401k Plan data: HORNBLOWER GROUP, INC. HEALTH AND WELFARE PLAN plan

HORNBLOWER GROUP, INC. HEALTH AND WELFARE PLAN 401k Plan overview

Plan Name	HORNBLOWER GROUP, INC. HEALTH AND WELFARE PLAN
Plan identification number	501

HORNBLOWER GROUP, INC. HEALTH AND WELFARE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Long-term disability cover Other welfare benefit cover

401k Sponsoring company profile

HORNBLOWER GROUP, INC. has sponsored the creation of one or more 401k plans.

Company Name: HORNBLOWER GROUP, INC.

Employer identification number (EIN): 943460564

NAIC Classification: 483000
NAIC Description: Water Transportation

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HORNBLOWER GROUP, INC. HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2021-07-01
501 2020-07-01
501 2020-05-01
501 2019-05-01
501 2019-05-01

Plan Statistics for HORNBLOWER GROUP, INC. HEALTH AND WELFARE PLAN

401k plan membership statisitcs for HORNBLOWER GROUP, INC. HEALTH AND WELFARE PLAN

Measure Date Value
2021: HORNBLOWER GROUP, INC. HEALTH AND WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year 2021-07-01 1,467
Total number of active participants reported on line 7a of the Form 5500 2021-07-01 2,728
Number of retired or separated participants receiving benefits 2021-07-01 13
Number of other retired or separated participants entitled to future benefits 2021-07-01 0
Total of all active and inactive participants 2021-07-01 2,741
2020: HORNBLOWER GROUP, INC. HEALTH AND WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year 2020-07-01 1,189
Total number of active participants reported on line 7a of the Form 5500 2020-07-01 1,436
Number of retired or separated participants receiving benefits 2020-07-01 34
Number of other retired or separated participants entitled to future benefits 2020-07-01 0
Total of all active and inactive participants 2020-07-01 1,470
Total participants, beginning-of-year 2020-05-01 1,233
Total number of active participants reported on line 7a of the Form 5500 2020-05-01 1,165
Number of retired or separated participants receiving benefits 2020-05-01 22
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 1,187
2019: HORNBLOWER GROUP, INC. HEALTH AND WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year 2019-05-01 977
Total number of active participants reported on line 7a of the Form 5500 2019-05-01 1,193
Number of retired or separated participants receiving benefits 2019-05-01 20
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 1,213

Measure	Date	Value
2021: HORNBLOWER GROUP, INC. HEALTH AND WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year	2021-07-01	1,467
Total number of active participants reported on line 7a of the Form 5500	2021-07-01	2,728
Number of retired or separated participants receiving benefits	2021-07-01	13
Number of other retired or separated participants entitled to future benefits	2021-07-01	0
Total of all active and inactive participants	2021-07-01	2,741
2020: HORNBLOWER GROUP, INC. HEALTH AND WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year	2020-07-01	1,189
Total number of active participants reported on line 7a of the Form 5500	2020-07-01	1,436
Number of retired or separated participants receiving benefits	2020-07-01	34
Number of other retired or separated participants entitled to future benefits	2020-07-01	0
Total of all active and inactive participants	2020-07-01	1,470
Total participants, beginning-of-year	2020-05-01	1,233
Total number of active participants reported on line 7a of the Form 5500	2020-05-01	1,165
Number of retired or separated participants receiving benefits	2020-05-01	22
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	1,187
2019: HORNBLOWER GROUP, INC. HEALTH AND WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year	2019-05-01	977
Total number of active participants reported on line 7a of the Form 5500	2019-05-01	1,193
Number of retired or separated participants receiving benefits	2019-05-01	20
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	1,213

Form 5500 Responses for HORNBLOWER GROUP, INC. HEALTH AND WELFARE PLAN

2021: HORNBLOWER GROUP, INC. HEALTH AND WELFARE PLAN 2021 form 5500 responses
2021-07-01	Type of plan entity	Single employer plan
2021-07-01	Plan funding arrangement – Insurance	Yes
2021-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-07-01	Plan benefit arrangement – Insurance	Yes
2021-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2020: HORNBLOWER GROUP, INC. HEALTH AND WELFARE PLAN 2020 form 5500 responses
2020-07-01	Type of plan entity	Single employer plan
2020-07-01	Submission has been amended	Yes
2020-07-01	Plan funding arrangement – Insurance	Yes
2020-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2020-07-01	Plan benefit arrangement – Insurance	Yes
2020-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2020-05-01	Type of plan entity	Single employer plan
2020-05-01	This return/report is a short plan year return/report (less than 12 months)	Yes
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: HORNBLOWER GROUP, INC. HEALTH AND WELFARE PLAN 2019 form 5500 responses
2019-05-01	Type of plan entity	Single employer plan
2019-05-01	First time form 5500 has been submitted	Yes
2019-05-01	Submission has been amended	Yes
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

