08-01 | 202 |
| Number of retired or separated participants receiving benefits | 2012-08-01 | 1 |
| Number of other retired or separated participants entitled to future benefits | 2012-08-01 | 0 |
| Total of all active and inactive participants | 2012-08-01 | 203 |
| Total participants | 2012-08-01 | 203 |
| 2011: SMITH FROZEN FOODS GROUP MEDICAL BENEFIT PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-08-01 | 127 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-08-01 | 217 |
| Number of retired or separated participants receiving benefits | 2011-08-01 | 2 |
| Number of other retired or separated participants entitled to future benefits | 2011-08-01 | 0 |
| Total of all active and inactive participants | 2011-08-01 | 219 |
| Total participants | 2011-08-01 | 219 |
| 2010: SMITH FROZEN FOODS GROUP MEDICAL BENEFIT PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-08-01 | 131 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-08-01 | 127 |
| Number of retired or separated participants receiving benefits | 2010-08-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2010-08-01 | 0 |
| Total of all active and inactive participants | 2010-08-01 | 127 |
| 2009: SMITH FROZEN FOODS GROUP MEDICAL BENEFIT PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-08-01 | 144 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-08-01 | 128 |
| Number of retired or separated participants receiving benefits | 2009-08-01 | 3 |
| Number of other retired or separated participants entitled to future benefits | 2009-08-01 | 0 |
| Total of all active and inactive participants | 2009-08-01 | 131 |
| 2008: SMITH FROZEN FOODS GROUP MEDICAL BENEFIT PLAN 2008 401k membership |
|---|
| Total participants, beginning-of-year | 2008-08-01 | 137 |
| Total number of active participants reported on line 7a of the Form 5500 | 2008-08-01 | 143 |
| Number of retired or separated participants receiving benefits | 2008-08-01 | 1 |
| Number of other retired or separated participants entitled to future benefits | 2008-08-01 | 0 |
| Total of all active and inactive participants | 2008-08-01 | 144 |
| 2007: SMITH FROZEN FOODS GROUP MEDICAL BENEFIT PLAN 2007 401k membership |
|---|
| Total participants, beginning-of-year | 2007-08-01 | 138 |
| Total number of active participants reported on line 7a of the Form 5500 | 2007-08-01 | 135 |
| Number of retired or separated participants receiving benefits | 2007-08-01 | 2 |
| Number of other retired or separated participants entitled to future benefits | 2007-08-01 | 0 |
| Total of all active and inactive participants | 2007-08-01 | 137 |
| 2006: SMITH FROZEN FOODS GROUP MEDICAL BENEFIT PLAN 2006 401k membership |
|---|
| Total participants, beginning-of-year | 2006-08-01 | 134 |
| Total number of active participants reported on line 7a of the Form 5500 | 2006-08-01 | 138 |
| Number of retired or separated participants receiving benefits | 2006-08-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2006-08-01 | 0 |
| Total of all active and inactive participants | 2006-08-01 | 138 |
| 2005: SMITH FROZEN FOODS GROUP MEDICAL BENEFIT PLAN 2005 401k membership |
|---|
| Total participants, beginning-of-year | 2005-08-01 | 155 |
| Total number of active participants reported on line 7a of the Form 5500 | 2005-08-01 | 132 |
| Number of retired or separated participants receiving benefits | 2005-08-01 | 2 |
| Number of other retired or separated participants entitled to future benefits | 2005-08-01 | 0 |
| Total of all active and inactive participants | 2005-08-01 | 134 |
| 2004: SMITH FROZEN FOODS GROUP MEDICAL BENEFIT PLAN 2004 401k membership |
|---|
| Total participants, beginning-of-year | 2004-08-01 | 155 |
| Total number of active participants reported on line 7a of the Form 5500 | 2004-08-01 | 154 |
| Number of retired or separated participants receiving benefits | 2004-08-01 | 1 |
| Number of other retired or separated participants entitled to future benefits | 2004-08-01 | 0 |
| Total of all active and inactive participants | 2004-08-01 | 155 |
| 2003: SMITH FROZEN FOODS GROUP MEDICAL BENEFIT PLAN 2003 401k membership |
|---|
| Total participants, beginning-of-year | 2003-08-01 | 155 |
| Total number of active participants reported on line 7a of the Form 5500 | 2003-08-01 | 155 |
| Number of retired or separated participants receiving benefits | 2003-08-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2003-08-01 | 0 |
| Total of all active and inactive participants | 2003-08-01 | 155 |
| 2002: SMITH FROZEN FOODS GROUP MEDICAL BENEFIT PLAN 2002 401k membership |
|---|
| Total participants, beginning-of-year | 2002-08-01 | 152 |
| Total number of active participants reported on line 7a of the Form 5500 | 2002-08-01 | 153 |
| Number of retired or separated participants receiving benefits | 2002-08-01 | 2 |
| Number of other retired or separated participants entitled to future benefits | 2002-08-01 | 0 |
| Total of all active and inactive participants | 2002-08-01 | 155 |
| 2001: SMITH FROZEN FOODS GROUP MEDICAL BENEFIT PLAN 2001 401k membership |
|---|
| Total participants, beginning-of-year | 2001-08-01 | 150 |
| Total number of active participants reported on line 7a of the Form 5500 | 2001-08-01 | 149 |
| Number of retired or separated participants receiving benefits | 2001-08-01 | 3 |
| Number of other retired or separated participants entitled to future benefits | 2001-08-01 | 0 |
| Total of all active and inactive participants | 2001-08-01 | 152 |
