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THE UNIVERSITY OF VERMONT MEDICAL CENTER EMPLOYEE WELFARE BENEFITS PLAN DCRA 401k Plan overview

Plan NameTHE UNIVERSITY OF VERMONT MEDICAL CENTER EMPLOYEE WELFARE BENEFITS PLAN DCRA
Plan identification number 501

THE UNIVERSITY OF VERMONT MEDICAL CENTER EMPLOYEE WELFARE BENEFITS PLAN DCRA 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
  • Other welfare benefit cover

401k Sponsoring company profile

THE UNIVERSITY OF VERMONT MEDICAL CENTER has sponsored the creation of one or more 401k plans.

Company Name:THE UNIVERSITY OF VERMONT MEDICAL CENTER
Employer identification number (EIN):030219309
NAIC Classification:622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan THE UNIVERSITY OF VERMONT MEDICAL CENTER EMPLOYEE WELFARE BENEFITS PLAN DCRA

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012021-01-01SARA PRYCE2022-10-17
5012021-01-01SARA PRYCE2023-07-06
5012020-01-01KRISTEN CARRIS2021-09-16
5012019-01-01KRISTEN CARRIS2020-08-07
5012018-01-01KRISTEN CARRIS2019-07-30
5012017-01-01
5012017-01-01
5012016-01-01
5012015-01-01
5012014-01-01
5012013-01-01JOHN M HERKO JOHN M HERKO2014-07-22
5012012-01-01JOHN M HERKO JOHN M HERKO2013-10-14
5012011-01-01JOHN M HERKO JOHN M HERKO2012-07-24
5012010-01-01JOHN M HERKO JOHN M HERKO2011-08-17
5012009-01-01JOHN M HERKO JOHN M HERKO2010-07-29

Plan Statistics for THE UNIVERSITY OF VERMONT MEDICAL CENTER EMPLOYEE WELFARE BENEFITS PLAN DCRA

401k plan membership statisitcs for THE UNIVERSITY OF VERMONT MEDICAL CENTER EMPLOYEE WELFARE BENEFITS PLAN DCRA

