RADIOLOGY ASSOCIATES OF BURLINGTON COUNTY has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan RADIOLOGY ASSOCIATES OF BURLINGTON COUNTY
| Measure | Date | Value |
|---|
| 2021: RADIOLOGY ASSOCIATES OF BURLINGTON COUNTY 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-05-01 | 139 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-05-01 | 0 |
| Number of retired or separated participants receiving benefits | 2021-05-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-05-01 | 0 |
| Total of all active and inactive participants | 2021-05-01 | 0 |
| Number of employers contributing to the scheme | 2021-05-01 | 0 |
| 2020: RADIOLOGY ASSOCIATES OF BURLINGTON COUNTY 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-05-01 | 169 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-05-01 | 139 |
| Number of retired or separated participants receiving benefits | 2020-05-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2020-05-01 | 0 |
| Total of all active and inactive participants | 2020-05-01 | 139 |
| Number of employers contributing to the scheme | 2020-05-01 | 0 |
| 2019: RADIOLOGY ASSOCIATES OF BURLINGTON COUNTY 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-05-01 | 175 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-05-01 | 169 |
| Number of retired or separated participants receiving benefits | 2019-05-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-05-01 | 0 |
| Total of all active and inactive participants | 2019-05-01 | 169 |
| Number of employers contributing to the scheme | 2019-05-01 | 0 |
| 2018: RADIOLOGY ASSOCIATES OF BURLINGTON COUNTY 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-05-01 | 178 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-05-01 | 175 |
| Number of retired or separated participants receiving benefits | 2018-05-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-05-01 | 0 |
| Total of all active and inactive participants | 2018-05-01 | 175 |
| Number of employers contributing to the scheme | 2018-05-01 | 0 |
| 2017: RADIOLOGY ASSOCIATES OF BURLINGTON COUNTY 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-05-01 | 178 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-05-01 | 176 |
| Number of retired or separated participants receiving benefits | 2017-05-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-05-01 | 0 |
| Total of all active and inactive participants | 2017-05-01 | 176 |
| 2016: RADIOLOGY ASSOCIATES OF BURLINGTON COUNTY 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-05-01 | 216 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-05-01 | 178 |
| Number of retired or separated participants receiving benefits | 2016-05-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2016-05-01 | 0 |
| Total of all active and inactive participants | 2016-05-01 | 178 |
| 2015: RADIOLOGY ASSOCIATES OF BURLINGTON COUNTY 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-05-01 | 181 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-05-01 | 216 |
| Number of retired or separated participants receiving benefits | 2015-05-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2015-05-01 | 0 |
| Total of all active and inactive participants | 2015-05-01 | 216 |
| 2014: RADIOLOGY ASSOCIATES OF BURLINGTON COUNTY 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-05-01 | 186 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-05-01 | 181 |
| Number of retired or separated participants receiving benefits | 2014-05-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2014-05-01 | 0 |
| Total of all active and inactive participants | 2014-05-01 | 181 |
| 2013: RADIOLOGY ASSOCIATES OF BURLINGTON COUNTY 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-05-01 | 194 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-05-01 | 186 |
| Number of retired or separated participants receiving benefits | 2013-05-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2013-05-01 | 0 |
| Total of all active and inactive participants | 2013-05-01 | 186 |
| 2012: RADIOLOGY ASSOCIATES OF BURLINGTON COUNTY 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-05-01 | 195 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-05-01 | 194 |
| Total of all active and inactive participants | 2012-05-01 | 194 |
| Total participants | 2012-05-01 | 194 |
| 2011: RADIOLOGY ASSOCIATES OF BURLINGTON COUNTY 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-05-01 | 201 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-05-01 | 195 |
| Total of all active and inactive participants | 2011-05-01 | 195 |
| Total participants | 2011-05-01 | 195 |
| 2008: RADIOLOGY ASSOCIATES OF BURLINGTON COUNTY 2008 401k membership |
|---|
| Total participants, beginning-of-year | 2008-05-01 | 211 |
| Total number of active participants reported on line 7a of the Form 5500 | 2008-05-01 | 211 |
| Total of all active and inactive participants | 2008-05-01 | 211 |
| Total participants | 2008-05-01 | 211 |
| 2007: RADIOLOGY ASSOCIATES OF BURLINGTON COUNTY 2007 401k membership |
|---|
| Total participants, beginning-of-year | 2007-05-01 | 212 |
| Total number of active participants reported on line 7a of the Form 5500 | 2007-05-01 | 211 |
| Total of all active and inactive participants | 2007-05-01 | 211 |
| Total participants | 2007-05-01 | 211 |
| 2006: RADIOLOGY ASSOCIATES OF BURLINGTON COUNTY 2006 401k membership |
|---|
| Total participants, beginning-of-year | 2006-05-01 | 210 |
