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PACIFIC COAST FEATHER LIFE AND MEDICAL PLAN 401k Plan overview

Plan NamePACIFIC COAST FEATHER LIFE AND MEDICAL PLAN
Plan identification number 502

PACIFIC COAST FEATHER LIFE AND MEDICAL PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

PACIFIC COAST FEATHER COMPANY has sponsored the creation of one or more 401k plans.

Company Name:PACIFIC COAST FEATHER COMPANY
Employer identification number (EIN):910891445
NAIC Classification:339900

Additional information about PACIFIC COAST FEATHER COMPANY

Jurisdiction of Incorporation: Washington Secretary of State Corporations Division
Incorporation Date: 1972-12-29
Company Identification Number: 600089445
Legal Registered Office Address: 500 UNION ST STE 847

SEATTLE
United States of America (USA)
981010000

More information about PACIFIC COAST FEATHER COMPANY

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PACIFIC COAST FEATHER LIFE AND MEDICAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022017-04-01
5022016-04-01
5022015-08-01ELANA ABERGE
5022014-08-01JOE CRAWFORD
5022013-08-01JOE CRAWFORD
5022012-08-01JOE CRAWFORD
5022011-08-01JOE CRAWFORD
5022010-08-01ERIC MOEN
5022009-08-01ERIC MOEN

Plan Statistics for PACIFIC COAST FEATHER LIFE AND MEDICAL PLAN

401k plan membership statisitcs for PACIFIC COAST FEATHER LIFE AND MEDICAL PLAN

Measure Date Value
2017: PACIFIC COAST FEATHER LIFE AND MEDICAL PLAN 2017 401k membership
Total participants, beginning-of-year2017-04-01880
Total number of active participants reported on line 7a of the Form 55002017-04-010
Number of retired or separated participants receiving benefits2017-04-010
Number of other retired or separated participants entitled to future benefits2017-04-010
Total of all active and inactive participants2017-04-010
2016: PACIFIC COAST FEATHER LIFE AND MEDICAL PLAN 2016 401k membership
Total participants, beginning-of-year2016-04-01902
Total number of active participants reported on line 7a of the Form 55002016-04-01844
Number of retired or separated participants receiving benefits2016-04-010
Number of other retired or separated participants entitled to future benefits2016-04-010
Total of all active and inactive participants2016-04-01844
2015: PACIFIC COAST FEATHER LIFE AND MEDICAL PLAN 2015 401k membership
Total participants, beginning-of-year2015-08-01982
Total number of active participants reported on line 7a of the Form 55002015-08-01902
Number of retired or separated participants receiving benefits2015-08-010
Number of other retired or separated participants entitled to future benefits2015-08-010
Total of all active and inactive participants2015-08-01902
2014: PACIFIC COAST FEATHER LIFE AND MEDICAL PLAN 2014 401k membership
Total participants, beginning-of-year2014-08-011,027
Total number of active participants reported on line 7a of the Form 55002014-08-01982
Total of all active and inactive participants2014-08-01982
Total participants2014-08-010
2013: PACIFIC COAST FEATHER LIFE AND MEDICAL PLAN 2013 401k membership
Total participants, beginning-of-year2013-08-011,076
Total number of active participants reported on line 7a of the Form 55002013-08-011,027
Total of all active and inactive participants2013-08-011,027
Total participants2013-08-010
2012: PACIFIC COAST FEATHER LIFE AND MEDICAL PLAN 2012 401k membership
Total participants, beginning-of-year2012-08-011,130
Total number of active participants reported on line 7a of the Form 55002012-08-011,076
Total of all active and inactive participants2012-08-011,076
Total participants2012-08-010
2011: PACIFIC COAST FEATHER LIFE AND MEDICAL PLAN 2011 401k membership
Total participants, beginning-of-year2011-08-011,151
Total number of active participants reported on line 7a of the Form 55002011-08-011,130
Total of all active and inactive participants2011-08-011,130
Total participants2011-08-011,130
2010: PACIFIC COAST FEATHER LIFE AND MEDICAL PLAN 2010 401k membership
Total participants, beginning-of-year2010-08-01990
Total number of active participants reported on line 7a of the Form 55002010-08-011,151
Total of all active and inactive participants2010-08-011,151
Total participants2010-08-011,151
2009: PACIFIC COAST FEATHER LIFE AND MEDICAL PLAN 2009 401k membership
Total participants, beginning-of-year2009-08-01938
Total number of active participants reported on line 7a of the Form 55002009-08-01990
Total of all active and inactive participants2009-08-01990
Total participants2009-08-01990

