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TREX ENTERPRISES CORPORATION WELFARE BENEFITS PLAN 401k Plan overview

Plan NameTREX ENTERPRISES CORPORATION WELFARE BENEFITS PLAN
Plan identification number 502

TREX ENTERPRISES CORPORATION WELFARE BENEFITS PLAN Benefits

401k Plan Type
Plan Features/Benefits

    401k Sponsoring company profile

    TREX ENTERPRISES CORPORATION has sponsored the creation of one or more 401k plans.

    Company Name:TREX ENTERPRISES CORPORATION
    Employer identification number (EIN):330913574
    NAIC Classification:541700

    Additional information about TREX ENTERPRISES CORPORATION

    Jurisdiction of Incorporation: California Department of State
    Incorporation Date:
    Company Identification Number: C2052267

    More information about TREX ENTERPRISES CORPORATION

    Form 5500 Filing Information

    Submission information for form 5500 for 401k plan TREX ENTERPRISES CORPORATION WELFARE BENEFITS PLAN

    Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
    5022013-09-01DEBORAH DOYLE
    5022012-09-01DEBORAH DOYLE DEBORAH DOYLE2014-03-27
    5022011-09-01STEVEN WILLETT
    5022010-09-01STEVEN WILLETT
    5022009-09-01STEVEN WILLETT STEVEN WILLETT2011-03-30

    Plan Statistics for TREX ENTERPRISES CORPORATION WELFARE BENEFITS PLAN

    401k plan membership statisitcs for TREX ENTERPRISES CORPORATION WELFARE BENEFITS PLAN

    Measure Date Value
    2013
    Total participants, beginning-of-year2013-09-01102
    Total number of active participants reported on line 7a of the Form 55002013-09-0189
    Number of retired or separated participants receiving benefits2013-09-017
    Number of other retired or separated participants entitled to future benefits2013-09-010
    Total of all active and inactive participants2013-09-0196
    2012
    Total participants, beginning-of-year2012-09-01119
    Total number of active participants reported on line 7a of the Form 55002012-09-0198
    Number of retired or separated participants receiving benefits2012-09-014
    Number of other retired or separated participants entitled to future benefits2012-09-010
    Total of all active and inactive participants2012-09-01102
    2011
    Total participants, beginning-of-year2011-09-01101
    Total number of active participants reported on line 7a of the Form 55002011-09-01105
    Number of retired or separated participants receiving benefits2011-09-0114
    Number of other retired or separated participants entitled to future benefits2011-09-010
    Total of all active and inactive participants2011-09-01119
    2010
    Total participants, beginning-of-year2010-09-01145
    Total number of active participants reported on line 7a of the Form 55002010-09-01101
    Number of retired or separated participants receiving benefits2010-09-010
    Number of other retired or separated participants entitled to future benefits2010-09-010
    Total of all active and inactive participants2010-09-01101
    2009
    Total participants, beginning-of-year2009-09-01148
    Total number of active participants reported on line 7a of the Form 55002009-09-01145
    Number of retired or separated participants receiving benefits2009-09-010
    Number of other retired or separated participants entitled to future benefits2009-09-010
    Total of all active and inactive participants2009-09-01145