| Total number of active participants reported on line 7a of the Form 5500 | 2006-05-01 | 212 |
| Total of all active and inactive participants | 2006-05-01 | 212 |
| Total participants | 2006-05-01 | 212 |
| 2005: RADIOLOGY ASSOCIATES OF BURLINGTON COUNTY 2005 401k membership |
|---|
| Total participants, beginning-of-year | 2005-05-01 | 206 |
| Total number of active participants reported on line 7a of the Form 5500 | 2005-05-01 | 210 |
| Total of all active and inactive participants | 2005-05-01 | 210 |
| Total participants | 2005-05-01 | 210 |
| 2004: RADIOLOGY ASSOCIATES OF BURLINGTON COUNTY 2004 401k membership |
|---|
| Total participants, beginning-of-year | 2004-05-01 | 202 |
| Total number of active participants reported on line 7a of the Form 5500 | 2004-05-01 | 206 |
| Total of all active and inactive participants | 2004-05-01 | 206 |
| Total participants | 2004-05-01 | 206 |
| 2003: RADIOLOGY ASSOCIATES OF BURLINGTON COUNTY 2003 401k membership |
|---|
| Total participants, beginning-of-year | 2003-05-01 | 170 |
| Total number of active participants reported on line 7a of the Form 5500 | 2003-05-01 | 202 |
| Total of all active and inactive participants | 2003-05-01 | 202 |
| Total participants | 2003-05-01 | 202 |
| 2021: RADIOLOGY ASSOCIATES OF BURLINGTON COUNTY 2021 form 5500 responses |
|---|
| 2021-05-01 | Type of plan entity | Single employer plan |
| 2021-05-01 | This submission is the final filing | Yes |
| 2021-05-01 | Plan funding arrangement – Insurance | Yes |
| 2021-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: RADIOLOGY ASSOCIATES OF BURLINGTON COUNTY 2020 form 5500 responses |
|---|
| 2020-05-01 | Type of plan entity | Single employer plan |
| 2020-05-01 | Plan funding arrangement – Insurance | Yes |
| 2020-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: RADIOLOGY ASSOCIATES OF BURLINGTON COUNTY 2019 form 5500 responses |
|---|
| 2019-05-01 | Type of plan entity | Single employer plan |
| 2019-05-01 | Plan funding arrangement – Insurance | Yes |
| 2019-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: RADIOLOGY ASSOCIATES OF BURLINGTON COUNTY 2018 form 5500 responses |
|---|
| 2018-05-01 | Type of plan entity | Single employer plan |
| 2018-05-01 | Plan funding arrangement – Insurance | Yes |
| 2018-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: RADIOLOGY ASSOCIATES OF BURLINGTON COUNTY 2017 form 5500 responses |
|---|
| 2017-05-01 | Type of plan entity | Single employer plan |
| 2017-05-01 | Plan funding arrangement – Insurance | Yes |
| 2017-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: RADIOLOGY ASSOCIATES OF BURLINGTON COUNTY 2016 form 5500 responses |
|---|
| 2016-05-01 | Type of plan entity | Single employer plan |
| 2016-05-01 | Submission has been amended | No |
| 2016-05-01 | This submission is the final filing | No |
| 2016-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-05-01 | Plan is a collectively bargained plan | No |
| 2016-05-01 | Plan funding arrangement – Insurance | Yes |
| 2016-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: RADIOLOGY ASSOCIATES OF BURLINGTON COUNTY 2015 form 5500 responses |
|---|
| 2015-05-01 | Type of plan entity | Single employer plan |
| 2015-05-01 | Submission has been amended | No |
| 2015-05-01 | This submission is the final filing | No |
| 2015-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-05-01 | Plan is a collectively bargained plan | No |
| 2015-05-01 | Plan funding arrangement – Insurance | Yes |
| 2015-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: RADIOLOGY ASSOCIATES OF BURLINGTON COUNTY 2014 form 5500 responses |
|---|
| 2014-05-01 | Type of plan entity | Single employer plan |
| 2014-05-01 | Submission has been amended | No |
| 2014-05-01 | This submission is the final filing | No |
| 2014-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-05-01 | Plan is a collectively bargained plan | No |
| 2014-05-01 | Plan funding arrangement – Insurance | Yes |
| 2014-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: RADIOLOGY ASSOCIATES OF BURLINGTON COUNTY 2013 form 5500 responses |
|---|
| 2013-05-01 | Type of plan entity | Single employer plan |
| 2013-05-01 | Submission has been amended | No |
| 2013-05-01 | This submission is the final filing | No |
| 2013-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-05-01 | Plan is a collectively bargained plan | No |
| 2013-05-01 | Plan funding arrangement – Insurance | Yes |
| 2013-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2012: RADIOLOGY ASSOCIATES OF BURLINGTON COUNTY 2012 form 5500 responses |
|---|
| 2012-05-01 | Type of plan entity | Single employer plan |
| 2012-05-01 | Submission has been amended | No |
| 2012-05-01 | This submission is the final filing | No |
| 2012-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-05-01 | Plan is a collectively bargained plan | No |
| 2012-05-01 | Plan funding arrangement – Insurance | Yes |
| 2012-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: RADIOLOGY ASSOCIATES OF BURLINGTON COUNTY 2011 form 5500 responses |
|---|
| 2011-05-01 | Type of plan entity | Single employer plan |
| 2011-05-01 | Submission has been amended | Yes |
| 2011-05-01 | This submission is the final filing | No |
| 2011-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-05-01 | Plan is a collectively bargained plan | No |
| 2011-05-01 | Plan funding arrangement – Insurance | Yes |
| 2011-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2008: RADIOLOGY ASSOCIATES OF BURLINGTON COUNTY 2008 form 5500 responses |