Form 5500 Responses for PACIFIC COAST FEATHER LIFE AND MEDICAL PLAN

2017: PACIFIC COAST FEATHER LIFE AND MEDICAL PLAN 2017 form 5500 responses
2017-04-01Type of plan entitySingle employer plan
2017-04-01Submission has been amendedNo
2017-04-01This submission is the final filingYes
2017-04-01This return/report is a short plan year return/report (less than 12 months)No
2017-04-01Plan is a collectively bargained planNo
2017-04-01Plan funding arrangement – InsuranceYes
2017-04-01Plan funding arrangement – General assets of the sponsorYes
2017-04-01Plan benefit arrangement – InsuranceYes
2017-04-01Plan benefit arrangement – General assets of the sponsorYes
2016: PACIFIC COAST FEATHER LIFE AND MEDICAL PLAN 2016 form 5500 responses
2016-04-01Type of plan entitySingle employer plan
2016-04-01Submission has been amendedNo
2016-04-01This submission is the final filingNo
2016-04-01This return/report is a short plan year return/report (less than 12 months)No
2016-04-01Plan is a collectively bargained planNo
2016-04-01Plan funding arrangement – InsuranceYes
2016-04-01Plan funding arrangement – General assets of the sponsorYes
2016-04-01Plan benefit arrangement – InsuranceYes
2016-04-01Plan benefit arrangement – General assets of the sponsorYes
2015: PACIFIC COAST FEATHER LIFE AND MEDICAL PLAN 2015 form 5500 responses
2015-08-01Type of plan entitySingle employer plan
2015-08-01Submission has been amendedNo
2015-08-01This submission is the final filingNo
2015-08-01This return/report is a short plan year return/report (less than 12 months)Yes
2015-08-01Plan is a collectively bargained planNo
2015-08-01Plan funding arrangement – InsuranceYes
2015-08-01Plan funding arrangement – General assets of the sponsorYes
2015-08-01Plan benefit arrangement – InsuranceYes
2015-08-01Plan benefit arrangement – General assets of the sponsorYes
2014: PACIFIC COAST FEATHER LIFE AND MEDICAL PLAN 2014 form 5500 responses
2014-08-01Type of plan entitySingle employer plan
2014-08-01Plan funding arrangement – InsuranceYes
2014-08-01Plan funding arrangement – General assets of the sponsorYes
2014-08-01Plan benefit arrangement – InsuranceYes
2014-08-01Plan benefit arrangement – General assets of the sponsorYes
2013: PACIFIC COAST FEATHER LIFE AND MEDICAL PLAN 2013 form 5500 responses
2013-08-01Type of plan entitySingle employer plan
2013-08-01Plan funding arrangement – InsuranceYes
2013-08-01Plan funding arrangement – General assets of the sponsorYes
2013-08-01Plan benefit arrangement – InsuranceYes
2013-08-01Plan benefit arrangement – General assets of the sponsorYes
2012: PACIFIC COAST FEATHER LIFE AND MEDICAL PLAN 2012 form 5500 responses
2012-08-01Type of plan entitySingle employer plan
2012-08-01Plan funding arrangement – InsuranceYes
2012-08-01Plan funding arrangement – General assets of the sponsorYes
2012-08-01Plan benefit arrangement – InsuranceYes
2012-08-01Plan benefit arrangement – General assets of the sponsorYes
2011: PACIFIC COAST FEATHER LIFE AND MEDICAL PLAN 2011 form 5500 responses
2011-08-01Type of plan entitySingle employer plan
2011-08-01Plan funding arrangement – InsuranceYes
2011-08-01Plan funding arrangement – General assets of the sponsorYes
2011-08-01Plan benefit arrangement – InsuranceYes
2011-08-01Plan benefit arrangement – General assets of the sponsorYes
2010: PACIFIC COAST FEATHER LIFE AND MEDICAL PLAN 2010 form 5500 responses
2010-08-01Type of plan entitySingle employer plan
2010-08-01Plan funding arrangement – InsuranceYes
2010-08-01Plan funding arrangement – General assets of the sponsorYes
2010-08-01Plan benefit arrangement – InsuranceYes
2010-08-01Plan benefit arrangement – General assets of the sponsorYes
2009: PACIFIC COAST FEATHER LIFE AND MEDICAL PLAN 2009 form 5500 responses
2009-08-01Type of plan entitySingle employer plan
2009-08-01Plan funding arrangement – InsuranceYes
2009-08-01Plan funding arrangement – General assets of the sponsorYes
2009-08-01Plan benefit arrangement – InsuranceYes
2009-08-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number01-016844-00
Policy instance 2
Insurance contract or identification number01-016844-00
Number of Individuals Covered629
Insurance policy start date2017-04-01
Insurance policy end date2018-03-31
Total amount of commissions paid to insurance brokerUSD $18,732
Total amount of fees paid to insurance companyUSD $4,092
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL 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 CarrierUSD $131,929
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,828
Amount paid for insurance broker fees4092
Additional information about fees paid to insurance brokerGROUP VOLUME BONUS
Insurance broker organization code?3
Insurance broker nameMERCER HEALTH AND BENEFITS, LLC
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract numberETB-144062
Policy instance 1
Insurance contract or identification numberETB-144062
Number of Individuals Covered736
Insurance policy start date2017-04-01
Insurance policy end date2018-03-31
Total amount of commissions paid to insurance brokerUSD $626
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 $4,170
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $626
Insurance broker organization code?3
Insurance broker nameSERVCO PACIFIC INSURANCE
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number01-016844-00