| 2000: SMITH FROZEN FOODS GROUP MEDICAL BENEFIT PLAN 2000 401k membership |
|---|
| Total participants, beginning-of-year | 2000-08-01 | 156 |
| Total number of active participants reported on line 7a of the Form 5500 | 2000-08-01 | 146 |
| Number of retired or separated participants receiving benefits | 2000-08-01 | 4 |
| Number of other retired or separated participants entitled to future benefits | 2000-08-01 | 0 |
| Total of all active and inactive participants | 2000-08-01 | 150 |
| 1999: SMITH FROZEN FOODS GROUP MEDICAL BENEFIT PLAN 1999 401k membership |
|---|
| Total participants, beginning-of-year | 1999-08-01 | 151 |
| Total number of active participants reported on line 7a of the Form 5500 | 1999-08-01 | 154 |
| Number of retired or separated participants receiving benefits | 1999-08-01 | 2 |
| Number of other retired or separated participants entitled to future benefits | 1999-08-01 | 0 |
| Total of all active and inactive participants | 1999-08-01 | 156 |
| 1998: SMITH FROZEN FOODS GROUP MEDICAL BENEFIT PLAN 1998 401k membership |
|---|
| Total participants, beginning-of-year | 1998-08-01 | 152 |
| Total number of active participants reported on line 7a of the Form 5500 | 1998-08-01 | 151 |
| Number of retired or separated participants receiving benefits | 1998-08-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 1998-08-01 | 0 |
| Total of all active and inactive participants | 1998-08-01 | 151 |
| 2022: SMITH FROZEN FOODS GROUP MEDICAL BENEFIT PLAN 2022 form 5500 responses |
|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: SMITH FROZEN FOODS GROUP MEDICAL BENEFIT PLAN 2021 form 5500 responses |
|---|
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: SMITH FROZEN FOODS GROUP MEDICAL BENEFIT PLAN 2020 form 5500 responses |
|---|
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: SMITH FROZEN FOODS GROUP MEDICAL BENEFIT PLAN 2019 form 5500 responses |
|---|
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: SMITH FROZEN FOODS GROUP MEDICAL BENEFIT PLAN 2018 form 5500 responses |
|---|
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: SMITH FROZEN FOODS GROUP MEDICAL BENEFIT PLAN 2017 form 5500 responses |
|---|
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: SMITH FROZEN FOODS GROUP MEDICAL BENEFIT PLAN 2016 form 5500 responses |
|---|
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: SMITH FROZEN FOODS GROUP MEDICAL BENEFIT PLAN 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: SMITH FROZEN FOODS GROUP MEDICAL BENEFIT PLAN 2014 form 5500 responses |
|---|
| 2014-08-01 | Type of plan entity | Single employer plan |
| 2014-08-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2014-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: SMITH FROZEN FOODS GROUP MEDICAL BENEFIT PLAN 2013 form 5500 responses |
|---|
| 2013-08-01 | Type of plan entity | Single employer plan |
| 2013-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2012: SMITH FROZEN FOODS GROUP MEDICAL BENEFIT PLAN 2012 form 5500 responses |
|---|
| 2012-08-01 | Type of plan entity | Single employer plan |
| 2012-08-01 | Submission has been amended | No |
| 2012-08-01 | This submission is the final filing | No |
| 2012-08-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-08-01 | Plan is a collectively bargained plan | No |
| 2012-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2012-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2011: SMITH FROZEN FOODS GROUP MEDICAL BENEFIT PLAN 2011 form 5500 responses |
|---|
| 2011-08-01 | Type of plan entity | Single employer plan |
| 2011-08-01 | Submission has been amended | No |
| 2011-08-01 | This submission is the final filing | No |
| 2011-08-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-08-01 | Plan is a collectively bargained plan | No |
| 2011-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2011-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2010: SMITH FROZEN FOODS GROUP MEDICAL BENEFIT PLAN 2010 form 5500 responses |
|---|
| 2010-08-01 | Type of plan entity | Single employer plan |
| 2010-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2010-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2009: SMITH FROZEN FOODS GROUP MEDICAL BENEFIT PLAN 2009 form 5500 responses |
|---|
| 2009-08-01 | Type of plan entity | Single employer plan |
| 2009-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2009-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2008: SMITH FROZEN FOODS GROUP MEDICAL BENEFIT PLAN 2008 form 5500 responses |
|---|
| 2008-08-01 | Type of plan entity | Single employer plan |
| 2008-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2008-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2007: SMITH FROZEN FOODS GROUP MEDICAL BENEFIT PLAN 2007 form 5500 responses |
|---|
| 2007-08-01 | Type of plan entity | Single employer plan |
| 2007-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2007-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2006: SMITH FROZEN FOODS GROUP MEDICAL BENEFIT PLAN 2006 form 5500 responses |
|---|
| 2006-08-01 | Type of plan entity | Single employer plan |
| 2006-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2006-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2005: SMITH FROZEN FOODS GROUP MEDICAL BENEFIT PLAN 2005 form 5500 responses |
|---|
| 2005-08-01 | Type of plan entity | Single employer plan |