|---|
| 2008-05-01 | Type of plan entity | Single employer plan |
| 2008-05-01 | Submission has been amended | No |
| 2008-05-01 | This submission is the final filing | No |
| 2008-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2008-05-01 | Plan is a collectively bargained plan | No |
| 2008-05-01 | Plan funding arrangement – Insurance | Yes |
| 2008-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2007: RADIOLOGY ASSOCIATES OF BURLINGTON COUNTY 2007 form 5500 responses |
|---|
| 2007-05-01 | Type of plan entity | Single employer plan |
| 2007-05-01 | Submission has been amended | No |
| 2007-05-01 | This submission is the final filing | No |
| 2007-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2007-05-01 | Plan is a collectively bargained plan | No |
| 2007-05-01 | Plan funding arrangement – Insurance | Yes |
| 2007-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2006: RADIOLOGY ASSOCIATES OF BURLINGTON COUNTY 2006 form 5500 responses |
|---|
| 2006-05-01 | Type of plan entity | Single employer plan |
| 2006-05-01 | Submission has been amended | No |
| 2006-05-01 | This submission is the final filing | No |
| 2006-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2006-05-01 | Plan is a collectively bargained plan | No |
| 2006-05-01 | Plan funding arrangement – Insurance | Yes |
| 2006-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2005: RADIOLOGY ASSOCIATES OF BURLINGTON COUNTY 2005 form 5500 responses |
|---|
| 2005-05-01 | Type of plan entity | Single employer plan |
| 2005-05-01 | Submission has been amended | No |
| 2005-05-01 | This submission is the final filing | No |
| 2005-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2005-05-01 | Plan is a collectively bargained plan | No |
| 2005-05-01 | Plan funding arrangement – Insurance | Yes |
| 2005-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2004: RADIOLOGY ASSOCIATES OF BURLINGTON COUNTY 2004 form 5500 responses |
|---|
| 2004-05-01 | Type of plan entity | Single employer plan |
| 2004-05-01 | Submission has been amended | No |
| 2004-05-01 | This submission is the final filing | No |
| 2004-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2004-05-01 | Plan is a collectively bargained plan | No |
| 2004-05-01 | Plan funding arrangement – Insurance | Yes |
| 2004-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2003: RADIOLOGY ASSOCIATES OF BURLINGTON COUNTY 2003 form 5500 responses |
|---|
| 2003-05-01 | Type of plan entity | Single employer plan |
| 2003-05-01 | Submission has been amended | No |
| 2003-05-01 | This submission is the final filing | No |
| 2003-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2003-05-01 | Plan is a collectively bargained plan | No |
| 2003-05-01 | Plan funding arrangement – Insurance | Yes |
| 2003-05-01 | Plan benefit arrangement – Insurance | Yes |
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 239023 |
| Policy instance | 1 |
| Insurance contract or identification number | 239023 | | Number of Individuals Covered | 100 | | Insurance policy start date | 2021-02-01 | | Insurance policy end date | 2022-01-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $80,027 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 239023 |
| Policy instance | 3 |
| Insurance contract or identification number | 239023 | | Number of Individuals Covered | 98 | | Insurance policy start date | 2022-02-01 | | Insurance policy end date | 2022-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $12,150 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30024452 |
| Policy instance | 2 |
| Insurance contract or identification number | 30024452 | | Number of Individuals Covered | 27 | | Insurance policy start date | 2021-02-01 | | Insurance policy end date | 2022-01-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $7,858 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30024452 |
| Policy instance | 4 |
| Insurance contract or identification number | 30024452 | | Number of Individuals Covered | 26 | | Insurance policy start date | 2022-02-01 | | Insurance policy end date | 2022-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,290 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 639993 |
| Policy instance | 5 |
| Insurance contract or identification number | 639993 | | Number of Individuals Covered | 162 | | Insurance policy start date | 2021-02-01 | | Insurance policy end date | 2022-01-31 | | Total amount of commissions paid to insurance broker | USD $18,773 | | Total amount of fees paid to insurance company | USD $2,086 | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $104,294 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $18,773 | | Amount paid for insurance broker fees | 2086 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) |
| Policy contract number | 86922 |
| Policy instance | 6 |
| Insurance contract or identification number | 86922 | | Number of Individuals Covered | 118 | | Insurance policy start date | 2021-02-01 | | Insurance policy end date | 2022-01-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Welfare Benefit Premiums Paid to Carrier | USD $1,265,344 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) |
| Policy contract number | 86922 |
| Policy instance | 7 |