Insurance Providers Used on plan

METROPOLITAN PROPERTY AND CASUALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26298 )

Policy contract number

9903565

Policy instance

Insurance contract or identification number	9903565
Number of Individuals Covered	181
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $3,710
Total amount of fees paid to insurance company	USD $599
Other welfare benefits provided	LEGAL
Welfare Benefit Premiums Paid to Carrier	USD $33,750
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,710
Amount paid for insurance broker fees	71
Additional information about fees paid to insurance broker	NON-MONETARY COMPENSATION
Insurance broker organization code?	3

DENTEGRA INS CO (National Association of Insurance Commissioners NAIC id number: 73474 )

Policy contract number

79138

Policy instance

Insurance contract or identification number	79138
Number of Individuals Covered	226
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $3,182
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $59,819
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,182
Insurance broker organization code?	3

LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )

Policy contract number

000010262291

Policy instance

Insurance contract or identification number	000010262291
Number of Individuals Covered	884
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $5,179
Total amount of fees paid to insurance company	USD $83
Other welfare benefits provided	NY DISABILITY AND NY FAMILY LEAVE
Welfare Benefit Premiums Paid to Carrier	USD $211,788
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,179
Insurance broker organization code?	3
Amount paid for insurance broker fees	83
Additional information about fees paid to insurance broker	BROKER BONUS

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

040000100026162

Policy instance

Insurance contract or identification number	040000100026162
Number of Individuals Covered	1030
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $16,420
Total amount of fees paid to insurance company	USD $1,321
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $205,247
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16,420
Insurance broker organization code?	3
Amount paid for insurance broker fees	1321
Additional information about fees paid to insurance broker	BROKER BONUS

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000402007704

Policy instance

Insurance contract or identification number	000402007704
Number of Individuals Covered	947
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $3,853
Total amount of fees paid to insurance company	USD $269
Other welfare benefits provided	VOLUNTARY AD&D
Welfare Benefit Premiums Paid to Carrier	USD $48,158
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,853
Insurance broker organization code?	3
Amount paid for insurance broker fees	269
Additional information about fees paid to insurance broker	BROKER BONUS

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

09-LF0606-0000

Policy instance

Insurance contract or identification number	09-LF0606-0000
Number of Individuals Covered	405
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $8,954
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $165,824
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,954
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010261593

Policy instance

Insurance contract or identification number	000010261593
Number of Individuals Covered	183
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $5,004
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $62,556
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,004
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010261265

Policy instance

Insurance contract or identification number	000010261265
Number of Individuals Covered	1480
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $15,203
Total amount of fees paid to insurance company	USD $539
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $190,032
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $15,203
Insurance broker organization code?	3
Amount paid for insurance broker fees	539
Additional information about fees paid to insurance broker	BROKER BONUS

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010261264

Policy instance

Insurance contract or identification number	000010261264
Number of Individuals Covered	2728
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $16,639
Total amount of fees paid to insurance company	USD $1,189
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $207,991
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16,639
Insurance broker organization code?	3
Amount paid for insurance broker fees	1189
Additional information about fees paid to insurance broker	BROKER BONUS

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010261263

Policy instance

Insurance contract or identification number	000010261263
Number of Individuals Covered	2729
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $23,603
Total amount of fees paid to insurance company	USD $1,434
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $295,043
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $23,603
Insurance broker organization code?	3
Amount paid for insurance broker fees	1434
Additional information about fees paid to insurance broker	BROKER BONUS

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

0227278

Policy instance

Insurance contract or identification number	0227278
Number of Individuals Covered	324
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $13,083
Total amount of fees paid to insurance company	USD $1,188
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $72,310
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,083
Amount paid for insurance broker fees	1188
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION NON-MONETARY COMPENSATION
Insurance broker organization code?	3

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

0227277

Policy instance

Insurance contract or identification number	0227277
Number of Individuals Covered	912
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $15,138
Total amount of fees paid to insurance company	USD $1,364
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $84,402
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $15,138
Amount paid for insurance broker fees	1364
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION NON-MONETARY COMPENSATION
Insurance broker organization code?	3