Measure Date Value
2021: THE UNIVERSITY OF VERMONT MEDICAL CENTER EMPLOYEE WELFARE BENEFITS PLAN DCRA 2021 401k membership
Total participants, beginning-of-year2021-01-018,436
Total number of active participants reported on line 7a of the Form 55002021-01-017,789
Number of retired or separated participants receiving benefits2021-01-01600
Number of other retired or separated participants entitled to future benefits2021-01-0183
Total of all active and inactive participants2021-01-018,472
2020: THE UNIVERSITY OF VERMONT MEDICAL CENTER EMPLOYEE WELFARE BENEFITS PLAN DCRA 2020 401k membership
Total participants, beginning-of-year2020-01-018,436
Total number of active participants reported on line 7a of the Form 55002020-01-017,792
Number of retired or separated participants receiving benefits2020-01-01577
Number of other retired or separated participants entitled to future benefits2020-01-0167
Total of all active and inactive participants2020-01-018,436
2019: THE UNIVERSITY OF VERMONT MEDICAL CENTER EMPLOYEE WELFARE BENEFITS PLAN DCRA 2019 401k membership
Total participants, beginning-of-year2019-01-017,885
Total number of active participants reported on line 7a of the Form 55002019-01-017,695
Number of retired or separated participants receiving benefits2019-01-01574
Number of other retired or separated participants entitled to future benefits2019-01-0165
Total of all active and inactive participants2019-01-018,334
2018: THE UNIVERSITY OF VERMONT MEDICAL CENTER EMPLOYEE WELFARE BENEFITS PLAN DCRA 2018 401k membership
Total participants, beginning-of-year2018-01-017,739
Total number of active participants reported on line 7a of the Form 55002018-01-017,306
Number of retired or separated participants receiving benefits2018-01-01519
Number of other retired or separated participants entitled to future benefits2018-01-0160
Total of all active and inactive participants2018-01-017,885
2017: THE UNIVERSITY OF VERMONT MEDICAL CENTER EMPLOYEE WELFARE BENEFITS PLAN DCRA 2017 401k membership
Total participants, beginning-of-year2017-01-017,743
Total number of active participants reported on line 7a of the Form 55002017-01-016,999
Number of retired or separated participants receiving benefits2017-01-01553
Number of other retired or separated participants entitled to future benefits2017-01-01187
Total of all active and inactive participants2017-01-017,739
2016: THE UNIVERSITY OF VERMONT MEDICAL CENTER EMPLOYEE WELFARE BENEFITS PLAN DCRA 2016 401k membership
Total participants, beginning-of-year2016-01-017,403
Total number of active participants reported on line 7a of the Form 55002016-01-017,017
Number of retired or separated participants receiving benefits2016-01-01505
Number of other retired or separated participants entitled to future benefits2016-01-01221
Total of all active and inactive participants2016-01-017,743
2015: THE UNIVERSITY OF VERMONT MEDICAL CENTER EMPLOYEE WELFARE BENEFITS PLAN DCRA 2015 401k membership
Total participants, beginning-of-year2015-01-017,122
Total number of active participants reported on line 7a of the Form 55002015-01-016,863
Number of retired or separated participants receiving benefits2015-01-01484
Number of other retired or separated participants entitled to future benefits2015-01-0156
Total of all active and inactive participants2015-01-017,403
2014: THE UNIVERSITY OF VERMONT MEDICAL CENTER EMPLOYEE WELFARE BENEFITS PLAN DCRA 2014 401k membership
Total participants, beginning-of-year2014-01-016,887
Total number of active participants reported on line 7a of the Form 55002014-01-016,598
Number of retired or separated participants receiving benefits2014-01-01477
Number of other retired or separated participants entitled to future benefits2014-01-0147
Total of all active and inactive participants2014-01-017,122
2013: THE UNIVERSITY OF VERMONT MEDICAL CENTER EMPLOYEE WELFARE BENEFITS PLAN DCRA 2013 401k membership
Total participants, beginning-of-year2013-01-016,786
Total number of active participants reported on line 7a of the Form 55002013-01-016,436
Number of retired or separated participants receiving benefits2013-01-01416
Number of other retired or separated participants entitled to future benefits2013-01-0135
Total of all active and inactive participants2013-01-016,887
2012: THE UNIVERSITY OF VERMONT MEDICAL CENTER EMPLOYEE WELFARE BENEFITS PLAN DCRA 2012 401k membership
Total participants, beginning-of-year2012-01-016,527
Total number of active participants reported on line 7a of the Form 55002012-01-016,340
Number of retired or separated participants receiving benefits2012-01-01411
Number of other retired or separated participants entitled to future benefits2012-01-0135
Total of all active and inactive participants2012-01-016,786
2011: THE UNIVERSITY OF VERMONT MEDICAL CENTER EMPLOYEE WELFARE BENEFITS PLAN DCRA 2011 401k membership
Total participants, beginning-of-year2011-01-016,203
Total number of active participants reported on line 7a of the Form 55002011-01-016,096
Number of retired or separated participants receiving benefits2011-01-01398
Number of other retired or separated participants entitled to future benefits2011-01-0133
Total of all active and inactive participants2011-01-016,527
2010: THE UNIVERSITY OF VERMONT MEDICAL CENTER EMPLOYEE WELFARE BENEFITS PLAN DCRA 2010 401k membership
Total participants, beginning-of-year2010-01-016,169
Total number of active participants reported on line 7a of the Form 55002010-01-015,791
Number of retired or separated participants receiving benefits2010-01-01383
Number of other retired or separated participants entitled to future benefits2010-01-0129
Total of all active and inactive participants2010-01-016,203
2009: THE UNIVERSITY OF VERMONT MEDICAL CENTER EMPLOYEE WELFARE BENEFITS PLAN DCRA 2009 401k membership
Total participants, beginning-of-year2009-01-015,009
Total number of active participants reported on line 7a of the Form 55002009-01-015,805
Number of retired or separated participants receiving benefits2009-01-01364
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-016,169