| Insurance contract or identification number | 86922 | | Number of Individuals Covered | 116 | | Insurance policy start date | 2022-02-01 | | Insurance policy end date | 2022-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Welfare Benefit Premiums Paid to Carrier | USD $218,842 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 639993 |
| Policy instance | 8 |
| Insurance contract or identification number | 639993 | | Number of Individuals Covered | 165 | | Insurance policy start date | 2022-02-01 | | Insurance policy end date | 2022-03-31 | | Total amount of commissions paid to insurance broker | USD $4,409 | | Total amount of fees paid to insurance company | USD $346 | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $17,282 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,111 | | Amount paid for insurance broker fees | 346 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30024452 |
| Policy instance | 2 |
| Insurance contract or identification number | 30024452 | | Number of Individuals Covered | 29 | | Insurance policy start date | 2020-02-01 | | Insurance policy end date | 2021-01-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $8,269 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 239023 |
| Policy instance | 1 |
| Insurance contract or identification number | 239023 | | Number of Individuals Covered | 108 | | Insurance policy start date | 2020-02-01 | | Insurance policy end date | 2021-01-31 | | Total amount of commissions paid to insurance broker | USD $2,001 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $83,103 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $2,001 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 639993-0001 |
| Policy instance | 4 |
| Insurance contract or identification number | 639993-0001 | | Number of Individuals Covered | 139 | | Insurance policy start date | 2020-02-01 | | Insurance policy end date | 2021-01-31 | | Total amount of commissions paid to insurance broker | USD $18,838 | | Total amount of fees paid to insurance company | USD $1,831 | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $95,950 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $18,838 | | Amount paid for insurance broker fees | 1831 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) |
| Policy contract number | 86922 |
| Policy instance | 3 |
| Insurance contract or identification number | 86922 | | Number of Individuals Covered | 122 | | Insurance policy start date | 2020-02-01 | | Insurance policy end date | 2021-01-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Welfare Benefit Premiums Paid to Carrier | USD $2,129,378 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 239023 |
| Policy instance | 1 |
| Insurance contract or identification number | 239023 | | Number of Individuals Covered | 112 | | Insurance policy start date | 2019-02-01 | | Insurance policy end date | 2020-01-31 | | Total amount of commissions paid to insurance broker | USD $1,613 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $91,700 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,613 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30024452 |
| Policy instance | 2 |
| Insurance contract or identification number | 30024452 | | Number of Individuals Covered | 29 | | Insurance policy start date | 2019-02-01 | | Insurance policy end date | 2020-01-31 | | Total amount of commissions paid to insurance broker | USD $822 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $12,008 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $822 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) |
| Policy contract number | 86922 |
| Policy instance | 3 |
| Insurance contract or identification number | 86922 | | Number of Individuals Covered | 130 | | Insurance policy start date | 2019-02-01 | | Insurance policy end date | 2020-01-31 | | Total amount of commissions paid to insurance broker | USD $57,600 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Welfare Benefit Premiums Paid to Carrier | USD $2,244,931 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $57,600 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 639993-0001 |
| Policy instance | 4 |
| Insurance contract or identification number | 639993-0001 | | Number of Individuals Covered | 169 | | Insurance policy start date | 2019-02-01 | | Insurance policy end date | 2020-01-31 | | Total amount of commissions paid to insurance broker | USD $18,632 | | Total amount of fees paid to insurance company | USD $1,812 | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $112,218 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $15,332 | | Amount paid for insurance broker fees | 1491 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) |
| Policy contract number | 86922 |
| Policy instance | 3 |
| Insurance contract or identification number | 86922 | | Number of Individuals Covered | 136 | | Insurance policy start date | 2018-02-01 | | Insurance policy end date | 2019-01-31 | | Total amount of commissions paid to insurance broker | USD $58,447 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Welfare Benefit Premiums Paid to Carrier | USD $2,007,427 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $58,447 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 239023 |
| Policy instance | 1 |
| Insurance contract or identification number | 239023 | | Number of Individuals Covered | 113 | | Insurance policy start date | 2018-02-01 | | Insurance policy end date | 2019-01-31 | | Total amount of commissions paid to insurance broker | USD $2,590 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $109,841 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,590 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30024452 |