    Form 5500 Responses

    2013
    2013-09-01Type of plan entitySingle employer plan
    2013-09-01Submission has been amendedNo
    2013-09-01This submission is the final filingNo
    2013-09-01This return/report is a short plan year return/report (less than 12 months)No
    2013-09-01Plan is a collectively bargained planNo
    2013-09-01Plan funding arrangement – InsuranceYes
    2013-09-01Plan benefit arrangement – InsuranceYes
    2012
    2012-09-01Type of plan entitySingle employer plan
    2012-09-01Submission has been amendedNo
    2012-09-01This submission is the final filingNo
    2012-09-01This return/report is a short plan year return/report (less than 12 months)No
    2012-09-01Plan is a collectively bargained planNo
    2012-09-01Plan funding arrangement – InsuranceYes
    2012-09-01Plan benefit arrangement – InsuranceYes
    2011
    2011-09-01Type of plan entitySingle employer plan
    2011-09-01Submission has been amendedNo
    2011-09-01This submission is the final filingNo
    2011-09-01This return/report is a short plan year return/report (less than 12 months)No
    2011-09-01Plan is a collectively bargained planNo
    2011-09-01Plan funding arrangement – InsuranceYes
    2011-09-01Plan benefit arrangement – InsuranceYes
    2010
    2010-09-01Type of plan entitySingle employer plan
    2010-09-01Submission has been amendedNo
    2010-09-01This submission is the final filingNo
    2010-09-01This return/report is a short plan year return/report (less than 12 months)No
    2010-09-01Plan is a collectively bargained planNo
    2010-09-01Plan funding arrangement – InsuranceYes
    2010-09-01Plan benefit arrangement – InsuranceYes
    2009
    2009-09-01Type of plan entitySingle employer plan
    2009-09-01Submission has been amendedNo
    2009-09-01This submission is the final filingNo
    2009-09-01This return/report is a short plan year return/report (less than 12 months)No
    2009-09-01Plan is a collectively bargained planNo
    2009-09-01Plan funding arrangement – InsuranceYes
    2009-09-01Plan funding arrangement – General assets of the sponsorYes
    2009-09-01Plan benefit arrangement – InsuranceYes
    2009-09-01Plan benefit arrangement – General assets of the sponsorYes