Form 5500 Responses for THE UNIVERSITY OF VERMONT MEDICAL CENTER EMPLOYEE WELFARE BENEFITS PLAN DCRA

2021: THE UNIVERSITY OF VERMONT MEDICAL CENTER EMPLOYEE WELFARE BENEFITS PLAN DCRA 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedYes
2021-01-01This submission is the final filingYes
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: THE UNIVERSITY OF VERMONT MEDICAL CENTER EMPLOYEE WELFARE BENEFITS PLAN DCRA 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: THE UNIVERSITY OF VERMONT MEDICAL CENTER EMPLOYEE WELFARE BENEFITS PLAN DCRA 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – General assets of the sponsorYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – General assets of the sponsorYes
2018: THE UNIVERSITY OF VERMONT MEDICAL CENTER EMPLOYEE WELFARE BENEFITS PLAN DCRA 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: THE UNIVERSITY OF VERMONT MEDICAL CENTER EMPLOYEE WELFARE BENEFITS PLAN DCRA 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedYes
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: THE UNIVERSITY OF VERMONT MEDICAL CENTER EMPLOYEE WELFARE BENEFITS PLAN DCRA 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – General assets of the sponsorYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – General assets of the sponsorYes
2015: THE UNIVERSITY OF VERMONT MEDICAL CENTER EMPLOYEE WELFARE BENEFITS PLAN DCRA 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – General assets of the sponsorYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – General assets of the sponsorYes
2014: THE UNIVERSITY OF VERMONT MEDICAL CENTER EMPLOYEE WELFARE BENEFITS PLAN DCRA 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – General assets of the sponsorYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – General assets of the sponsorYes
2013: THE UNIVERSITY OF VERMONT MEDICAL CENTER EMPLOYEE WELFARE BENEFITS PLAN DCRA 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – General assets of the sponsorYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – General assets of the sponsorYes
2012: THE UNIVERSITY OF VERMONT MEDICAL CENTER EMPLOYEE WELFARE BENEFITS PLAN DCRA 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – General assets of the sponsorYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – General assets of the sponsorYes
2011: THE UNIVERSITY OF VERMONT MEDICAL CENTER EMPLOYEE WELFARE BENEFITS PLAN DCRA 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – General assets of the sponsorYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – General assets of the sponsorYes
2010: THE UNIVERSITY OF VERMONT MEDICAL CENTER EMPLOYEE WELFARE BENEFITS PLAN DCRA 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan funding arrangement – General assets of the sponsorYes
2010-01-01Plan benefit arrangement – InsuranceYes
2010-01-01Plan benefit arrangement – General assets of the sponsorYes
2009: THE UNIVERSITY OF VERMONT MEDICAL CENTER EMPLOYEE WELFARE BENEFITS PLAN DCRA 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – General assets of the sponsorYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract numberADDS08828
Policy instance 8
Insurance contract or identification numberADDS08828
Number of Individuals Covered1429
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $3,563
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $118,763
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,563
Insurance broker organization code?3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number12157661
Policy instance 1
Insurance contract or identification number12157661
Number of Individuals Covered6708
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number681038G
Policy instance 2
Insurance contract or identification number681038G
Number of Individuals Covered7538
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedLIFE-BTRM
Welfare Benefit Premiums Paid to CarrierUSD $1,062,441
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number681038G
Policy instance 3
Insurance contract or identification number681038G
Number of Individuals Covered2856
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedLIFE-SDEP
Welfare Benefit Premiums Paid to CarrierUSD $404,331
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number681038G
Policy instance 4
Insurance contract or identification number681038G
Number of Individuals Covered3454
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedLIFE-VOL
Welfare Benefit Premiums Paid to CarrierUSD $766,582
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number681038G
Policy instance 5
Insurance contract or identification number681038G
Number of Individuals Covered6330
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $150,562
Total amount of fees paid to insurance companyUSD $71,167
Other welfare benefits providedLTD-ABIL
Welfare Benefit Premiums Paid to CarrierUSD $2,390,719
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $150,562
Amount paid for insurance broker fees71167
Additional information about fees paid to insurance brokerBONUS PAID
Insurance broker organization code?3
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number0008528507
Policy instance 6
Insurance contract or identification number0008528507
Number of Individuals Covered1073
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $10,060
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedACCIDENT, CRITILLNES, ISWL STND
Welfare Benefit Premiums Paid to CarrierUSD $233,589
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,288
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number676472G
Policy instance 7
Insurance contract or identification number676472G
Number of Individuals Covered1336
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $86,581
Total amount of fees paid to insurance companyUSD $52,540
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,633,843
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $86,581
Amount paid for insurance broker fees52540
Additional information about fees paid to insurance brokerBONUS PAID
Insurance broker organization code?3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number12157661
Policy instance 1
Insurance contract or identification number12157661
Number of Individuals Covered5427
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number681038G