| Policy instance | 2 |
| Insurance contract or identification number | 30024452 | | Number of Individuals Covered | 28 | | Insurance policy start date | 2018-02-01 | | Insurance policy end date | 2019-01-31 | | Total amount of commissions paid to insurance broker | USD $827 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $12,154 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $827 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 639994-0001 |
| Policy instance | 4 |
| Insurance contract or identification number | 639994-0001 | | Number of Individuals Covered | 148 | | Insurance policy start date | 2018-02-01 | | Insurance policy end date | 2019-01-31 | | Total amount of commissions paid to insurance broker | USD $19,609 | | Total amount of fees paid to insurance company | USD $1,907 | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $108,940 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $19,609 | | Amount paid for insurance broker fees | 1907 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 239023 |
| Policy instance | 1 |
| Insurance contract or identification number | 239023 | | Number of Individuals Covered | 114 | | Insurance policy start date | 2017-02-01 | | Insurance policy end date | 2018-01-31 | | Total amount of commissions paid to insurance broker | USD $2,105 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $101,008 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,355 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Insurance broker name | GALLAGHER BENEFIT SERVICES, INC. |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30024452 |
| Policy instance | 2 |
| Insurance contract or identification number | 30024452 | | Number of Individuals Covered | 29 | | Insurance policy start date | 2017-02-01 | | Insurance policy end date | 2018-01-31 | | Total amount of commissions paid to insurance broker | USD $838 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $12,476 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $838 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Insurance broker name | GALLAGHER BENEFIT SERVICES, INC. |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) |
| Policy contract number | 86922 |
| Policy instance | 3 |
| Insurance contract or identification number | 86922 | | Number of Individuals Covered | 139 | | Insurance policy start date | 2017-02-01 | | Insurance policy end date | 2018-01-31 | | Total amount of commissions paid to insurance broker | USD $60,395 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Welfare Benefit Premiums Paid to Carrier | USD $1,973,868 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $51,414 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Insurance broker name | GALLAGHER BENEFIT SERVICES, INC. |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 639993 |
| Policy instance | 4 |
| Insurance contract or identification number | 639993 | | Number of Individuals Covered | 176 | | Insurance policy start date | 2017-02-01 | | Insurance policy end date | 2018-01-31 | | Total amount of commissions paid to insurance broker | USD $19,377 | | Total amount of fees paid to insurance company | USD $1,884 | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $98,389 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $19,377 | | Amount paid for insurance broker fees | 1884 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | KISTLER-TIFFANY BENEFITS COMPANY |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TM05985683 |
| Policy instance | 4 |
| Insurance contract or identification number | TM05985683 | | Number of Individuals Covered | 508 | | Insurance policy start date | 2015-02-01 | | Insurance policy end date | 2016-01-31 | | Total amount of commissions paid to insurance broker | USD $11,028 | | Total amount of fees paid to insurance company | USD $3,677 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $112,393 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,028 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 3677 | | Additional information about fees paid to insurance broker | GROSS DEALER CONCESSION | | Insurance broker name | METLIFE FINANCIAL |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30024452 |
| Policy instance | 3 |
| Insurance contract or identification number | 30024452 | | Number of Individuals Covered | 33 | | Insurance policy start date | 2015-02-01 | | Insurance policy end date | 2016-01-31 | | Total amount of commissions paid to insurance broker | USD $854 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $12,918 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $854 | | Insurance broker organization code? | 3 | | Insurance broker name | GALLAGHER BENEFIT SERVICES, INC. |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 239023 |
| Policy instance | 2 |
| Insurance contract or identification number | 239023 | | Number of Individuals Covered | 115 | | Insurance policy start date | 2015-02-01 | | Insurance policy end date | 2016-01-31 | | Total amount of commissions paid to insurance broker | USD $2,082 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $100,025 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,082 | | Insurance broker organization code? | 3 | | Insurance broker name | GALLAGHER BENEFIT SERVICES, INC. |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) |