| 2005-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2005-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2004: SMITH FROZEN FOODS GROUP MEDICAL BENEFIT PLAN 2004 form 5500 responses |
|---|
| 2004-08-01 | Type of plan entity | Single employer plan |
| 2004-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2004-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2003: SMITH FROZEN FOODS GROUP MEDICAL BENEFIT PLAN 2003 form 5500 responses |
|---|
| 2003-08-01 | Type of plan entity | Single employer plan |
| 2003-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2003-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2002: SMITH FROZEN FOODS GROUP MEDICAL BENEFIT PLAN 2002 form 5500 responses |
|---|
| 2002-08-01 | Type of plan entity | Single employer plan |
| 2002-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2002-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2001: SMITH FROZEN FOODS GROUP MEDICAL BENEFIT PLAN 2001 form 5500 responses |
|---|
| 2001-08-01 | Type of plan entity | Single employer plan |
| 2001-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2001-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2000: SMITH FROZEN FOODS GROUP MEDICAL BENEFIT PLAN 2000 form 5500 responses |
|---|
| 2000-08-01 | Type of plan entity | Single employer plan |
| 2000-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2000-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 1999: SMITH FROZEN FOODS GROUP MEDICAL BENEFIT PLAN 1999 form 5500 responses |
|---|
| 1999-08-01 | Type of plan entity | Single employer plan |
| 1999-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 1999-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 1998: SMITH FROZEN FOODS GROUP MEDICAL BENEFIT PLAN 1998 form 5500 responses |
|---|
| 1998-08-01 | Type of plan entity | Single employer plan |
| 1998-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 1998-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 427883 |
| Policy instance | 5 |
| Insurance contract or identification number | 427883 | | Number of Individuals Covered | 129 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $9,476 | | Total amount of fees paid to insurance company | USD $3,745 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $114,820 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,476 | | Amount paid for insurance broker fees | 3745 | | Additional information about fees paid to insurance broker | ADDTL COMP | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 427882 |
| Policy instance | 4 |
| Insurance contract or identification number | 427882 | | Number of Individuals Covered | 73 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $3,750 | | Total amount of fees paid to insurance company | USD $1,000 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $26,299 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,750 | | Amount paid for insurance broker fees | 1000 | | Additional information about fees paid to insurance broker | ADDTL COMP | | Insurance broker organization code? | 3 |
|
| PAUL REVERE VARIABLE ANNUITY INS. CO. (National Association of Insurance Commissioners NAIC id number: 67601 ) |
| Policy contract number | 427881 |
| Policy instance | 3 |
| Insurance contract or identification number | 427881 | | Number of Individuals Covered | 32 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $1,785 | | Total amount of fees paid to insurance company | USD $238 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $11,858 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,785 | | Amount paid for insurance broker fees | 238 | | Additional information about fees paid to insurance broker | ADDTL COMP | | Insurance broker organization code? | 3 |
|
| PAUL REVERE VARIABLE ANNUITY INS. CO. (National Association of Insurance Commissioners NAIC id number: 67601 ) |
| Policy contract number | 427880 |
| Policy instance | 2 |
| Insurance contract or identification number | 427880 | | Number of Individuals Covered | 38 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Temporary Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | GROUP ACCIDENT | | Welfare Benefit Premiums Paid to Carrier | USD $9,364 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 948372 |
| Policy instance | 1 |
| Insurance contract or identification number | 948372 | | Number of Individuals Covered | 127 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $28,631 | | Total amount of fees paid to insurance company | USD $7,219 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $572,617 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $28,631 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 7219 | | Additional information about fees paid to insurance broker | BONUS |
|
| SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
| Policy contract number | 16-015096-000 |
| Policy instance | 1 |
| Insurance contract or identification number | 16-015096-000 | | Number of Individuals Covered | 119 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of fees paid to insurance company | USD $30,202 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $582,384 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 27221 | | Additional information about fees paid to insurance broker | ADMINISTRATION FEE GROUP VOLUME BONUS | | Insurance broker organization code? | 3 |
|
| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
| Policy contract number | 168003 |
| Policy instance | 2 |