    Insurance Providers Used on plan

    CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 )
    Policy contract numberZH5037/H51645
    Policy instance 6
    Insurance contract or identification numberZH5037/H51645
    Number of Individuals Covered59
    Insurance policy start date2013-09-01
    Insurance policy end date2014-08-31
    Total amount of commissions paid to insurance brokerUSD $46,312
    Total amount of fees paid to insurance companyUSD $476
    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 $926,246
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $46,312
    Amount paid for insurance broker fees476
    Additional information about fees paid to insurance brokerBONUS OVERRIDE ALLOCATION
    Insurance broker organization code?3
    Insurance broker nameBARNEY & BARNEY
    GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 )
    Policy contract numberBTA34835
    Policy instance 1
    Insurance contract or identification numberBTA34835
    Number of Individuals Covered93
    Insurance policy start date2013-09-01
    Insurance policy end date2014-08-31
    Total amount of commissions paid to insurance brokerUSD $150
    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 providedBUSINESS TRAVEL ACCIDENT
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $1,000
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $150
    Insurance broker organization code?3
    Insurance broker nameBARNEY & BARNEY
    KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
    Policy contract number15441
    Policy instance 3
    Insurance contract or identification number15441
    Number of Individuals Covered3
    Insurance policy start date2013-09-01
    Insurance policy end date2014-08-31
    Total amount of commissions paid to insurance brokerUSD $199
    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 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 $8,501
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $199
    Insurance broker organization code?3
    Insurance broker nameBARNEY & BARNEY
    LOVELACE HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95808 )
    Policy contract number20114800
    Policy instance 4
    Insurance contract or identification number20114800
    Number of Individuals Covered4
    Insurance policy start date2013-09-01
    Insurance policy end date2014-05-31
    Total amount of commissions paid to insurance brokerUSD $2,427
    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 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
    Other welfare benefits providedPOS 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 $52,947
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $2,427
    Insurance broker organization code?3
    Insurance broker nameBARNEY & BARNEY
    HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )
    Policy contract number13719
    Policy instance 5
    Insurance contract or identification number13719
    Number of Individuals Covered21
    Insurance policy start date2013-09-01
    Insurance policy end date2014-08-31
    Total amount of commissions paid to insurance brokerUSD $0
    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 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 $192,887
    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 number490945
    Policy instance 7
    Insurance contract or identification number490945
    Number of Individuals Covered90
    Insurance policy start date2013-09-01
    Insurance policy end date2014-08-31
    Total amount of commissions paid to insurance brokerUSD $15,162
    Total amount of fees paid to insurance companyUSD $3,305
    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 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 $138,807
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $13,881
    Amount paid for insurance broker fees3305
    Additional information about fees paid to insurance brokerBONUS
    Insurance broker organization code?3
    Insurance broker namePACIFIC ADVISORS INC.
    UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
    Policy contract number552549
    Policy instance 8
    Insurance contract or identification number552549
    Number of Individuals Covered87
    Insurance policy start date2013-09-01
    Insurance policy end date2014-08-31
    Total amount of commissions paid to insurance brokerUSD $6,614
    Total amount of fees paid to insurance companyUSD $1,385
    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 BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    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 $63,763
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $6,614
    Amount paid for insurance broker fees1385
    Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
    Insurance broker organization code?3
    Insurance broker nameBARNEY & BARNEY
    BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
    Policy contract numberL01148
    Policy instance 9
    Insurance contract or identification numberL01148
    Number of Individuals Covered5
    Insurance policy start date2014-06-01
    Insurance policy end date2014-08-31
    Total amount of commissions paid to insurance brokerUSD $288
    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 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
    Other welfare benefits providedPOS 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 $28,838
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $288
    Insurance broker organization code?3
    Insurance broker nameBARNEY & BARNEY
    TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
    Policy contract number44008000
    Policy instance 2
    Insurance contract or identification number44008000
    Number of Individuals Covered6
    Insurance policy start date2013-09-01
    Insurance policy end date2014-08-31
    Total amount of commissions paid to insurance brokerUSD $1,534
    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 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 $132,184
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,534
    Insurance broker organization code?3
    Insurance broker nameBARNEY & BARNEY
    KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
    Policy contract number15441
    Policy instance 1
    Insurance contract or identification number15441
    Number of Individuals Covered4
    Insurance policy start date2012-09-01
    Insurance policy end date2013-08-31
    Total amount of commissions paid to insurance brokerUSD $29
    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 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 $23,262
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $29
    Insurance broker organization code?3
    Insurance broker nameBARNEY & BARNEY, LLC
    UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
    Policy contract number552549
    Policy instance 8
    Insurance contract or identification number552549
    Number of Individuals Covered95
    Insurance policy start date2012-09-01
    Insurance policy end date2013-08-31
    Total amount of commissions paid to insurance brokerUSD $7,049
    Total amount of fees paid to insurance companyUSD $1,479
    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 BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    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 $73,938
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $7,049
    Amount paid for insurance broker fees1479
    Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
    Insurance broker organization code?3
    Insurance broker nameBARNEY & BARNEY, LLC
    TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
    Policy contract number44008000
    Policy instance 2
    Insurance contract or identification number44008000
    Number of Individuals Covered5
    Insurance policy start date2012-09-01
    Insurance policy end date2013-08-31
    Total amount of commissions paid to insurance brokerUSD $4,537
    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 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 $148,903
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $4,537
    Insurance broker organization code?3
    Insurance broker nameBARNEY & BARNEY, LLC
    GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 )