| Policy contract number | 86922 |
| Policy instance | 1 |
| Insurance contract or identification number | 86922 | | Number of Individuals Covered | 137 | | Insurance policy start date | 2015-02-01 | | Insurance policy end date | 2016-01-31 | | Total amount of commissions paid to insurance broker | USD $58,170 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $1,902,780 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $58,170 | | Insurance broker organization code? | 3 | | Insurance broker name | GALLAGHER BENEFIT SERVICES, INC. |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TM05985683 |
| Policy instance | 4 |
| Insurance contract or identification number | TM05985683 | | Number of Individuals Covered | 426 | | Insurance policy start date | 2014-02-01 | | Insurance policy end date | 2015-01-31 | | Total amount of commissions paid to insurance broker | USD $12,357 | | Total amount of fees paid to insurance company | USD $4,118 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $106,452 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $12,357 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 4118 | | Additional information about fees paid to insurance broker | GROSS DEALER CONCESSION | | Insurance broker name | METLIFE FINANCIAL |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 239023 |
| Policy instance | 2 |
| Insurance contract or identification number | 239023 | | Number of Individuals Covered | 116 | | Insurance policy start date | 2014-02-01 | | Insurance policy end date | 2015-01-31 | | Total amount of commissions paid to insurance broker | USD $2,638 | | Total amount of fees paid to insurance company | USD $3,719 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $112,803 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,638 | | Amount paid for insurance broker fees | 3719 | | Additional information about fees paid to insurance broker | FEES | | Insurance broker organization code? | 3 | | Insurance broker name | GALLAGHER BENEFIT SERVICES, INC. |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) |
| Policy contract number | 86922 |
| Policy instance | 1 |
| Insurance contract or identification number | 86922 | | Number of Individuals Covered | 139 | | Insurance policy start date | 2014-02-01 | | Insurance policy end date | 2015-01-31 | | Total amount of commissions paid to insurance broker | USD $62,334 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $1,939,682 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $62,334 | | Insurance broker organization code? | 3 | | Insurance broker name | GALLAGHER BENEFIT SERVICES, INC. |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30024452 |
| Policy instance | 3 |
| Insurance contract or identification number | 30024452 | | Number of Individuals Covered | 35 | | Insurance policy start date | 2014-02-01 | | Insurance policy end date | 2015-01-31 | | Total amount of commissions paid to insurance broker | USD $872 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $13,437 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $872 | | Insurance broker organization code? | 3 | | Insurance broker name | GALLAGHER BENEFIT SERVICES, INC. |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) |
| Policy contract number | 86922 |
| Policy instance | 1 |
| Insurance contract or identification number | 86922 | | Number of Individuals Covered | 132 | | Insurance policy start date | 2013-02-01 | | Insurance policy end date | 2014-01-31 | | Total amount of commissions paid to insurance broker | USD $48,319 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $2,063,257 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $48,319 | | Insurance broker organization code? | 3 | | Insurance broker name | GALLAGHER BENEFIT SERVICES, INC. |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 239023 |
| Policy instance | 2 |
| Insurance contract or identification number | 239023 | | Number of Individuals Covered | 115 | | Insurance policy start date | 2013-02-01 | | Insurance policy end date | 2014-01-31 | | Total amount of commissions paid to insurance broker | USD $1,692 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $97,457 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,692 | | Insurance broker organization code? | 3 | | Insurance broker name | GALLAGHER BENEFIT SERVICES, INC. |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30024452 |
| Policy instance | 3 |
| Insurance contract or identification number | 30024452 | | Number of Individuals Covered | 35 | | Insurance policy start date | 2013-02-01 | | Insurance policy end date | 2014-01-31 | | Total amount of commissions paid to insurance broker | USD $863 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $13,184 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $863 | | Insurance broker organization code? | 3 | | Insurance broker name | GALLAGHER BENEFIT SERVICES, INC. |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TM05985683 |
| Policy instance | 4 |
| Insurance contract or identification number | TM05985683 | | Number of Individuals Covered | 511 | | Insurance policy start date | 2013-02-01 | | Insurance policy end date | 2014-01-31 | | Total amount of commissions paid to insurance broker | USD $12,488 | | Total amount of fees paid to insurance company | USD $5,273 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $123,073 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $12,488 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 5273 | | Additional information about fees paid to insurance broker | GROSS DEALER CONCESSION | | Insurance broker name | METLIFE FINANCIAL |
