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INDUCTOTHERM COMPANIES MEDICAL PREMIUM COVERSION PLAN 401k Plan overview

Plan NameINDUCTOTHERM COMPANIES MEDICAL PREMIUM COVERSION PLAN
Plan identification number 501

INDUCTOTHERM COMPANIES MEDICAL PREMIUM COVERSION PLAN Benefits

401k Plan Type
Plan Features/Benefits

    401k Sponsoring company profile

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

    Company Name:INDEL, INC
    Employer identification number (EIN):210677939
    NAIC Classification:561110
    NAIC Description:Office Administrative Services

    Additional information about INDEL, INC

    Jurisdiction of Incorporation: Colorado Department of State
    Incorporation Date: 2017-03-03
    Company Identification Number: 20171181788
    Legal Registered Office Address: 1550 Larimer Street
    #1017
    Denver
    United States of America (USA)
    80202

    More information about INDEL, INC

    Form 5500 Filing Information

    Submission information for form 5500 for 401k plan INDUCTOTHERM COMPANIES MEDICAL PREMIUM COVERSION PLAN

    Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
    5012019-06-01
    5012018-06-01
    5012017-06-01CRAIG JOHNSON CRAIG JOHNSON2019-03-08
    5012016-06-01CRAIG JOHNSON CRAIG JOHNSON2018-01-19
    5012015-06-01CRAIG JOHNSON CRAIG JOHNSON2017-03-04
    5012014-06-01CRAIG JOHNSON CRAIG JOHNSON2016-03-14
    5012013-06-01CRAIG JOHNSON CRAIG JOHNSON2015-03-13
    5012012-06-01CRAIG JOHNSON CRAIG JOHNSON2014-03-10
    5012011-06-01CRAIG JOHNSON CRAIG JOHNSON2013-03-07
    5012010-06-01CRAIG JOHNSON
    5012009-06-01CRAIG JOHNSON CRAIG JOHNSON2011-03-11
    5012009-06-01CRAIG JOHNSON CRAIG JOHNSON2011-03-11

    Plan Statistics for INDUCTOTHERM COMPANIES MEDICAL PREMIUM COVERSION PLAN

    401k plan membership statisitcs for INDUCTOTHERM COMPANIES MEDICAL PREMIUM COVERSION PLAN

    Measure Date Value
    2019
    Total participants, beginning-of-year2019-06-01745
    Total number of active participants reported on line 7a of the Form 55002019-06-01782
    Total of all active and inactive participants2019-06-01782
    Total participants2019-06-01782
    2018
    Total participants, beginning-of-year2018-06-01745
    Total number of active participants reported on line 7a of the Form 55002018-06-01745
    Total of all active and inactive participants2018-06-01745
    Total participants2018-06-01745
    2017
    Total participants, beginning-of-year2017-06-01475
    Total number of active participants reported on line 7a of the Form 55002017-06-01745
    Total of all active and inactive participants2017-06-01745
    Total participants2017-06-01745
    2016
    Total participants, beginning-of-year2016-06-01865
    Total number of active participants reported on line 7a of the Form 55002016-06-01475
    Total of all active and inactive participants2016-06-01475
    Total participants2016-06-01475
    2015
    Total participants, beginning-of-year2015-06-011,732
    Total number of active participants reported on line 7a of the Form 55002015-06-01865
    Total of all active and inactive participants2015-06-01865
    Total participants2015-06-01865
    2014
    Total participants, beginning-of-year2014-06-011,436
    Total number of active participants reported on line 7a of the Form 55002014-06-011,732
    Total of all active and inactive participants2014-06-011,732
    Total participants2014-06-011,732
    2013
    Total participants, beginning-of-year2013-06-011,154
    Total number of active participants reported on line 7a of the Form 55002013-06-011,436
    Total of all active and inactive participants2013-06-011,436
    Total participants2013-06-011,436
    2012
    Total participants, beginning-of-year2012-06-011,415
    Total number of active participants reported on line 7a of the Form 55002012-06-011,154
    Total of all active and inactive participants2012-06-011,154
    Total participants2012-06-011,154
    2011
    Total participants, beginning-of-year2011-06-011,544
    Total number of active participants reported on line 7a of the Form 55002011-06-011,415
    Total of all active and inactive participants2011-06-011,415
    Total participants2011-06-011,415
    2010
    Total participants, beginning-of-year2010-06-011,514
    Total number of active participants reported on line 7a of the Form 55002010-06-011,544
    Total of all active and inactive participants2010-06-011,544
    Total participants2010-06-011,544
    2009
    Total participants, beginning-of-year2009-06-011,645
    Total number of active participants reported on line 7a of the Form 55002009-06-011,514
    Total of all active and inactive participants2009-06-011,514
    Total participants2009-06-011,514