    Policy contract numberBTA34835
    Policy instance 3
    Insurance contract or identification numberBTA34835
    Number of Individuals Covered99
    Insurance policy start date2012-09-01
    Insurance policy end date2013-08-31
    Total amount of commissions paid to insurance brokerUSD $197
    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 providedBUSINESS TRAVEL ACCIDENT
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $1,310
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $197
    Insurance broker organization code?3
    Insurance broker nameBARNEY & BARNEY, LLC
    AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
    Policy contract number010-010467
    Policy instance 4
    Insurance contract or identification number010-010467
    Number of Individuals Covered222
    Insurance policy start date2012-09-01
    Insurance policy end date2013-08-31
    Total amount of commissions paid to insurance brokerUSD $7,583
    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 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 $189,569
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $7,583
    Insurance broker organization code?3
    Insurance broker nameBARNEY & BARNEY, LLC
    CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 )
    Policy contract numberZH5037/H51645
    Policy instance 5
    Insurance contract or identification numberZH5037/H51645
    Number of Individuals Covered58
    Insurance policy start date2012-09-01
    Insurance policy end date2013-08-31
    Total amount of commissions paid to insurance brokerUSD $48,738
    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 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 $974,761
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $48,738
    Insurance broker organization code?3
    Insurance broker nameBARNEY & BARNEY, LLC
    LOVELACE HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95808 )
    Policy contract number20114800
    Policy instance 6
    Insurance contract or identification number20114800
    Number of Individuals Covered4
    Insurance policy start date2012-09-01
    Insurance policy end date2013-08-31
    Total amount of commissions paid to insurance brokerUSD $2,337
    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 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
    Other welfare benefits providedPOS 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 $77,915
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $2,337
    Insurance broker organization code?3
    Insurance broker nameBARNEY & BARNEY, LLC
    HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )
    Policy contract number13719
    Policy instance 7
    Insurance contract or identification number13719
    Number of Individuals Covered30
    Insurance policy start date2012-09-01
    Insurance policy end date2013-08-31
    Total amount of commissions paid to insurance brokerUSD $0
    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 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 $257,288
    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 number44008000
    Policy instance 7
    Insurance contract or identification number44008000
    Number of Individuals Covered9
    Insurance policy start date2011-09-01
    Insurance policy end date2012-08-31
    Total amount of commissions paid to insurance brokerUSD $7,486
    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 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 $204,850
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 )
    Policy contract numberBTA34835
    Policy instance 6
    Insurance contract or identification numberBTA34835
    Number of Individuals Covered105
    Insurance policy start date2011-09-01
    Insurance policy end date2012-08-31
    Total amount of commissions paid to insurance brokerUSD $197
    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 providedBUSINESS TRAVEL ACCIDENT
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $1,310
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
    Policy contract number552549
    Policy instance 5
    Insurance contract or identification number552549
    Number of Individuals Covered105
    Insurance policy start date2011-09-01
    Insurance policy end date2012-08-31
    Total amount of commissions paid to insurance brokerUSD $7,021
    Total amount of fees paid to insurance companyUSD $1,368
    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 BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    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 $74,539
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 )
    Policy contract numberZH5037/H51645
    Policy instance 4
    Insurance contract or identification numberZH5037/H51645
    Number of Individuals Covered60
    Insurance policy start date2011-09-01
    Insurance policy end date2012-08-31
    Total amount of commissions paid to insurance brokerUSD $46,276
    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 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 $925,528
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
    Policy contract number010-010467
    Policy instance 3
    Insurance contract or identification number010-010467
    Number of Individuals Covered242
    Insurance policy start date2011-09-01
    Insurance policy end date2012-08-31
    Total amount of commissions paid to insurance brokerUSD $7,411
    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 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 $185,267
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )
    Policy contract number13719
    Policy instance 2
    Insurance contract or identification number13719
    Number of Individuals Covered34
    Insurance policy start date2011-09-01
    Insurance policy end date2012-08-31
    Total amount of commissions paid to insurance brokerUSD $0
    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 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 $337,560
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    LOVELACE HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95808 )
    Policy contract number20114800
    Policy instance 1
    Insurance contract or identification number20114800
    Number of Individuals Covered4
    Insurance policy start date2011-09-01
    Insurance policy end date2012-08-31
    Total amount of commissions paid to insurance brokerUSD $2,436
    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 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
    Other welfare benefits providedPOS 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 $81,207
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
    Policy contract number15441
    Policy instance 8
    Insurance contract or identification number15441
    Number of Individuals Covered2
    Insurance policy start date2011-09-01
    Insurance policy end date2012-08-31
    Total amount of commissions paid to insurance brokerUSD $0
    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 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 $16,278
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 )
    Policy contract numberBTA34835
    Policy instance 1
    Insurance contract or identification numberBTA34835
    Number of Individuals Covered101
    Insurance policy start date2010-09-01
    Insurance policy end date2011-08-31
    Total amount of commissions paid to insurance brokerUSD $197
    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 providedBUSINESS TRAVEL ACCIDENT
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $1,310
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
    Policy contract number552549
    Policy instance 2
    Insurance contract or identification number552549
    Number of Individuals Covered101
    Insurance policy start date2010-09-01
    Insurance policy end date2011-08-31
    Total amount of commissions paid to insurance brokerUSD $7,653
    Total amount of fees paid to insurance companyUSD $386
    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 BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    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 $79,886
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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