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| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) |
| Policy contract number | 86922 |
| Policy instance | 4 |
| Insurance contract or identification number | 86922 | | Number of Individuals Covered | 140 | | Insurance policy start date | 2012-02-01 | | Insurance policy end date | 2013-01-31 | | Total amount of commissions paid to insurance broker | USD $38,544 | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,678,539 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Other information about contract | GROUP | | Commission paid to Insurance Broker | USD $38,544 | | Insurance broker organization code? | 3 | | Insurance broker name | RSI, DIVISION OF GALLAGHER BENEFITS |
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| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30024452 |
| Policy instance | 2 |
| Insurance contract or identification number | 30024452 | | Number of Individuals Covered | 34 | | Insurance policy start date | 2012-02-01 | | Insurance policy end date | 2013-01-31 | | Total amount of commissions paid to insurance broker | USD $850 | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $12,815 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Other information about contract | GROUP PLAN | | Commission paid to Insurance Broker | USD $850 | | Insurance broker organization code? | 3 | | Insurance broker name | GALLAGHER BENEFIT SERVICES, INC. |
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| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TM05985683 |
| Policy instance | 1 |
| Insurance contract or identification number | TM05985683 | | Number of Individuals Covered | 194 | | Insurance policy start date | 2012-02-01 | | Insurance policy end date | 2013-01-31 | | Total amount of commissions paid to insurance broker | USD $4,364 | | Total amount of fees paid to insurance company | USD $1,454 | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $123,853 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Other information about contract | GROUP | | Commission paid to Insurance Broker | USD $4,364 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 1454 | | Additional information about fees paid to insurance broker | GROSS DEALER CONCESSION | | Insurance broker name | METLIFE FINANCIAL,METLIFE SEC |
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| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) |
| Policy contract number | 86922 |
| Policy instance | 5 |
| Insurance contract or identification number | 86922 | | Number of Individuals Covered | 140 | | Insurance policy start date | 2012-02-01 | | Insurance policy end date | 2013-01-31 | | Total amount of commissions paid to insurance broker | USD $10,454 | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $411,002 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Other information about contract | GROUP | | Commission paid to Insurance Broker | USD $10,454 | | Insurance broker organization code? | 3 | | Insurance broker name | RSI, DIVISION OF GALLAGHER BENEFITS |
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| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00239023 |
| Policy instance | 3 |
| Insurance contract or identification number | 00239023 | | Number of Individuals Covered | 117 | | Insurance policy start date | 2012-02-01 | | Insurance policy end date | 2013-01-31 | | Total amount of commissions paid to insurance broker | USD $2,599 | | Total amount of fees paid to insurance company | USD $6,679 | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $110,146 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Other information about contract | GROUP POLICY | | Commission paid to Insurance Broker | USD $2,602 | | Amount paid for insurance broker fees | 6679 | | Additional information about fees paid to insurance broker | FEES | | Insurance broker organization code? | 3 | | Insurance broker name | PETER ROSENGARD |
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| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 584847 |
| Policy instance | 6 |
| Insurance contract or identification number | 584847 | | Number of Individuals Covered | 194 | | Insurance policy start date | 2011-10-01 | | Insurance policy end date | 2011-11-01 | | Total amount of commissions paid to insurance broker | USD $1,010 | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,732 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Other information about contract | GROUP | | Commission paid to Insurance Broker | USD $1,010 | | Insurance broker organization code? | 3 | | Insurance broker name | PETER ROSENGARD |
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| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 584847 |
| Policy instance | 5 |
| Insurance contract or identification number | 584847 | | Number of Individuals Covered | 194 | | Insurance policy start date | 2010-10-01 | | Insurance policy end date | 2011-10-01 | | Total amount of commissions paid to insurance broker | USD $4,782 | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $71,664 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Other information about contract | GROUP PLAN |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TM05985683 |