| Insurance contract or identification number | 168003 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $645 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,160 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $622 | | Insurance broker organization code? | 3 |
|
| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
| Policy contract number | 168004 |
| Policy instance | 3 |
| Insurance contract or identification number | 168004 | | Number of Individuals Covered | 4 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $1,077 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $7,001 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,039 | | Insurance broker organization code? | 3 |
|
| PAUL REVERE VARIABLE ANNUITY INS. CO. (National Association of Insurance Commissioners NAIC id number: 67601 ) |
| Policy contract number | 427880 |
| Policy instance | 4 |
| Insurance contract or identification number | 427880 | | Number of Individuals Covered | 34 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Temporary Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | GROUP ACCIDENT | | Welfare Benefit Premiums Paid to Carrier | USD $8,660 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PAUL REVERE VARIABLE ANNUITY INS. CO. (National Association of Insurance Commissioners NAIC id number: 67601 ) |
| Policy contract number | 427881 |
| Policy instance | 5 |
| Insurance contract or identification number | 427881 | | Number of Individuals Covered | 27 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $1,623 | | Total amount of fees paid to insurance company | USD $226 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $11,631 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,623 | | Amount paid for insurance broker fees | 226 | | Additional information about fees paid to insurance broker | ADDTL COMP | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 427882 |
| Policy instance | 6 |
| Insurance contract or identification number | 427882 | | Number of Individuals Covered | 73 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $3,490 | | Total amount of fees paid to insurance company | USD $834 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $21,344 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,490 | | Amount paid for insurance broker fees | 834 | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 427883 |
| Policy instance | 7 |
| Insurance contract or identification number | 427883 | | Number of Individuals Covered | 124 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $8,945 | | Total amount of fees paid to insurance company | USD $3,457 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $102,151 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,945 | | Amount paid for insurance broker fees | 3457 | | Additional information about fees paid to insurance broker | ADDTL COMP | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 427883 |
| Policy instance | 10 |
| Insurance contract or identification number | 427883 | | Number of Individuals Covered | 133 | | Insurance policy start date | 2020-02-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $7,364 | | Total amount of fees paid to insurance company | USD $1,595 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $63,779 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,364 | | Amount paid for insurance broker fees | 1595 | | Additional information about fees paid to insurance broker | ADDTL COMP | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 427882 |
| Policy instance | 9 |
| Insurance contract or identification number | 427882 | | Number of Individuals Covered | 53 | | Insurance policy start date | 2020-02-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $2,510 | | Total amount of fees paid to insurance company | USD $419 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $17,747 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,510 | | Amount paid for insurance broker fees | 419 | | Insurance broker organization code? | 3 |
|
| PAUL REVERE VARIABLE ANNUITY INS. CO. (National Association of Insurance Commissioners NAIC id number: 67601 ) |
| Policy contract number | 427881 |
| Policy instance | 8 |
| Insurance contract or identification number | 427881 | | Number of Individuals Covered | 25 | | Insurance policy start date | 2020-03-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $1,358 | | Total amount of fees paid to insurance company | USD $193 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $7,723 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,358 | | Amount paid for insurance broker fees | 193 | | Additional information about fees paid to insurance broker | ADDTL COMP | | Insurance broker organization code? | 3 |
|
| PAUL REVERE VARIABLE ANNUITY INS. CO. (National Association of Insurance Commissioners NAIC id number: 67601 ) |
| Policy contract number | 427880 |
| Policy instance | 7 |
| Insurance contract or identification number | 427880 | | Number of Individuals Covered | 30 | | Insurance policy start date | 2020-03-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $679 | | Total amount of fees paid to insurance company | USD $113 | | Temporary Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | GROUP ACCIDENT | | Welfare Benefit Premiums Paid to Carrier | USD $7,293 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $679 | | Amount paid for insurance broker fees | 113 | | Additional information about fees paid to insurance broker | ADDTL COMP | | Insurance broker organization code? | 3 |