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

0227276

Policy instance

Insurance contract or identification number	0227276
Number of Individuals Covered	542
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $23,515
Total amount of fees paid to insurance company	USD $2,095
Other welfare benefits provided	CII
Welfare Benefit Premiums Paid to Carrier	USD $129,606
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $23,515
Amount paid for insurance broker fees	2095
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION NON-MONETARY COMPENSATION
Insurance broker organization code?	3

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

201908-0222

Policy instance

Insurance contract or identification number	201908-0222
Number of Individuals Covered	7
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $1,304
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $7,668
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $947
Insurance broker organization code?	3

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

020617

Policy instance

Insurance contract or identification number	020617
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 $104
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $610
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $67
Insurance broker organization code?	3

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

709396D

Policy instance

Insurance contract or identification number	709396D
Number of Individuals Covered	755
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of fees paid to insurance company	USD $13
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	PFL
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	13
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30090584

Policy instance

Insurance contract or identification number	30090584
Number of Individuals Covered	1205
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $19,515
Vision 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 $19,515
Insurance broker organization code?	3

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

752023

Policy instance

Insurance contract or identification number	752023
Number of Individuals Covered	2250
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $157,020
Welfare Benefit Premiums Paid to Carrier	USD $1,578,631
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $157,020
Insurance broker organization code?	3

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00899123

Policy instance

Insurance contract or identification number	00899123
Insurance policy start date	2021-05-01
Insurance policy end date	2022-04-30
Total amount of commissions paid to insurance broker	USD $1,854
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $16,975
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,854
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

38773

Policy instance

Insurance contract or identification number	38773
Number of Individuals Covered	161
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $14,895
Total amount of fees paid to insurance company	USD $249
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $232,445
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,895
Insurance broker organization code?	3
Amount paid for insurance broker fees	249
Additional information about fees paid to insurance broker	BONUS

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

225807

Policy instance

Insurance contract or identification number	225807
Number of Individuals Covered	61
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $8,846
Total amount of fees paid to insurance company	USD $95
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $156,784
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,846
Insurance broker organization code?	3
Amount paid for insurance broker fees	95
Additional information about fees paid to insurance broker	BONUS

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010266284

Policy instance

Insurance contract or identification number	000010266284
Number of Individuals Covered	1
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $74
Total amount of fees paid to insurance company	USD $116
Other welfare benefits provided	NJ DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $741
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	116
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $74

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

020582

Policy instance

Insurance contract or identification number	020582
Number of Individuals Covered	38
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $8,109
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $47,704
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,655
Insurance broker organization code?	3

CURALINC HEALTHCARE (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

02950

Policy instance

Insurance contract or identification number	02950
Number of Individuals Covered	3549
Insurance policy start date	2022-03-01
Insurance policy end date	2022-06-30
Other welfare benefits provided	EAP
Welfare Benefit Premiums Paid to Carrier	USD $16,183
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010266302

Policy instance

Insurance contract or identification number	000010266302
Number of Individuals Covered	11
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $428
Total amount of fees paid to insurance company	USD $275
Other welfare benefits provided	NJ DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $4,282
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $428
Insurance broker organization code?	3
Amount paid for insurance broker fees	275
Additional information about fees paid to insurance broker	BROKER BONUS

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010266281

Policy instance

Insurance contract or identification number	000010266281
Number of Individuals Covered	7
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $259
Total amount of fees paid to insurance company	USD $373
Other welfare benefits provided	NJ DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $2,592
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	373
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $259

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010266282

Policy instance

Insurance contract or identification number	000010266282
Number of Individuals Covered	145
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $4,182
Total amount of fees paid to insurance company	USD $4,413
Other welfare benefits provided	NJ DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $41,819
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	4413
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $4,182

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010261265

Policy instance

Insurance contract or identification number	000010261265
Number of Individuals Covered	281
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $5,329
Total amount of fees paid to insurance company	USD $4,618
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $66,617
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,329
Insurance broker organization code?	3
Amount paid for insurance broker fees	4618
Additional information about fees paid to insurance broker	BROKER BONUS

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010261593

Policy instance

Insurance contract or identification number	000010261593
Number of Individuals Covered	85
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $5,160
Total amount of fees paid to insurance company	USD $4,643
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $64,504
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,160
Insurance broker organization code?	3
Amount paid for insurance broker fees	4643
Additional information about fees paid to insurance broker	BROKER BONUS