    Form 5500 Responses

    2019
    2019-06-01Type of plan entitySingle employer plan
    2019-06-01Submission has been amendedNo
    2019-06-01This submission is the final filingNo
    2019-06-01This return/report is a short plan year return/report (less than 12 months)No
    2019-06-01Plan is a collectively bargained planNo
    2019-06-01Plan funding arrangement – InsuranceYes
    2019-06-01Plan funding arrangement – General assets of the sponsorYes
    2019-06-01Plan benefit arrangement – InsuranceYes
    2019-06-01Plan benefit arrangement – General assets of the sponsorYes
    2018
    2018-06-01Type of plan entitySingle employer plan
    2018-06-01Submission has been amendedNo
    2018-06-01This submission is the final filingNo
    2018-06-01This return/report is a short plan year return/report (less than 12 months)No
    2018-06-01Plan is a collectively bargained planNo
    2018-06-01Plan funding arrangement – InsuranceYes
    2018-06-01Plan funding arrangement – General assets of the sponsorYes
    2018-06-01Plan benefit arrangement – InsuranceYes
    2018-06-01Plan benefit arrangement – General assets of the sponsorYes
    2017
    2017-06-01Type of plan entitySingle employer plan
    2017-06-01Submission has been amendedNo
    2017-06-01This submission is the final filingNo
    2017-06-01This return/report is a short plan year return/report (less than 12 months)No
    2017-06-01Plan is a collectively bargained planNo
    2017-06-01Plan funding arrangement – InsuranceYes
    2017-06-01Plan funding arrangement – General assets of the sponsorYes
    2017-06-01Plan benefit arrangement – InsuranceYes
    2017-06-01Plan benefit arrangement – General assets of the sponsorYes
    2016
    2016-06-01Type of plan entitySingle employer plan
    2016-06-01Submission has been amendedNo
    2016-06-01This submission is the final filingNo
    2016-06-01This return/report is a short plan year return/report (less than 12 months)No
    2016-06-01Plan is a collectively bargained planNo
    2016-06-01Plan funding arrangement – InsuranceYes
    2016-06-01Plan funding arrangement – General assets of the sponsorYes
    2016-06-01Plan benefit arrangement – InsuranceYes
    2016-06-01Plan benefit arrangement – General assets of the sponsorYes
    2015
    2015-06-01Type of plan entitySingle employer plan
    2015-06-01Submission has been amendedNo
    2015-06-01This submission is the final filingNo
    2015-06-01This return/report is a short plan year return/report (less than 12 months)No
    2015-06-01Plan is a collectively bargained planNo
    2015-06-01Plan funding arrangement – InsuranceYes
    2015-06-01Plan benefit arrangement – InsuranceYes
    2014
    2014-06-01Type of plan entitySingle employer plan
    2014-06-01Submission has been amendedNo
    2014-06-01This submission is the final filingNo
    2014-06-01This return/report is a short plan year return/report (less than 12 months)No
    2014-06-01Plan is a collectively bargained planNo
    2014-06-01Plan funding arrangement – InsuranceYes
    2014-06-01Plan benefit arrangement – InsuranceYes
    2013
    2013-06-01Type of plan entitySingle employer plan
    2013-06-01Submission has been amendedNo
    2013-06-01This submission is the final filingNo
    2013-06-01This return/report is a short plan year return/report (less than 12 months)No
    2013-06-01Plan is a collectively bargained planNo
    2013-06-01Plan funding arrangement – InsuranceYes
    2013-06-01Plan benefit arrangement – InsuranceYes
    2012
    2012-06-01Type of plan entitySingle employer plan
    2012-06-01Submission has been amendedNo
    2012-06-01This submission is the final filingNo
    2012-06-01This return/report is a short plan year return/report (less than 12 months)No
    2012-06-01Plan is a collectively bargained planNo
    2012-06-01Plan funding arrangement – InsuranceYes
    2012-06-01Plan benefit arrangement – InsuranceYes
    2011
    2011-06-01Type of plan entitySingle employer plan
    2011-06-01Submission has been amendedNo
    2011-06-01This submission is the final filingNo
    2011-06-01This return/report is a short plan year return/report (less than 12 months)No
    2011-06-01Plan is a collectively bargained planNo
    2011-06-01Plan funding arrangement – InsuranceYes
    2011-06-01Plan benefit arrangement – InsuranceYes
    2010
    2010-06-01Type of plan entitySingle employer plan
    2010-06-01Submission has been amendedYes
    2010-06-01This submission is the final filingNo
    2010-06-01This return/report is a short plan year return/report (less than 12 months)No
    2010-06-01Plan is a collectively bargained planNo
    2010-06-01Plan funding arrangement – InsuranceYes
    2010-06-01Plan benefit arrangement – InsuranceYes
    2009
    2009-06-01Type of plan entitySingle employer plan
    2009-06-01Submission has been amendedNo
    2009-06-01This submission is the final filingNo
    2009-06-01This return/report is a short plan year return/report (less than 12 months)No
    2009-06-01Plan is a collectively bargained planNo
    2009-06-01Plan funding arrangement – InsuranceYes
    2009-06-01Plan benefit arrangement – InsuranceYes