|
| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
| Policy contract number | 168004 |
| Policy instance | 6 |
| Insurance contract or identification number | 168004 | | Number of Individuals Covered | 4 | | Insurance policy start date | 2020-03-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $1,455 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $7,001 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,039 | | Insurance broker organization code? | 3 |
|
| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
| Policy contract number | 168003 |
| Policy instance | 5 |
| Insurance contract or identification number | 168003 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2020-03-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $871 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,160 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $622 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLTD0114I |
| Policy instance | 4 |
| Insurance contract or identification number | GLTD0114I | | Number of Individuals Covered | 134 | | Insurance policy start date | 2019-02-01 | | Insurance policy end date | 2020-01-31 | | Total amount of commissions paid to insurance broker | USD $2,690 | | Total amount of fees paid to insurance company | USD $641 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $19,403 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,690 | | Amount paid for insurance broker fees | 641 | | Insurance broker organization code? | 3 |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 223899 |
| Policy instance | 3 |
| Insurance contract or identification number | 223899 | | Number of Individuals Covered | 122 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of fees paid to insurance company | USD $11,283 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $512,326 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 5755 | | Additional information about fees paid to insurance broker | BONUS PMT | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG0114I |
| Policy instance | 2 |
| Insurance contract or identification number | GLUG0114I | | Number of Individuals Covered | 135 | | Insurance policy start date | 2019-02-01 | | Insurance policy end date | 2020-01-31 | | Total amount of commissions paid to insurance broker | USD $3,426 | | Total amount of fees paid to insurance company | USD $1,289 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $38,529 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,426 | | Amount paid for insurance broker fees | 1289 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GVTL0114I |
| Policy instance | 1 |
| Insurance contract or identification number | GVTL0114I | | Number of Individuals Covered | 39 | | Insurance policy start date | 2019-02-01 | | Insurance policy end date | 2020-01-31 | | Total amount of commissions paid to insurance broker | USD $1,312 | | Total amount of fees paid to insurance company | USD $520 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $13,124 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,312 | | Amount paid for insurance broker fees | 520 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLTD0114I |
| Policy instance | 4 |
| Insurance contract or identification number | GLTD0114I | | Number of Individuals Covered | 254 | | Insurance policy start date | 2018-02-01 | | Insurance policy end date | 2019-01-31 | | Total amount of commissions paid to insurance broker | USD $2,615 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $18,648 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,615 | | Insurance broker organization code? | 3 |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 223899 |
| Policy instance | 3 |
| Insurance contract or identification number | 223899 | | Number of Individuals Covered | 126 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $10,019 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $465,944 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,968 | | Additional information about fees paid to insurance broker | BONUS PMT | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG0114I |
| Policy instance | 2 |
| Insurance contract or identification number | GLUG0114I | | Number of Individuals Covered | 254 | | Insurance policy start date | 2018-02-01 | | Insurance policy end date | 2019-01-31 | | Total amount of commissions paid to insurance broker | USD $3,376 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $37,513 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,376 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GVTL0114I |
| Policy instance | 1 |
| Insurance contract or identification number | GVTL0114I | | Number of Individuals Covered | 39 | | Insurance policy start date | 2018-02-01 | | Insurance policy end date | 2019-01-31 | | Total amount of commissions paid to insurance broker | USD $1,481 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $14,805 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,481 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GVTL0114I |
| Policy instance | 1 |
| Insurance contract or identification number | GVTL0114I | | Number of Individuals Covered | 42 | | Insurance policy start date | 2017-02-01 | | Insurance policy end date | 2018-01-31 | | Total amount of commissions paid to insurance broker | USD $1,702 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $17,022 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,702 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG0114I |