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010261594

Policy instance

Insurance contract or identification number	000010261594
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $4,909
Total amount of fees paid to insurance company	USD $4,484
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $61,365
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,909
Insurance broker organization code?	3
Amount paid for insurance broker fees	4484
Additional information about fees paid to insurance broker	BROKER BONUS

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000402007704

Policy instance

Insurance contract or identification number	000402007704
Number of Individuals Covered	618
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $2,114
Total amount of fees paid to insurance company	USD $1,815
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOLUNTARY AD&D
Welfare Benefit Premiums Paid to Carrier	USD $26,427
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,114
Insurance broker organization code?	3
Amount paid for insurance broker fees	1815
Additional information about fees paid to insurance broker	BROKER BONUS

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

040000100026162

Policy instance

Insurance contract or identification number	040000100026162
Number of Individuals Covered	682
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $12,700
Total amount of fees paid to insurance company	USD $10,973
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $158,750
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,700
Insurance broker organization code?	3
Amount paid for insurance broker fees	10973
Additional information about fees paid to insurance broker	BROKER BONUS

LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )

Policy contract number

000010262291

Policy instance

Insurance contract or identification number	000010262291
Number of Individuals Covered	695
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $1,574
Total amount of fees paid to insurance company	USD $88
Other welfare benefits provided	NY DISABILITY AND NY FAMILY LEAVE
Welfare Benefit Premiums Paid to Carrier	USD $17,773
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,574
Insurance broker organization code?	3
Amount paid for insurance broker fees	88
Additional information about fees paid to insurance broker	BROKER BONUS

DENTEGRA INS CO (National Association of Insurance Commissioners NAIC id number: 73474 )

Policy contract number

79138

Policy instance

Insurance contract or identification number	79138
Number of Individuals Covered	142
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $4,766
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $40,733
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,766
Insurance broker organization code?	3

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

201908-0222

Policy instance

Insurance contract or identification number	201908-0222
Number of Individuals Covered	3
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $7,015
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $41,266
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,061
Insurance broker organization code?	3

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

020583

Policy instance

Insurance contract or identification number	020583
Number of Individuals Covered	1
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $1,126
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $6,623
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $594
Insurance broker organization code?	3

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

020582

Policy instance

Insurance contract or identification number	020582
Number of Individuals Covered	7
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $6,700
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $39,408
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,335
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010261264

Policy instance

Insurance contract or identification number	000010261264
Number of Individuals Covered	1436
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $10,635
Total amount of fees paid to insurance company	USD $9,126
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $132,937
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	9126
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $10,635

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010261263

Policy instance

Insurance contract or identification number	000010261263
Number of Individuals Covered	954
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $8,949
Total amount of fees paid to insurance company	USD $7,140
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $111,858
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,949
Insurance broker organization code?	3
Amount paid for insurance broker fees	7140
Additional information about fees paid to insurance broker	BROKER BONUS

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

225807

Policy instance

Insurance contract or identification number	225807
Number of Individuals Covered	52
Insurance policy start date	2020-05-01
Insurance policy end date	2021-04-30
Total amount of commissions paid to insurance broker	USD $23,778
Total amount of fees paid to insurance company	USD $549
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $610,028
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $23,778
Insurance broker organization code?	3
Amount paid for insurance broker fees	549
Additional information about fees paid to insurance broker	BONUS

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

38773

Policy instance

Insurance contract or identification number	38773
Number of Individuals Covered	105
Insurance policy start date	2020-05-01
Insurance policy end date	2021-04-30
Total amount of commissions paid to insurance broker	USD $46,214
Total amount of fees paid to insurance company	USD $1,089
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,155,593
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $46,214
Insurance broker organization code?	3
Amount paid for insurance broker fees	1089
Additional information about fees paid to insurance broker	BONUS

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

225807

Policy instance

Insurance contract or identification number	225807
Number of Individuals Covered	50
Insurance policy start date	2021-05-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $23
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $14,740
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $23
Insurance broker organization code?	3

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

38773

Policy instance

Insurance contract or identification number	38773
Number of Individuals Covered	110
Insurance policy start date	2021-05-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $-22
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $594
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $-22
Insurance broker organization code?	3

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00899123

Policy instance

Insurance contract or identification number	00899123
Number of Individuals Covered	79
Insurance policy start date	2020-07-01
Insurance policy end date	2021-04-30
Total amount of commissions paid to insurance broker	USD $4,334
Total amount of fees paid to insurance company	USD $917
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $34,979
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,948
Insurance broker organization code?	3
Amount paid for insurance broker fees	917
Additional information about fees paid to insurance broker	FEES