    Insurance Providers Used on plan

    SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
    Policy contract number01-016851-00
    Policy instance 2
    Insurance contract or identification number01-016851-00
    Number of Individuals Covered544
    Insurance policy start date2018-08-01
    Insurance policy end date2019-07-31
    Total amount of commissions paid to insurance brokerUSD $6,544
    Total amount of fees paid to insurance companyUSD $741
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedAD&D
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $17,963
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
    Policy contract number10043961001
    Policy instance 1
    Insurance contract or identification number10043961001
    Number of Individuals Covered745
    Insurance policy start date2018-01-01
    Insurance policy end date2018-12-31
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitYes
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $34,130
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
    Policy contract numberHCL32944
    Policy instance 3
    Insurance contract or identification numberHCL32944
    Number of Individuals Covered431
    Insurance policy start date2018-01-01
    Insurance policy end date2018-12-31
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $387,377
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
    Policy contract number3337606
    Policy instance 4
    Insurance contract or identification number3337606
    Number of Individuals Covered289
    Insurance policy start date2018-01-01
    Insurance policy end date2018-12-31
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
    Policy contract number3337606
    Policy instance 4
    Insurance contract or identification number3337606
    Number of Individuals Covered289
    Insurance policy start date2017-01-01
    Insurance policy end date2017-12-31
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $139,934
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
    Policy contract number10043961001
    Policy instance 1
    Insurance contract or identification number10043961001
    Number of Individuals Covered745
    Insurance policy start date2017-01-01
    Insurance policy end date2017-01-01
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitYes
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $34,130
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
    Policy contract number01-016851-00
    Policy instance 2
    Insurance contract or identification number01-016851-00
    Number of Individuals Covered544
    Insurance policy start date2017-08-01
    Insurance policy end date2018-07-31
    Total amount of commissions paid to insurance brokerUSD $6,544
    Total amount of fees paid to insurance companyUSD $741
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedAD&D
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $17,963
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
    Policy contract numberHCL32944
    Policy instance 3
    Insurance contract or identification numberHCL32944
    Insurance policy start date2017-01-01
    Insurance policy end date2017-12-31
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $387,377
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
    Policy contract number3337606
    Policy instance 1
    Insurance contract or identification number3337606
    Number of Individuals Covered865
    Insurance policy start date2015-01-01
    Insurance policy end date2015-12-31
    Total amount of commissions paid to insurance brokerUSD $18,596
    Total amount of fees paid to insurance companyUSD $3,330
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitYes
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedPREPAID DENTAL
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $923,248
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $18,596
    Amount paid for insurance broker fees3330
    Additional information about fees paid to insurance brokerGENERAL AGENT PAYMENTS
    Insurance broker organization code?3
    Insurance broker nameCORPORATE SYNERGIES GROUP LLC
    OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 78026 )
    Policy contract numberTC22382
    Policy instance 9
    Insurance contract or identification numberTC22382
    Number of Individuals Covered16
    Insurance policy start date2014-01-01
    Insurance policy end date2014-12-31
    Total amount of commissions paid to insurance brokerUSD $2,246
    Total amount of fees paid to insurance companyUSD $901
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $85,237
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $305
    Insurance broker organization code?3
    Amount paid for insurance broker fees901
    Additional information about fees paid to insurance brokerADMINISTRATIVE SERVICES
    Insurance broker nameEMERSON REID LLC
    AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
    Policy contract number874321,874337
    Policy instance 10
    Insurance contract or identification number874321,874337
    Number of Individuals Covered29
    Insurance policy start date2014-01-01
    Insurance policy end date2014-12-31
    Total amount of commissions paid to insurance brokerUSD $15,171
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $223,185
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $6,957
    Insurance broker nameCAUDILL INSURANCE & ASSOCIATES, INC
    CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
    Policy contract number3337606
    Policy instance 11
    Insurance contract or identification number3337606
    Number of Individuals Covered927
    Insurance policy start date2014-01-01
    Insurance policy end date2014-12-31
    Total amount of commissions paid to insurance brokerUSD $241,563
    Total amount of fees paid to insurance companyUSD $18,673
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitYes
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedPREPAID DENTAL
    Were dividends or retroactive rate refunds paid in cash?Yes
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $927,672
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $241,563
    Amount paid for insurance broker fees18673
    Additional information about fees paid to insurance brokerGENERAL AGENT PAYMENTS
    Insurance broker organization code?3
    Insurance broker nameCORPORATE SYNERGIES GROUP LLC
    THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
    Policy contract number000010136175
    Policy instance 12
    Insurance contract or identification number000010136175
    Number of Individuals Covered527
    Insurance policy start date2014-01-01
    Insurance policy end date2014-12-31
    Total amount of commissions paid to insurance brokerUSD $2,976
    Total amount of fees paid to insurance companyUSD $651
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedAD&D
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $19,842
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $2,976
    Amount paid for insurance broker fees651
    Additional information about fees paid to insurance brokerBROKER BONUS
    Insurance broker organization code?3
    Insurance broker nameCORPORATE SYNERGIES GROUP LLC
    KEYSTONE HEALTH PLAN EAST (National Association of Insurance Commissioners NAIC id number: 95056 )
    Policy contract number27089
    Policy instance 13
    Insurance contract or identification number27089
    Number of Individuals Covered84
    Insurance policy start date2014-01-01
    Insurance policy end date2014-12-31
    Total amount of commissions paid to insurance brokerUSD $44,206
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $44,206
    Insurance broker organization code?3
    Insurance broker nameBROWN & BROWN OF PENNA LP
    DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )
    Policy contract number5968
    Policy instance 2
    Insurance contract or identification number5968
    Number of Individuals Covered149
    Insurance policy start date2013-08-01
    Insurance policy end date2014-07-31
    Total amount of commissions paid to insurance brokerUSD $4,004
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $4,004
    Insurance broker organization code?3
    Insurance broker nameBROWN & BROWN OF DETROIT, INC.
    AETNA HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: 95287 )
    Policy contract number0865523HNO
    Policy instance 8
    Insurance contract or identification number0865523HNO
    Number of Individuals Covered162
    Insurance policy start date2014-03-01
    Insurance policy end date2015-02-28
    Total amount of commissions paid to insurance brokerUSD $43,167
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $903,612
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $43,167
    Insurance broker nameNICK TAFARO
    THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
    Policy contract number00456531
    Policy instance 7
    Insurance contract or identification number00456531
    Number of Individuals Covered73
    Insurance policy start date2014-04-01
    Insurance policy end date2015-03-31
    Total amount of commissions paid to insurance brokerUSD $2,581
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $42,201
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $26