| Policy instance | 2 |
| Insurance contract or identification number | GLUG0114I | | Number of Individuals Covered | 127 | | Insurance policy start date | 2017-02-01 | | Insurance policy end date | 2018-01-31 | | Total amount of commissions paid to insurance broker | USD $3,321 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $36,414 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,321 | | Insurance broker organization code? | 3 |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 223899 |
| Policy instance | 3 |
| Insurance contract or identification number | 223899 | | Number of Individuals Covered | 137 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of fees paid to insurance company | USD $11,953 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $316,206 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 6870 | | Additional information about fees paid to insurance broker | BONUS PMT | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLTD0114I |
| Policy instance | 4 |
| Insurance contract or identification number | GLTD0114I | | Number of Individuals Covered | 126 | | Insurance policy start date | 2017-02-01 | | Insurance policy end date | 2018-01-31 | | Total amount of commissions paid to insurance broker | USD $2,529 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $17,787 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,529 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLTD0114I |
| Policy instance | 4 |
| Insurance contract or identification number | GLTD0114I | | Number of Individuals Covered | 123 | | Insurance policy start date | 2016-02-01 | | Insurance policy end date | 2017-01-31 | | Total amount of commissions paid to insurance broker | USD $2,171 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $14,472 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,656 | | Insurance broker organization code? | 3 | | Insurance broker name | DAVIDSON BENEFITS PLANNING LLC |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 223899 |
| Policy instance | 3 |
| Insurance contract or identification number | 223899 | | Number of Individuals Covered | 132 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of fees paid to insurance company | USD $9,763 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $262,691 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 4974 | | Additional information about fees paid to insurance broker | BONUS PMT | | Insurance broker organization code? | 3 | | Insurance broker name | HEALTHCARE MGMT ADMINISTRATORS INC |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG0114I |
| Policy instance | 2 |
| Insurance contract or identification number | GLUG0114I | | Number of Individuals Covered | 124 | | Insurance policy start date | 2016-02-01 | | Insurance policy end date | 2017-01-31 | | Total amount of commissions paid to insurance broker | USD $3,040 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $30,786 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,296 | | Insurance broker organization code? | 3 | | Insurance broker name | MILLER & WADE INSURANCE AGENCY |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GVTL0114I |
| Policy instance | 1 |
| Insurance contract or identification number | GVTL0114I | | Number of Individuals Covered | 44 | | Insurance policy start date | 2016-02-01 | | Insurance policy end date | 2017-01-31 | | Total amount of commissions paid to insurance broker | USD $1,489 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $14,893 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,097 | | Insurance broker organization code? | 3 | | Insurance broker name | MILLER & WADE INSURANCE AGENCY |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 223899 |
| Policy instance | 3 |
| Insurance contract or identification number | 223899 | | Number of Individuals Covered | 120 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of fees paid to insurance company | USD $1,356 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $233,673 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 1356 | | Additional information about fees paid to insurance broker | BONUS PMT | | Insurance broker organization code? | 3 | | Insurance broker name | HEALTHCARE MGMT ADMINISTRATORS INC |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000114I |
| Policy instance | 2 |
| Insurance contract or identification number | G000114I | | Number of Individuals Covered | 109 | | Insurance policy start date | 2014-02-01 | | Insurance policy end date | 2015-01-31 | | Total amount of commissions paid to insurance broker | USD $1,941 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $12,937 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,941 | | Insurance broker organization code? | 3 | | Insurance broker name | MILLER & WADE INSURANCE AGENCY |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000114I |
| Policy instance | 1 |
| Insurance contract or identification number | G000114I | | Number of Individuals Covered | 110 | | Insurance policy start date | 2014-02-01 | | Insurance policy end date | 2015-01-31 | | Total amount of commissions paid to insurance broker | USD $2,585 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $25,849 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,585 | | Insurance broker organization code? | 3 | | Insurance broker name | MILLER & WADE INSURANCE AGENCY |
|