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

752023

Policy instance

Insurance contract or identification number	752023
Number of Individuals Covered	1619
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $144,261
Welfare Benefit Premiums Paid to Carrier	USD $863,123
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $144,261
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30090584

Policy instance

Insurance contract or identification number	30090584
Number of Individuals Covered	858
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $17,816
Vision 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 $17,816
Insurance broker organization code?	3

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

0227278

Policy instance

Insurance contract or identification number	0227278
Number of Individuals Covered	162
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $6,447
Total amount of fees paid to insurance company	USD $455
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $38,468
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,447
Amount paid for insurance broker fees	455
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION NON-MONETARY COMPENSATION
Insurance broker organization code?	3

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

0227277

Policy instance

Insurance contract or identification number	0227277
Number of Individuals Covered	445
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $7,725
Total amount of fees paid to insurance company	USD $535
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $45,532
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,725
Amount paid for insurance broker fees	535
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION NON-MONETARY COMPENSATION
Insurance broker organization code?	3

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

0227276

Policy instance

Insurance contract or identification number	0227276
Number of Individuals Covered	350
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $12,984
Total amount of fees paid to insurance company	USD $864
Other welfare benefits provided	CII
Welfare Benefit Premiums Paid to Carrier	USD $76,066
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,984
Amount paid for insurance broker fees	864
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION NON-MONETARY COMPENSATION
Insurance broker organization code?	3

METROPOLITAN PROPERTY AND CASUALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26298 )

Policy contract number

9903565

Policy instance

Insurance contract or identification number	9903565
Number of Individuals Covered	111
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $2,482
Total amount of fees paid to insurance company	USD $285
Other welfare benefits provided	LEGAL
Welfare Benefit Premiums Paid to Carrier	USD $20,664
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,482
Insurance broker organization code?	3
Amount paid for insurance broker fees	285
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

312477C,709396D

Policy instance

Insurance contract or identification number	312477C,709396D
Number of Individuals Covered	779
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $477
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	PFL
Welfare Benefit Premiums Paid to Carrier	USD $7,869
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $477
Insurance broker organization code?	3

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

GP-020617

Policy instance

Insurance contract or identification number	GP-020617
Number of Individuals Covered	7
Insurance policy start date	2020-05-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $507
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $8,451
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $507
Insurance broker organization code?	3

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

0752023

Policy instance

Insurance contract or identification number	0752023
Number of Individuals Covered	1494
Insurance policy start date	2020-05-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $56,758
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,419,152
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $56,758
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

703607

Policy instance

Insurance contract or identification number	703607
Number of Individuals Covered	425
Insurance policy start date	2020-05-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $915
Total amount of fees paid to insurance company	USD $159
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $6,098
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $915
Amount paid for insurance broker fees	159
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

GRH 684041, 042

Policy instance

Insurance contract or identification number	GRH 684041, 042
Number of Individuals Covered	621
Insurance policy start date	2020-05-01
Insurance policy end date	2020-06-30
Other welfare benefits provided	CA VOLUNTARY DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $4,976
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

703595

Policy instance

Insurance contract or identification number	703595
Number of Individuals Covered	158
Insurance policy start date	2020-05-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $1,401
Total amount of fees paid to insurance company	USD $213
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $9,341
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,401
Amount paid for insurance broker fees	213
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

703594

Policy instance

Insurance contract or identification number	703594
Number of Individuals Covered	606
Insurance policy start date	2020-05-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $2,218
Total amount of fees paid to insurance company	USD $446
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $13,337
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,218
Amount paid for insurance broker fees	446
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30090584

Policy instance

Insurance contract or identification number	30090584
Number of Individuals Covered	1013
Insurance policy start date	2020-05-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $911
Vision 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 $911
Insurance broker organization code?	3

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

38773

Policy instance

Insurance contract or identification number	38773
Number of Individuals Covered	253
Insurance policy start date	2020-05-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $73
Health 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 $73
Insurance broker organization code?	3

HEALTH MANAGEMENT SYSTEMS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

Policy instance

Insurance contract or identification number	1
Number of Individuals Covered	876
Insurance policy start date	2020-05-01
Insurance policy end date	2020-06-09
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $368
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00899123

Policy instance

Insurance contract or identification number	00899123
Number of Individuals Covered	35
Insurance policy start date	2020-05-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $99
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $922
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $99
Insurance broker organization code?	3