Policy instance 2
Insurance contract or identification number01-016844-00
Number of Individuals Covered902
Insurance policy start date2015-08-01
Insurance policy end date2016-03-31
Total amount of commissions paid to insurance brokerUSD $21,671
Total amount of fees paid to insurance companyUSD $2,102
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 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 CarrierUSD $144,472
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,452
Amount paid for insurance broker fees2102
Additional information about fees paid to insurance brokerGROUP VOLUME BONUS
Insurance broker organization code?3
Insurance broker nameSERVCO INSURANCE SERVICES OF WA
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract numberETB144062
Policy instance 1
Insurance contract or identification numberETB144062
Number of Individuals Covered902
Insurance policy start date2015-08-01
Insurance policy end date2016-03-31
Total amount of commissions paid to insurance brokerUSD $791
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 $5,274
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $791
Insurance broker organization code?3
Insurance broker nameLIFE AND HEALTH UNDERWRITERS
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL 147473
Policy instance 2
Insurance contract or identification numberGL 147473
Number of Individuals Covered982
Insurance policy start date2014-08-01
Insurance policy end date2015-07-31
Total amount of commissions paid to insurance brokerUSD $12,809
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $79,131
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,809
Insurance broker organization code?3
Insurance broker nameLIFE AND HEALTH UNDERWRITERS INC
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberLTD 121107
Policy instance 3
Insurance contract or identification numberLTD 121107
Number of Individuals Covered250
Insurance policy start date2014-08-01
Insurance policy end date2015-07-31
Total amount of commissions paid to insurance brokerUSD $10,231
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $55,695
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,231
Insurance broker organization code?3
Insurance broker nameLIFE AND HEALTH UNDERWRITERS INC
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberG 161231
Policy instance 4
Insurance contract or identification numberG 161231
Number of Individuals Covered793
Insurance policy start date2014-08-01
Insurance policy end date2015-07-31
Total amount of commissions paid to insurance brokerUSD $19,737
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $122,445
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,737
Insurance broker organization code?3
Insurance broker nameLIFE AND HEALTH UNDERWRITERS INC
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number404770 0010
Policy instance 5
Insurance contract or identification number404770 0010
Number of Individuals Covered852
Insurance policy start date2014-08-01
Insurance policy end date2015-07-31
Total amount of commissions paid to insurance brokerUSD $70,716
Welfare Benefit Premiums Paid to CarrierUSD $471,443
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $70,716
Insurance broker organization code?3
Insurance broker nameLIFE AND HEALTH UNDERWRITERS INC
DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 74341 )
Policy contract number09407
Policy instance 6
Insurance contract or identification number09407
Number of Individuals Covered614
Insurance policy start date2014-08-01
Insurance policy end date2015-07-31
Total amount of commissions paid to insurance brokerUSD $6,546
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $50,701
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,546
Insurance broker nameLIFE AND HEALTH UNDERWRITERS INC
GROUP HEALTH COOPERATIVE (National Association of Insurance Commissioners NAIC id number: 95672 )
Policy contract number0039300
Policy instance 1
Insurance contract or identification number0039300
Number of Individuals Covered7
Insurance policy start date2014-08-01
Insurance policy end date2015-07-31
Total amount of commissions paid to insurance brokerUSD $1,954
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $113,767
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,954
Insurance broker organization code?3
Insurance broker nameLIFE AND HEALTH UNDERWRITERS INC
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number404770
Policy instance 5
Insurance contract or identification number404770
Number of Individuals Covered738
Insurance policy start date2013-08-01
Insurance policy end date2014-07-31
Total amount of commissions paid to insurance brokerUSD $57,556
Welfare Benefit Premiums Paid to CarrierUSD $426,340
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $57,556
Insurance broker organization code?3
Insurance broker nameLIFE AND HEALTH UNDERWRITERS INC
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number536326
Policy instance 6
Insurance contract or identification number536326
Number of Individuals Covered15
Insurance policy start date2013-08-01
Insurance policy end date2014-07-31
Total amount of commissions paid to insurance brokerUSD $448
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $4,481
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $448