    Insurance broker nameCHERRY HILL BENEFITS, INC.
    SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
    Policy contract number012223
    Policy instance 6
    Insurance contract or identification number012223
    Number of Individuals Covered34
    Insurance policy start date2014-09-01
    Insurance policy end date2015-08-31
    Total amount of commissions paid to insurance brokerUSD $1,407
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $9,377
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,407
    Insurance broker nameCHERRY HILL BENEFITS, INC.
    SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
    Policy contract number012223
    Policy instance 5
    Insurance contract or identification number012223
    Number of Individuals Covered121
    Insurance policy start date2014-09-01
    Insurance policy end date2014-08-31
    Total amount of commissions paid to insurance brokerUSD $2,436
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $29,225
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $2,436
    Insurance broker nameCHERRY HILL BENEFITS INC.
    HUMANA (National Association of Insurance Commissioners NAIC id number: 70580 )
    Policy contract number676346
    Policy instance 1
    Insurance contract or identification number676346
    Number of Individuals Covered30
    Insurance policy start date2014-01-01
    Insurance policy end date2014-12-31
    Total amount of commissions paid to insurance brokerUSD $1,890
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $21,273
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,890
    Insurance broker nameHIPSKIND SEYFARTH RISK SOLUTION
    CONNECTICARE, INC. (National Association of Insurance Commissioners NAIC id number: 95675 )
    Policy contract number1712
    Policy instance 3
    Insurance contract or identification number1712
    Number of Individuals Covered137
    Insurance policy start date2014-01-01
    Insurance policy end date2014-12-31
    Total amount of commissions paid to insurance brokerUSD $27,835
    Total amount of fees paid to insurance companyUSD $3,607
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $738,150
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $27,835
    Amount paid for insurance broker fees3607
    Additional information about fees paid to insurance brokerBONUS
    Insurance broker organization code?3
    Insurance broker nameGROUP INSURANCE ASSOCIATES
    UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
    Policy contract number635858
    Policy instance 2
    Insurance contract or identification number635858
    Number of Individuals Covered106
    Insurance policy start date2014-07-01
    Insurance policy end date2014-12-31
    Total amount of commissions paid to insurance brokerUSD $20,672
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $523,116
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $20,672
    Insurance broker organization code?3
    Insurance broker nameHIPSKIND SEYFARTH RISK SOLUTIONS
    DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )
    Policy contract number5968
    Policy instance 14
    Insurance contract or identification number5968
    Number of Individuals Covered164
    Insurance policy start date2014-08-01
    Insurance policy end date2015-07-31
    Total amount of commissions paid to insurance brokerUSD $4,303
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $2,048
    Insurance broker organization code?3
    Insurance broker nameBROWN & BROWN OF DETROIT, INC.
    HEALTH ALLIANCE PLAN (National Association of Insurance Commissioners NAIC id number: 95844 )
    Policy contract number10000805
    Policy instance 15
    Insurance contract or identification number10000805
    Number of Individuals Covered176
    Insurance policy start date2014-08-01
    Insurance policy end date2015-07-31
    Total amount of commissions paid to insurance brokerUSD $35,483
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $800,253
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $4,317
    Insurance broker nameBROWN & BROWN OF DETROIT
    CIGNA DENTAL HEALTH OF TEXAS, INC. (National Association of Insurance Commissioners NAIC id number: 95037 )
    Policy contract number3337606
    Policy instance 26
    Insurance contract or identification number3337606
    Number of Individuals Covered1
    Insurance policy start date2014-01-01
    Insurance policy end date2014-12-31
    Total amount of commissions paid to insurance brokerUSD $25
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $253
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $25
    Insurance broker nameCORPORATE SYNERGIES GROUP LLC
    CIGNA DENTAL HEALTH OF PENNSYLVANIA, INC. (National Association of Insurance Commissioners NAIC id number: 47041 )
    Policy contract number3337606
    Policy instance 25
    Insurance contract or identification number3337606
    Number of Individuals Covered16
    Insurance policy start date2014-01-01
    Insurance policy end date2014-12-31
    Total amount of commissions paid to insurance brokerUSD $387
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $3,895
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $387
    Insurance broker nameCORPORATE SYNERGIES GROUP LLC
    ALLIANCE HEALTH AND LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60134 )
    Policy contract number10000882
    Policy instance 17
    Insurance contract or identification number10000882
    Number of Individuals Covered47
    Insurance policy start date2014-08-01
    Insurance policy end date2015-07-31
    Total amount of commissions paid to insurance brokerUSD $14,706
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedAHL CONTRACT
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $257,849
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $4,388
    Insurance broker nameBROWN & BROWN OF DETROIT
    CIGNA DENTAL HEALTH OF NEW JERSEY, INC. (National Association of Insurance Commissioners NAIC id number: 11167 )
    Policy contract number3337606
    Policy instance 24
    Insurance contract or identification number3337606
    Number of Individuals Covered76
    Insurance policy start date2014-01-01
    Insurance policy end date2014-12-31
    Total amount of commissions paid to insurance brokerUSD $1,823
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $18,158
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,823
    Insurance broker nameCORPORATE SYNERGIES GROUP LLC
    HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC. (National Association of Insurance Commissioners NAIC id number: 95519 )
    Policy contract number735849
    Policy instance 23
    Insurance contract or identification number735849
    Number of Individuals Covered30
    Insurance policy start date2014-11-01
    Insurance policy end date2014-12-31
    Total amount of commissions paid to insurance brokerUSD $1,599
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $69,091
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,599
    Insurance broker nameNUVISION FINANCIAL CORP INC
    AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
    Policy contract number010-031042
    Policy instance 22
    Insurance contract or identification number010-031042
    Number of Individuals Covered59
    Insurance policy start date2014-01-01
    Insurance policy end date2014-12-31
    Total amount of commissions paid to insurance brokerUSD $1,746
    Total amount of fees paid to insurance companyUSD $33
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $17,458
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,746
    Amount paid for insurance broker fees33
    Additional information about fees paid to insurance brokerGENERAL AGENT PAYMENTS
    Insurance broker organization code?3
    Insurance broker nameNUVISION FINANCIAL CORP INC
    BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 )
    Policy contract numberA10995
    Policy instance 21
    Insurance contract or identification numberA10995
    Number of Individuals Covered32
    Insurance policy start date2014-01-01
    Insurance policy end date2014-12-31
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $207,605
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 )
    Policy contract number676346
    Policy instance 20
    Insurance contract or identification number676346
    Number of Individuals Covered10
    Insurance policy start date2014-01-01
    Insurance policy end date2014-12-31
    Total amount of commissions paid to insurance brokerUSD $135
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitYes
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $1,348
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $135
    Insurance broker nameHIPSKIND SEYFARTH RISK SOLUTIONS
    HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 52028 )
    Policy contract number676346
    Policy instance 19
    Insurance contract or identification number676346
    Number of Individuals Covered7
    Insurance policy start date2014-01-01
    Insurance policy end date2014-12-31
    Total amount of commissions paid to insurance brokerUSD $176
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $1,896
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $176
    Insurance broker nameHIPSKIND SEYFARTH RISK SOLUTIONS
    MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
    Policy contract numberG000ALXT
    Policy instance 18
    Insurance contract or identification numberG000ALXT
    Number of Individuals Covered137
    Insurance policy start date2014-08-01
    Insurance policy end date2015-08-01
    Total amount of commissions paid to insurance brokerUSD $1,610
    Total amount of fees paid to insurance companyUSD $925
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedAD&D
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $16,099
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $530
    Insurance broker organization code?3
    Amount paid for insurance broker fees925
    Additional information about fees paid to insurance brokerSERVICE FEES/OTHER FEES
    Insurance broker nameBROWN AND BROWN OF DETROIT INC
    MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
    Policy contract numberG000ALXT
    Policy instance 16
    Insurance contract or identification numberG000ALXT
    Number of Individuals Covered59
    Insurance policy start date2014-08-01
    Insurance policy end date2015-08-01
    Total amount of commissions paid to insurance brokerUSD $2,609
    Total amount of fees paid to insurance companyUSD $1,118
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $18,590
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $715
    Insurance broker organization code?3
    Amount paid for insurance broker fees1118
    Additional information about fees paid to insurance brokerSERVICE FEES/OTHER FEES
    Insurance broker nameBROWN & BROWN OF DETROIT INC
    KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
    Policy contract number640961
    Policy instance 4
    Insurance contract or identification number640961
    Number of Individuals Covered36
    Insurance policy start date2013-10-01
    Insurance policy end date2014-09-30
    Total amount of commissions paid to insurance brokerUSD $6,649
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $152,758
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $665
    Insurance broker nameDAVID PARR
    THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
    Policy contract number000010136175
    Policy instance 14
    Insurance contract or identification number000010136175
    Number of Individuals Covered577
    Insurance policy start date2013-01-01
    Insurance policy end date2013-12-31
    Total amount of commissions paid to insurance brokerUSD $2,792
    Total amount of fees paid to insurance companyUSD $280
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedAD & D
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $18,613
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $2,792
    Amount paid for insurance broker fees280
    Additional information about fees paid to insurance brokerBROKER BONUS
    Insurance broker organization code?3
    Insurance broker nameCORPORATE SYNERGIES GROUP LLC
    AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 95490 )
    Policy contract number874321, 874322
    Policy instance 22
    Insurance contract or identification number874321, 874322
    Number of Individuals Covered24
    Insurance policy start date2012-12-01
    Insurance policy end date2013-11-30
    Total amount of commissions paid to insurance brokerUSD $8,356
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $219,849
    Commission paid to Insurance BrokerUSD $8,356
    Insurance broker nameCAUDILL INSURANCE & ASSOCIATES, INC
    HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )
    Policy contract number86400
    Policy instance 10
    Insurance contract or identification number86400
    Number of Individuals Covered586
    Insurance policy start date2013-01-01
    Insurance policy end date2013-12-31
    Total amount of commissions paid to insurance brokerUSD $167,246
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $4,183,330
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $167,246
    Insurance broker nameCORPORATE SYNERGIES GROUP, LLC
    KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
    Policy contract number640961
    Policy instance 9
    Insurance contract or identification number640961
    Number of Individuals Covered37
    Insurance policy start date2012-10-01
    Insurance policy end date2013-09-30
    Total amount of commissions paid to insurance brokerUSD $7,056
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $151,421
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $6,350
    Insurance broker namePRESIDIO BENEFITS GROUP
    CONNECTICARE, INC. (National Association of Insurance Commissioners NAIC id number: 95675 )
    Policy contract number1712
    Policy instance 8
    Insurance contract or identification number1712
    Number of Individuals Covered137
    Insurance policy start date2013-01-01
    Insurance policy end date2013-12-31
    Total amount of commissions paid to insurance brokerUSD $27,327
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $723,638
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $27,327
    Insurance broker nameGROUP INSURANCE ASSOCIATES
    UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
    Policy contract number635858
    Policy instance 7
    Insurance contract or identification number635858
    Number of Individuals Covered103
    Insurance policy start date2013-07-01
    Insurance policy end date2013-12-31
    Total amount of commissions paid to insurance brokerUSD $11,104
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $265,561
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $11,104
    Insurance broker organization code?3
    Insurance broker nameHIPSKIND SEYFARTH RISK SOLUTIONS
    HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
    Policy contract number676346
    Policy instance 6
    Insurance contract or identification number676346
    Number of Individuals Covered44
    Insurance policy start date2013-01-01
    Insurance policy end date2013-12-31
    Total amount of commissions paid to insurance brokerUSD $3,486
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitYes
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $119,070
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $3,016
    Amount paid for insurance broker fees470
    Additional information about fees paid to insurance brokerVOLUME INCENTIVES
    Insurance broker nameHIPSKIND SEYFARTH RISK SOLUTION
    MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
    Policy contract numberGLUG0ALXT
    Policy instance 4
    Insurance contract or identification numberGLUG0ALXT
    Number of Individuals Covered140
    Insurance policy start date2013-08-01
    Insurance policy end date2014-08-01
    Total amount of commissions paid to insurance brokerUSD $1,461
    Total amount of fees paid to insurance companyUSD $356
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedAD & D
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $14,610
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,461
    Amount paid for insurance broker fees356
    Additional information about fees paid to insurance brokerOTHER COMPENSATION
    Insurance broker organization code?3
    Insurance broker nameBROWN & BROWN OF DETROIT, INC.
    MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
    Policy contract numberGUPR0ALXT
    Policy instance 5
    Insurance contract or identification numberGUPR0ALXT
    Number of Individuals Covered60
    Insurance policy start date2013-08-01
    Insurance policy end date2014-08-01
    Total amount of commissions paid to insurance brokerUSD $2,574
    Total amount of fees paid to insurance companyUSD $448
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $18,236
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $2,574
    Amount paid for insurance broker fees448
    Additional information about fees paid to insurance brokerOTHER COMPENSATION
    Insurance broker organization code?3
    Insurance broker nameBROWN & BROWN OF DETROIT, INC.
    HEALTH ALLIANCE PLAN (National Association of Insurance Commissioners NAIC id number: 95844 )
    Policy contract number10000805
    Policy instance 3
    Insurance contract or identification number10000805
    Number of Individuals Covered181
    Insurance policy start date2013-08-01
    Insurance policy end date2014-07-31
    Total amount of commissions paid to insurance brokerUSD $40,856
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $893,793
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $40,866
    Insurance broker nameBROWN & BROWN OF DETROIT
    ALLIANCE HEALTH AND LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60134 )
    Policy contract number10000882
    Policy instance 1
    Insurance contract or identification number10000882
    Number of Individuals Covered47
    Insurance policy start date2013-08-01
    Insurance policy end date2014-07-31
    Total amount of commissions paid to insurance brokerUSD $17,150
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedAHL CONTRACT
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $309,571
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $17,150
    Insurance broker nameBROWN & BROWN OF DETROIT
    HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )
    Policy contract number86400
    Policy instance 11