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00899123

Policy instance

Insurance contract or identification number	00899123
Number of Individuals Covered	161
Insurance policy start date	2019-04-01
Insurance policy end date	2020-03-31
Total amount of commissions paid to insurance broker	USD $7,256
Total amount of fees paid to insurance company	USD $2,254
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $58,563
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,256
Amount paid for insurance broker fees	2254
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00923469

Policy instance

Insurance contract or identification number	00923469
Number of Individuals Covered	418
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $1,343
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $956
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,343
Insurance broker organization code?	3

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

20583

Policy instance

Insurance contract or identification number	20583
Number of Individuals Covered	13
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $1,024
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $17,060
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,024
Insurance broker organization code?	3

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

GP-20582

Policy instance

Insurance contract or identification number	GP-20582
Number of Individuals Covered	90
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $12,181
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $203,013
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,181
Insurance broker organization code?	3

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

20581

Policy instance

Insurance contract or identification number	20581
Number of Individuals Covered	40
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $22,230
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $130,764
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $15,969
Insurance broker organization code?	3

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

0752023

Policy instance

Insurance contract or identification number	0752023
Number of Individuals Covered	1544
Insurance policy start date	2019-05-01
Insurance policy end date	2020-04-30
Total amount of commissions paid to insurance broker	USD $497,995
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $10,338,218
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $497,995
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

703596

Policy instance

Insurance contract or identification number	703596
Number of Individuals Covered	187
Insurance policy start date	2019-05-01
Insurance policy end date	2020-04-30
Total amount of commissions paid to insurance broker	USD $18,176
Total amount of fees paid to insurance company	USD $5,992
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $119,843
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,176
Amount paid for insurance broker fees	5992
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

703608

Policy instance

Insurance contract or identification number	703608
Number of Individuals Covered	153
Insurance policy start date	2019-05-01
Insurance policy end date	2020-04-30
Total amount of commissions paid to insurance broker	USD $13,450
Total amount of fees paid to insurance company	USD $4,417
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $88,332
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,450
Amount paid for insurance broker fees	4417
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

703607

Policy instance

Insurance contract or identification number	703607
Number of Individuals Covered	1029
Insurance policy start date	2019-05-01
Insurance policy end date	2020-04-30
Total amount of commissions paid to insurance broker	USD $9,767
Total amount of fees paid to insurance company	USD $3,255
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $65,110
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,767
Amount paid for insurance broker fees	3255
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

225807

Policy instance

Insurance contract or identification number	225807
Number of Individuals Covered	113
Insurance policy start date	2019-05-01
Insurance policy end date	2020-04-30
Total amount of commissions paid to insurance broker	USD $23,109
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $605,373
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $23,109
Insurance broker organization code?	3

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

38773

Policy instance

Insurance contract or identification number	38773
Number of Individuals Covered	276
Insurance policy start date	2019-05-01
Insurance policy end date	2020-04-30
Total amount of commissions paid to insurance broker	USD $68,772
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,716,141
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $68,772
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30090584

Policy instance

Insurance contract or identification number	30090584
Number of Individuals Covered	998
Insurance policy start date	2019-05-01
Insurance policy end date	2020-04-30
Total amount of commissions paid to insurance broker	USD $18,131
Vision 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 $18,131
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

703594

Policy instance

Insurance contract or identification number	703594
Number of Individuals Covered	1646
Insurance policy start date	2019-05-01
Insurance policy end date	2020-04-30
Total amount of commissions paid to insurance broker	USD $30,343
Total amount of fees paid to insurance company	USD $10,115
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $202,287
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $30,343
Amount paid for insurance broker fees	10115
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

703595

Policy instance

Insurance contract or identification number	703595
Number of Individuals Covered	539
Insurance policy start date	2019-05-01
Insurance policy end date	2020-04-30
Total amount of commissions paid to insurance broker	USD $20,443
Total amount of fees paid to insurance company	USD $6,748
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $134,948
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $20,443
Amount paid for insurance broker fees	6748
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

15608

Policy instance

Insurance contract or identification number	15608
Number of Individuals Covered	13
Insurance policy start date	2019-05-01
Insurance policy end date	2020-04-30
Total amount of commissions paid to insurance broker	USD $223
Other welfare benefits provided	ACCIDENT AND CANCER
Welfare Benefit Premiums Paid to Carrier	USD $6,100
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $223
Insurance broker organization code?	3

Potentially related plans

HORNBLOWER GROUP, INC. WELFARE PLAN [EIN = 452807640]

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Company Name:	HORNBLOWER GROUP, INC.
Employer identification number (EIN):	943460564
NAIC Classification:	483000
NAIC Description:	Water Transportation