Insurance broker organization code?3
Insurance broker nameTRAMMELL-MCKINLEY & ASSOCIATES INC
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberG 161231
Policy instance 4
Insurance contract or identification numberG 161231
Number of Individuals Covered870
Insurance policy start date2013-08-01
Insurance policy end date2014-07-31
Total amount of commissions paid to insurance brokerUSD $17,797
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $118,646
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,797
Insurance broker organization code?3
Insurance broker nameLIFE AND HEALTH UNDERWRITERS INC
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberLTD 121107
Policy instance 3
Insurance contract or identification numberLTD 121107
Number of Individuals Covered242
Insurance policy start date2013-08-01
Insurance policy end date2014-07-31
Total amount of commissions paid to insurance brokerUSD $9,849
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $57,936
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,849
Insurance broker organization code?3
Insurance broker nameLIFE AND HEALTH UNDERWRITERS INC
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL 147473
Policy instance 2
Insurance contract or identification numberGL 147473
Number of Individuals Covered1027
Insurance policy start date2013-08-01
Insurance policy end date2014-07-31
Total amount of commissions paid to insurance brokerUSD $11,661
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $77,739
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,661
Insurance broker organization code?3
Insurance broker nameLIFE AND HEALTH UNDERWRITERS INC
GROUP HEALTH COOPERATIVE (National Association of Insurance Commissioners NAIC id number: 95672 )
Policy contract number0039300
Policy instance 1
Insurance contract or identification number0039300
Number of Individuals Covered11
Insurance policy start date2013-08-01
Insurance policy end date2014-07-31
Total amount of commissions paid to insurance brokerUSD $2,626
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $140,169
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,626
Insurance broker organization code?3
Insurance broker nameLIFE AND HEALTH UNDERWRITERS INC
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberG 161231
Policy instance 2
Insurance contract or identification numberG 161231
Number of Individuals Covered925
Insurance policy start date2012-08-01
Insurance policy end date2013-07-31
Total amount of commissions paid to insurance brokerUSD $21,401
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $142,672
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $21,401
Additional information about fees paid to insurance brokerADMINISTRATIVE
Insurance broker organization code?3
Insurance broker nameLIFE AND HEALTH UNDERWRITERS INC
ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )
Policy contract numberMSL 3702752
Policy instance 1
Insurance contract or identification numberMSL 3702752
Number of Individuals Covered894
Insurance policy start date2012-08-01
Insurance policy end date2013-07-31
Total amount of commissions paid to insurance brokerUSD $58,785
Welfare Benefit Premiums Paid to CarrierUSD $391,897
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $58,785
Insurance broker organization code?3
Insurance broker nameLIFE AND HEALTH UNDERWRITERS INC
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL 147473
Policy instance 4
Insurance contract or identification numberGL 147473
Number of Individuals Covered1076
Insurance policy start date2012-08-01
Insurance policy end date2013-07-31
Total amount of commissions paid to insurance brokerUSD $11,583
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $77,223
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,583
Insurance broker organization code?3
Insurance broker nameLIFE AND HEALTH UNDERWRITERS INC
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberLTD 121107
Policy instance 3
Insurance contract or identification numberLTD 121107
Number of Individuals Covered248
Insurance policy start date2012-08-01
Insurance policy end date2013-07-31
Total amount of commissions paid to insurance brokerUSD $11,915
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $70,086
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,915
Additional information about fees paid to insurance brokerADMINISTRATIVE
Insurance broker organization code?3
Insurance broker nameLIFE AND HEALTH UNDERWRITERS INC
GROUP HEALTH COOPERATIVE (National Association of Insurance Commissioners NAIC id number: 95672 )
Policy contract number0039300
Policy instance 6
Insurance contract or identification number0039300
Number of Individuals Covered10
Insurance policy start date2012-08-01
Insurance policy end date2013-07-31
Total amount of commissions paid to insurance brokerUSD $2,926
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $174,784
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,926
Insurance broker organization code?3
Insurance broker nameLIFE AND HEALTH UNDERWRITERS INC
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number235328/7455
Policy instance 5
Insurance contract or identification number235328/7455
Number of Individuals Covered25
Insurance policy start date2012-08-01
Insurance policy end date2013-07-31