    Insurance contract or identification number86400
    Number of Individuals Covered586
    Insurance policy start date2013-01-01
    Insurance policy end date2013-12-31
    Total amount of commissions paid to insurance brokerUSD $47,734
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $1,192,947
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $47,734
    Insurance broker nameCORPORATE SYNERGIES GROUP LLC
    UNITED CONCORDIA DENTAL PLANS, INC. (National Association of Insurance Commissioners NAIC id number: 95253 )
    Policy contract number253569-001
    Policy instance 12
    Insurance contract or identification number253569-001
    Number of Individuals Covered137
    Insurance policy start date2013-01-01
    Insurance policy end date2013-12-31
    Total amount of commissions paid to insurance brokerUSD $1,677
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $16,807
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,677
    Insurance broker nameCORPORATE SYNERGIES GROUP, LLC
    PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
    Policy contract number1034201
    Policy instance 21
    Insurance contract or identification number1034201
    Number of Individuals Covered108
    Insurance policy start date2013-03-01
    Insurance policy end date2013-12-31
    Total amount of commissions paid to insurance brokerUSD $5,732
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $55,555
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $5,732
    Insurance broker organization code?3
    Insurance broker nameBROWN AND BROWN OF PA LP
    OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 78026 )
    Policy contract numberTC22382
    Policy instance 20
    Insurance contract or identification numberTC22382
    Number of Individuals Covered51
    Insurance policy start date2013-01-01
    Insurance policy end date2013-12-31
    Total amount of commissions paid to insurance brokerUSD $2,258
    Total amount of fees paid to insurance companyUSD $646
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $89,276
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Amount paid for insurance broker fees646
    Additional information about fees paid to insurance brokerADMINISTRATIVE SERVICES
    Insurance broker organization code?3
    Commission paid to Insurance BrokerUSD $1,129
    Insurance broker nameROSANNE GIL
    WELLCHOICE HMO OF NEW JERSEY (National Association of Insurance Commissioners NAIC id number: 95433 )
    Policy contract number393329
    Policy instance 19
    Insurance contract or identification number393329
    Number of Individuals Covered3
    Insurance policy start date2013-01-01
    Insurance policy end date2013-12-31
    Total amount of commissions paid to insurance brokerUSD $182
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitYes
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $24,668
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $182
    Insurance broker organization code?3
    Insurance broker nameCHRISTOPHER MANCINI
    AETNA HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: 95287 )
    Policy contract number0865523HNO
    Policy instance 18
    Insurance contract or identification number0865523HNO
    Number of Individuals Covered162
    Insurance policy start date2013-03-01
    Insurance policy end date2014-02-28
    Total amount of commissions paid to insurance brokerUSD $43,167
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $903,612
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $43,167
    Insurance broker nameNICK TAFARO
    THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
    Policy contract number00456531
    Policy instance 17
    Insurance contract or identification number00456531
    Number of Individuals Covered73
    Insurance policy start date2013-04-01
    Insurance policy end date2014-03-31
    Total amount of commissions paid to insurance brokerUSD $2,581
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $42,201
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $2,555
    Insurance broker nameINDEPENDENCE PLANNING GROUP, L
    SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
    Policy contract number012223
    Policy instance 16
    Insurance contract or identification number012223
    Number of Individuals Covered34
    Insurance policy start date2013-09-01
    Insurance policy end date2014-08-31
    Total amount of commissions paid to insurance brokerUSD $1,407
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $9,379
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,407
    Insurance broker nameCHERRY HILL BENEFITS, INC.
    SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
    Policy contract number012223
    Policy instance 15
    Insurance contract or identification number012223
    Number of Individuals Covered121
    Insurance policy start date2013-09-01
    Insurance policy end date2014-08-31
    Total amount of commissions paid to insurance brokerUSD $2,436
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $29,225
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $2,436
    Insurance broker nameCHERRY HILL BENEFITS INC.
    UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62294 )
    Policy contract number253569-196,-108
    Policy instance 13
    Insurance contract or identification number253569-196,-108
    Number of Individuals Covered487
    Insurance policy start date2013-01-01
    Insurance policy end date2013-12-31
    Total amount of commissions paid to insurance brokerUSD $14,901
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $163,413
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $14,901
    Insurance broker nameCORPORATE SYNERGIES GROUP, LLC
    OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 78026 )
    Policy contract numberTC22392
    Policy instance 9
    Insurance contract or identification numberTC22392
    Number of Individuals Covered15
    Insurance policy start date2012-01-01
    Insurance policy end date2012-12-31
    Total amount of commissions paid to insurance brokerUSD $2,623
    Total amount of fees paid to insurance companyUSD $910
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $59,502
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Insurance broker organization code?3
    Commission paid to Insurance BrokerUSD $1,130
    Amount paid for insurance broker fees770
    Additional information about fees paid to insurance brokerADMINISTRATIVE SERVICES
    Insurance broker nameFIDUCIARY INTERMEDIARY LTD
    HUMANA HEALTH PLAN, INC. (National Association of Insurance Commissioners NAIC id number: 95885 )
    Policy contract numberR3697
    Policy instance 8
    Insurance contract or identification numberR3697
    Number of Individuals Covered34
    Insurance policy start date2012-01-01
    Insurance policy end date2012-12-31
    Total amount of commissions paid to insurance brokerUSD $7,335
    Total amount of fees paid to insurance companyUSD $567
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $373,983
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,085
    Amount paid for insurance broker fees40
    Additional information about fees paid to insurance brokerVOLUME INCENTIVES
    Insurance broker organization code?3
    Insurance broker nameHIPSKIND SEYFARTH RISK SOLUTION
    SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
    Policy contract number012223
    Policy instance 7
    Insurance contract or identification number012223
    Number of Individuals Covered164
    Insurance policy start date2012-09-01
    Insurance policy end date2013-08-31
    Total amount of commissions paid to insurance brokerUSD $3,868
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $38,072
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $3,868
    Insurance broker nameCHERRY HILL BENEFITS INC
    THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
    Policy contract number000010136175
    Policy instance 6
    Insurance contract or identification number000010136175
    Number of Individuals Covered591
    Insurance policy start date2012-01-01
    Insurance policy end date2013-12-31
    Total amount of commissions paid to insurance brokerUSD $2,805
    Total amount of fees paid to insurance companyUSD $433
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $18,699
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $2,805
    Amount paid for insurance broker fees433
    Additional information about fees paid to insurance brokerBROKER BONUS
    Insurance broker organization code?3
    Insurance broker nameCORPORATE SYNERGIES GROUP LLC
    HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )
    Policy contract number86400
    Policy instance 5
    Insurance contract or identification number86400
    Number of Individuals Covered586
    Insurance policy start date2012-01-01
    Insurance policy end date2012-12-31
    Total amount of commissions paid to insurance brokerUSD $199,300
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $4,982,384
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $199,300
    Insurance broker nameCORPORATE SYNERGIES GROUP LLC
    MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
    Policy contract numberG000ALXT
    Policy instance 4
    Insurance contract or identification numberG000ALXT