| Policy instance | 6 |
| Insurance contract or identification number | TM05985683 | | Number of Individuals Covered | 195 | | Insurance policy start date | 2011-11-01 | | Insurance policy end date | 2012-10-31 | | Total amount of commissions paid to insurance broker | USD $11,560 | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $125,725 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Other information about contract | GROUP CONTRACT |
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| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) |
| Policy contract number | 86922 |
| Policy instance | 1 |
| Insurance contract or identification number | 86922 | | Number of Individuals Covered | 152 | | Insurance policy start date | 2011-02-01 | | Insurance policy end date | 2012-01-31 | | Total amount of commissions paid to insurance broker | USD $61,630 | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Health Insurance Welfare Benefit | Yes | | Were dividends or retroactive rate refunds paid as a credit? | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,986,870 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Other information about contract | GROUP |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00239023 |
| Policy instance | 2 |
| Insurance contract or identification number | 00239023 | | Number of Individuals Covered | 124 | | Insurance policy start date | 2011-05-01 | | Insurance policy end date | 2012-04-30 | | Total amount of commissions paid to insurance broker | USD $4,633 | | Total amount of fees paid to insurance company | USD $6,679 | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $137,890 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Other information about contract | GROUP POLICY |
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| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30024452 |
| Policy instance | 3 |
| Insurance contract or identification number | 30024452 | | Number of Individuals Covered | 34 | | Insurance policy start date | 2011-02-01 | | Insurance policy end date | 2012-01-31 | | Total amount of commissions paid to insurance broker | USD $712 | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $9,239 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Other information about contract | GROUP PLAN |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) |
| Policy contract number | 86922 |
| Policy instance | 4 |
| Insurance contract or identification number | 86922 | | Number of Individuals Covered | 152 | | Insurance policy start date | 2011-02-01 | | Insurance policy end date | 2012-01-31 | | Total amount of commissions paid to insurance broker | USD $15,435 | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Were dividends or retroactive rate refunds paid as a credit? | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $429,529 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Other information about contract | GROUP PLAN |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00239023 |
| Policy instance | 4 |
| Insurance contract or identification number | 00239023 | | Number of Individuals Covered | 201 | | Insurance policy start date | 2010-05-01 | | Insurance policy end date | 2011-04-30 | | Total amount of commissions paid to insurance broker | USD $6,102 | | Total amount of fees paid to insurance company | USD $5,477 | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $158,117 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Other information about contract | GROUP POLICY |
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| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) |
| Policy contract number | 86922 |
| Policy instance | 1 |
| Insurance contract or identification number | 86922 | | Number of Individuals Covered | 162 | | Insurance policy start date | 2010-02-01 | | Insurance policy end date | 2011-01-31 | | Total amount of commissions paid to insurance broker | USD $62,385 | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Health Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,563,860 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Other information about contract | GROUP PLAN |
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| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 584847 |
| Policy instance | 2 |
| Insurance contract or identification number | 584847 | | Number of Individuals Covered | 200 | | Insurance policy start date | 2009-10-01 | | Insurance policy end date | 2010-10-01 | | Total amount of commissions paid to insurance broker | USD $4,779 | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $77,881 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Other information about contract | GROUP PLAN |
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| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) |
| Policy contract number | 86922 |
| Policy instance | 3 |
| Insurance contract or identification number | 86922 | | Number of Individuals Covered | 162 | | Insurance policy start date | 2010-02-01 | | Insurance policy end date | 2011-01-31 | | Total amount of commissions paid to insurance broker | USD $15,858 | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Health Insurance Welfare Benefit | No | | Welfare Benefit Premiums Paid to Carrier | USD $396,722 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Other information about contract | GROUP PLAN |
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