Total amount of commissions paid to insurance brokerUSD $103
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,065
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $103
Insurance broker organization code?3
Insurance broker nameLIFE AND HEALTH UNDERWRITERS INC
GROUP HEALTH COOPERATIVE (National Association of Insurance Commissioners NAIC id number: 95672 )
Policy contract number0039300
Policy instance 6
Insurance contract or identification number0039300
Number of Individuals Covered14
Insurance policy start date2011-08-01
Insurance policy end date2012-07-31
Total amount of commissions paid to insurance brokerUSD $2,630
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $139,033
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number235328/7455
Policy instance 5
Insurance contract or identification number235328/7455
Number of Individuals Covered14
Insurance policy start date2011-08-01
Insurance policy end date2012-07-31
Total amount of commissions paid to insurance brokerUSD $70
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,408
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number4030680 0010
Policy instance 4
Insurance contract or identification number4030680 0010
Number of Individuals Covered906
Insurance policy start date2011-08-01
Insurance policy end date2012-07-31
Total amount of commissions paid to insurance brokerUSD $50,891
Welfare Benefit Premiums Paid to CarrierUSD $339,275
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL 147473
Policy instance 3
Insurance contract or identification numberGL 147473
Number of Individuals Covered1130
Insurance policy start date2011-08-01
Insurance policy end date2012-07-31
Total amount of commissions paid to insurance brokerUSD $12,953
Total amount of fees paid to insurance companyUSD $1,854
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $86,354
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberLTD 121107
Policy instance 2
Insurance contract or identification numberLTD 121107
Number of Individuals Covered287
Insurance policy start date2011-08-01
Insurance policy end date2012-07-31
Total amount of commissions paid to insurance brokerUSD $10,556
Total amount of fees paid to insurance companyUSD $1,323
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $62,096
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberG 161231
Policy instance 1
Insurance contract or identification numberG 161231
Number of Individuals Covered977
Insurance policy start date2011-08-01
Insurance policy end date2012-07-31
Total amount of commissions paid to insurance brokerUSD $16,815
Total amount of fees paid to insurance companyUSD $2,563
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $112,098
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
GROUP HEALTH COOPERATIVE (National Association of Insurance Commissioners NAIC id number: 95672 )
Policy contract number0039300
Policy instance 6
Insurance contract or identification number0039300
Number of Individuals Covered17
Insurance policy start date2010-08-01
Insurance policy end date2011-07-31
Total amount of commissions paid to insurance brokerUSD $3,197
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $163,548
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number235328
Policy instance 5
Insurance contract or identification number235328
Number of Individuals Covered11
Insurance policy start date2010-08-01
Insurance policy end date2011-07-31
Total amount of commissions paid to insurance brokerUSD $74
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,479
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number4030680 0010
Policy instance 4
Insurance contract or identification number4030680 0010
Number of Individuals Covered930
Insurance policy start date2010-08-01
Insurance policy end date2011-07-31
Total amount of commissions paid to insurance brokerUSD $51,767
Welfare Benefit Premiums Paid to CarrierUSD $345,111
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberLTD 121107
Policy instance 2
Insurance contract or identification numberLTD 121107
Number of Individuals Covered293
Insurance policy start date2010-08-01
Insurance policy end date2011-07-31
Total amount of commissions paid to insurance brokerUSD $10,834
Total amount of fees paid to insurance companyUSD $908
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $63,731
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberG 161231
Policy instance 1
Insurance contract or identification numberG 161231
Number of Individuals Covered1151
Insurance policy start date2010-08-01
Insurance policy end date2011-07-31
Total amount of commissions paid to insurance brokerUSD $24,420
Total amount of fees paid to insurance companyUSD $2,375
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $162,797
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL 147473
Policy instance 3
Insurance contract or identification numberGL 147473
Number of Individuals Covered1148
Insurance policy start date2010-08-01
Insurance policy end date2011-07-31
Total amount of commissions paid to insurance brokerUSD $13,592
Total amount of fees paid to insurance companyUSD $1,318
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $90,614
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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