    Number of Individuals Covered143
    Insurance policy start date2012-08-01
    Insurance policy end date2013-08-01
    Total amount of commissions paid to insurance brokerUSD $1,395
    Total amount of fees paid to insurance companyUSD $125
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $13,946
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,395
    Amount paid for insurance broker fees125
    Additional information about fees paid to insurance brokerAGENT OR BROKER OF RECORD OTHER COMPENSATION
    Insurance broker organization code?3
    Insurance broker nameBROWN AND BROWN OF DETROIT INC
    UNITED OF OMAHA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69868 )
    Policy contract numberG000ALXT
    Policy instance 3
    Insurance contract or identification numberG000ALXT
    Number of Individuals Covered61
    Insurance policy start date2012-08-01
    Insurance policy end date2013-08-01
    Total amount of commissions paid to insurance brokerUSD $2,557
    Total amount of fees paid to insurance companyUSD $158
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $18,074
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $2,557
    Amount paid for insurance broker fees158
    Additional information about fees paid to insurance brokerAGENT OR BROKER OF RECORD OTHER COMPENSATION
    Insurance broker organization code?3
    Insurance broker nameBROWN AND BROWN OF DETROIT INC
    HEALTH ALLIANCE PLAN (National Association of Insurance Commissioners NAIC id number: 95844 )
    Policy contract number1-22155AA
    Policy instance 2
    Insurance contract or identification number1-22155AA
    Number of Individuals Covered170
    Insurance policy start date2012-08-01
    Insurance policy end date2013-07-31
    Total amount of commissions paid to insurance brokerUSD $31,599
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $646,182
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $31,599
    Insurance broker nameBROWN AND BROWN OF DETROIT INC
    WELLCHOICE HMO OF NEW JERSEY (National Association of Insurance Commissioners NAIC id number: 95433 )
    Policy contract number393329
    Policy instance 10
    Insurance contract or identification number393329
    Number of Individuals Covered4
    Insurance policy start date2012-01-01
    Insurance policy end date2012-12-31
    Total amount of commissions paid to insurance brokerUSD $332
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitYes
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $28,296
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $105
    Insurance broker nameCHRISTOPHER MANCINI
    HEALTH ALLIANCE PLAN (National Association of Insurance Commissioners NAIC id number: 95844 )
    Policy contract number1-31776AA,AB,AD
    Policy instance 1
    Insurance contract or identification number1-31776AA,AB,AD
    Number of Individuals Covered49
    Insurance policy start date2012-08-01
    Insurance policy end date2013-07-31
    Total amount of commissions paid to insurance brokerUSD $13,064
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $251,178
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $13,064
    Insurance broker nameBROWN AND BROWN OF DETROIT INC
    CONNECTICARE, INC. (National Association of Insurance Commissioners NAIC id number: 95675 )
    Policy contract number1712
    Policy instance 11
    Insurance contract or identification number1712
    Number of Individuals Covered132
    Insurance policy start date2012-01-01
    Insurance policy end date2012-12-31
    Total amount of commissions paid to insurance brokerUSD $23,831
    Total amount of fees paid to insurance companyUSD $1,494
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $623,730
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $23,831
    Amount paid for insurance broker fees1494
    Additional information about fees paid to insurance brokerBONUS
    Insurance broker organization code?3
    Insurance broker nameGROUP INSURANCE ASSOCIATES
    BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
    Policy contract number37254-182
    Policy instance 3
    Insurance contract or identification number37254-182
    Number of Individuals Covered14
    Insurance policy start date2011-08-01
    Insurance policy end date2012-07-31
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )
    Policy contract number5968
    Policy instance 4
    Insurance contract or identification number5968
    Number of Individuals Covered144
    Insurance policy start date2011-08-01
    Insurance policy end date2012-07-31
    Total amount of commissions paid to insurance brokerUSD $3,999
    Dental Insurance Welfare BenefitYes
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    AMERIHEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60061 )
    Policy contract number0000270042
    Policy instance 5
    Insurance contract or identification number0000270042
    Number of Individuals Covered811
    Insurance policy start date2011-01-01
    Insurance policy end date2011-12-31
    Total amount of commissions paid to insurance brokerUSD $124,588
    Other welfare benefits providedCMM
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    UNITED CONCORDIA DENTAL PLANS, INC. (National Association of Insurance Commissioners NAIC id number: 95253 )
    Policy contract number0177392
    Policy instance 6
    Insurance contract or identification number0177392
    Number of Individuals Covered139
    Insurance policy start date2011-01-01
    Insurance policy end date2011-12-31
    Total amount of commissions paid to insurance brokerUSD $1,848
    Dental Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $18,466
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    KEYSTONE HEALTH PLAN EAST (National Association of Insurance Commissioners NAIC id number: 95056 )
    Policy contract number27089
    Policy instance 8
    Insurance contract or identification number27089
    Number of Individuals Covered98
    Insurance policy start date2011-03-01
    Insurance policy end date2012-02-28
    Total amount of commissions paid to insurance brokerUSD $32,796
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $504,547
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
    Policy contract number676346
    Policy instance 9
    Insurance contract or identification number676346
    Number of Individuals Covered43
    Insurance policy start date2011-01-01
    Insurance policy end date2011-12-31
    Total amount of commissions paid to insurance brokerUSD $7,760
    Total amount of fees paid to insurance companyUSD $526
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $122,428
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    HUMANA HEALTH PLAN, INC. (National Association of Insurance Commissioners NAIC id number: 95885 )
    Policy contract numberR3697
    Policy instance 10
    Insurance contract or identification numberR3697
    Number of Individuals Covered31
    Insurance policy start date2011-06-01
    Insurance policy end date2011-12-31
    Total amount of commissions paid to insurance brokerUSD $7,490
    Total amount of fees paid to insurance companyUSD $229
    Welfare Benefit Premiums Paid to CarrierUSD $210,612
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    WELLCHOICE HMO OF NEW JERSEY (National Association of Insurance Commissioners NAIC id number: 95433 )
    Policy contract number393329
    Policy instance 11
    Insurance contract or identification number393329
    Number of Individuals Covered3
    Insurance policy start date2011-01-01
    Insurance policy end date2011-12-31
    Total amount of commissions paid to insurance brokerUSD $791
    Vision Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $27,640
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 78026 )
    Policy contract numberTC22382
    Policy instance 12
    Insurance contract or identification numberTC22382
    Number of Individuals Covered13
    Insurance policy start date2011-01-01
    Insurance policy end date2011-12-31
    Total amount of commissions paid to insurance brokerUSD $2,226
    Total amount of fees paid to insurance companyUSD $968
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $57,106
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    CONNECTICARE, INC. (National Association of Insurance Commissioners NAIC id number: 95675 )
    Policy contract number1712
    Policy instance 13
    Insurance contract or identification number1712
    Number of Individuals Covered133
    Insurance policy start date2011-01-01
    Insurance policy end date2011-12-31
    Total amount of commissions paid to insurance brokerUSD $22,915
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $597,564
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: )
    Policy contract number00261654/0001
    Policy instance 2
    Insurance contract or identification number00261654/0001
    Number of Individuals Covered144
    Insurance policy start date2011-08-01
    Insurance policy end date2012-07-31
    Total amount of commissions paid to insurance brokerUSD $27,483
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $552,619
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 )
    Policy contract number00170399
    Policy instance 1
    Insurance contract or identification number00170399
    Number of Individuals Covered125
    Insurance policy start date2011-07-01
    Insurance policy end date2012-06-30
    Total amount of commissions paid to insurance brokerUSD $17,257
    Total amount of fees paid to insurance companyUSD $87
    Welfare Benefit Premiums Paid to CarrierUSD $553,319
    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 number000010136175
    Policy instance 7
    Insurance contract or identification number000010136175
    Number of Individuals Covered557
    Insurance policy start date2011-01-01
    Insurance policy end date2011-12-31
    Total amount of commissions paid to insurance brokerUSD $2,597
    Life Insurance Welfare BenefitYes
    Other welfare benefits providedAD&D
    Welfare Benefit Premiums Paid to CarrierUSD $17,313
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 78026 )
    Policy contract numberTC22382
    Policy instance 2
    Insurance contract or identification numberTC22382
    Number of Individuals Covered12
    Insurance policy start date2010-01-01
    Insurance policy end date2010-12-31
    Total amount of commissions paid to insurance brokerUSD $1,944
    Total amount of fees paid to insurance companyUSD $882
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $47,458
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62294 )
    Policy contract number253569-108,-196
    Policy instance 3
    Insurance contract or identification number253569-108,-196
    Number of Individuals Covered356
    Insurance policy start date2010-01-01
    Insurance policy end date2010-12-31
    Total amount of commissions paid to insurance brokerUSD $11,183
    Dental Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $111,393
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    UNITED CONCORDIA DENTAL PLANS, INC. (National Association of Insurance Commissioners NAIC id number: 95253 )
    Policy contract numberVARIOUS
    Policy instance 4
    Insurance contract or identification numberVARIOUS
    Number of Individuals Covered152
    Insurance policy start date2010-01-01
    Insurance policy end date2010-12-31
    Total amount of commissions paid to insurance brokerUSD $1,863
    Dental Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $18,662
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
    Policy contract number37254-181
    Policy instance 1
    Insurance contract or identification number37254-181
    Number of Individuals Covered45
    Insurance policy start date2010-08-01
    Insurance policy end date2011-07-31
    Health Insurance Welfare BenefitYes
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
    Policy contract numberMG18701
    Policy instance 6
    Insurance contract or identification numberMG18701
    Number of Individuals Covered519
    Insurance policy start date2010-01-01
    Insurance policy end date2010-12-31
    Total amount of commissions paid to insurance brokerUSD $1,709
    Total amount of fees paid to insurance companyUSD $1,234
    Life Insurance Welfare BenefitYes
    Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
    Welfare Benefit Premiums Paid to CarrierUSD $17,090
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
    Policy contract number01267500
    Policy instance 9
    Insurance contract or identification number01267500
    Number of Individuals Covered116
    Insurance policy start date2010-03-01
    Insurance policy end date2011-02-28
    Total amount of commissions paid to insurance brokerUSD $18,411
    Health Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $609,076
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 )
    Policy contract number00170399
    Policy instance 7
    Insurance contract or identification number00170399
    Number of Individuals Covered124
    Insurance policy start date2010-07-01
    Insurance policy end date2011-06-30
    Total amount of commissions paid to insurance brokerUSD $16,043
    Total amount of fees paid to insurance companyUSD $1,859
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $477,498
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    AMERIHEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60061 )
    Policy contract number0000270042
    Policy instance 5
    Insurance contract or identification number0000270042
    Number of Individuals Covered747
    Insurance policy start date2010-01-01
    Insurance policy end date2010-12-31
    Total amount of commissions paid to insurance brokerUSD $116,090
    Other welfare benefits providedCMM
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )
    Policy contract number00261654/0001
    Policy instance 8
    Insurance contract or identification number00261654/0001
    Number of Individuals Covered135
    Insurance policy start date2010-08-01
    Insurance policy end date2011-07-31
    Total amount of commissions paid to insurance brokerUSD $26,484
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $532,016
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    KEYSTONE HEALTH PLAN EAST (National Association of Insurance Commissioners NAIC id number: 95056 )
    Policy contract number27089
    Policy instance 10
    Insurance contract or identification number27089
    Number of Individuals Covered98
    Insurance policy start date2010-03-01
    Insurance policy end date2011-02-28
    Total amount of commissions paid to insurance brokerUSD $32,796
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $504,547
    BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
    Policy contract numberB88965 P88965
    Policy instance 11
    Insurance contract or identification numberB88965 P88965
    Number of Individuals Covered111
    Insurance policy start date2010-06-01
    Insurance policy end date2011-05-31
    Total amount of commissions paid to insurance brokerUSD $18,033
    Total amount of fees paid to insurance companyUSD $404
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $413,843
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
    Policy contract numberR0049270
    Policy instance 12
    Insurance contract or identification numberR0049270
    Number of Individuals Covered111
    Insurance policy start date2010-07-31
    Insurance policy end date2011-07-30
    Total amount of commissions paid to insurance brokerUSD $3,483
    Total amount of fees paid to insurance companyUSD $346
    Life Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
    Welfare Benefit Premiums Paid to CarrierUSD $27,344
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )
    Policy contract number5968
    Policy instance 13
    Insurance contract or identification number5968
    Number of Individuals Covered136
    Insurance policy start date2010-08-01
    Insurance policy end date2011-07-31
    Total amount of commissions paid to insurance brokerUSD $3,323
    Dental Insurance Welfare BenefitYes
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    WELLCHOICE HMO OF NEW JERSEY (National Association of Insurance Commissioners NAIC id number: 95433 )
    Policy contract number393329
    Policy instance 14
    Insurance contract or identification number393329
    Number of Individuals Covered4
    Insurance policy start date2010-01-01
    Insurance policy end date2010-12-31
    Total amount of commissions paid to insurance brokerUSD $788
    Welfare Benefit Premiums Paid to CarrierUSD $23,904
    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 number00345671
    Policy instance 16
    Insurance contract or identification number00345671
    Number of Individuals Covered36
    Insurance policy start date2010-03-01
    Insurance policy end date2011-02-28
    Total amount of commissions paid to insurance brokerUSD $1,834
    Life Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $20,857
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
    Policy contract number45240800
    Policy instance 17
    Insurance contract or identification number45240800
    Number of Individuals Covered4
    Insurance policy start date2010-06-30
    Insurance policy end date2010-12-31
    Total amount of commissions paid to insurance brokerUSD $887
    Total amount of fees paid to insurance companyUSD $2,260
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $22,168
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
    Policy contract number68999000
    Policy instance 18
    Insurance contract or identification number68999000
    Number of Individuals Covered33
    Insurance policy start date2010-06-30
    Insurance policy end date2010-12-31
    Total amount of commissions paid to insurance brokerUSD $8,862
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $188,425
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    CONNECTICARE, INC. (National Association of Insurance Commissioners NAIC id number: 95675 )
    Policy contract number006345
    Policy instance 15
    Insurance contract or identification number006345
    Number of Individuals Covered117
    Insurance policy start date2010-01-01
    Insurance policy end date2010-12-31
    Total amount of commissions paid to insurance brokerUSD $21,256
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $550,161
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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