Policy instance 2
Insurance contract or identification number681038G
Number of Individuals Covered6767
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedLIFE-BTRM
Welfare Benefit Premiums Paid to CarrierUSD $1,109,181
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number681038G
Policy instance 3
Insurance contract or identification number681038G
Number of Individuals Covered2870
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedLIFE-SDEP
Welfare Benefit Premiums Paid to CarrierUSD $413,790
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number681038G
Policy instance 4
Insurance contract or identification number681038G
Number of Individuals Covered1945
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedLIFE-VOL
Welfare Benefit Premiums Paid to CarrierUSD $922,085
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number681038G
Policy instance 5
Insurance contract or identification number681038G
Number of Individuals Covered6369
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $153,220
Total amount of fees paid to insurance companyUSD $51,014
Other welfare benefits providedLTD-ABIL
Welfare Benefit Premiums Paid to CarrierUSD $2,662,292
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $153,220
Amount paid for insurance broker fees51014
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number0008528507
Policy instance 6
Insurance contract or identification number0008528507
Number of Individuals Covered1216
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $12,737
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedACCIDENT, CRITILLNES, ISWL STND
Welfare Benefit Premiums Paid to CarrierUSD $231,280
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,963
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number676472G
Policy instance 7
Insurance contract or identification number676472G
Number of Individuals Covered1332
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $87,227
Total amount of fees paid to insurance companyUSD $28,695
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,907,569
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $85,112
Amount paid for insurance broker fees28695
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract numberADDS08828
Policy instance 8
Insurance contract or identification numberADDS08828
Number of Individuals Covered2850
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $2,787
Total amount of fees paid to insurance companyUSD $325
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $92,900
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,787
Amount paid for insurance broker fees325
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number12157661
Policy instance 1
Insurance contract or identification number12157661
Number of Individuals Covered5370
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number681038G
Policy instance 2
Insurance contract or identification number681038G
Number of Individuals Covered7576
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedLIFE-BTRM
Welfare Benefit Premiums Paid to CarrierUSD $1,066,746
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number681038G
Policy instance 3
Insurance contract or identification number681038G
Number of Individuals Covered2807
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedLIFE-SDEP
Welfare Benefit Premiums Paid to CarrierUSD $391,531
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number681038G
Policy instance 4
Insurance contract or identification number681038G
Number of Individuals Covered2007
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedLIFE-VOL
Welfare Benefit Premiums Paid to CarrierUSD $891,268
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number681038G
Policy instance 5
Insurance contract or identification number681038G
Number of Individuals Covered6268
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $145,553
Total amount of fees paid to insurance companyUSD $75,596
Other welfare benefits providedLTD-ABIL
Welfare Benefit Premiums Paid to CarrierUSD $2,502,224
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $145,553
Amount paid for insurance broker fees73380
Additional information about fees paid to insurance brokerBONUS PAID
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number0008528507
Policy instance 6
Insurance contract or identification number0008528507
Number of Individuals Covered1339
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $11,682
Total amount of fees paid to insurance companyUSD $4,388
Other welfare benefits providedACCIDENT, CRITILLNES, ISWL STND
Welfare Benefit Premiums Paid to CarrierUSD $271,836
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,589
Amount paid for insurance broker fees4388
Additional information about fees paid to insurance brokerADDITIONAL COMP.
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number676472G
Policy instance 7
Insurance contract or identification number676472G
Number of Individuals Covered1301
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $77,043
Total amount of fees paid to insurance companyUSD $38,749
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,568,112
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $77,043
Amount paid for insurance broker fees37732
Additional information about fees paid to insurance brokerBONUS PAID
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract numberADDS08828
Policy instance 8
Insurance contract or identification numberADDS08828
Number of Individuals Covered2670
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $2,992
Total amount of fees paid to insurance companyUSD $1,277
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $99,728
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,992
Amount paid for insurance broker fees1277
Additional information about fees paid to insurance brokerBONUS PAID
CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )
Policy contract number3336647
Policy instance 1
Insurance contract or identification number3336647
Number of Individuals Covered4
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
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 number12157661
Policy instance 2
Insurance contract or identification number12157661
Number of Individuals Covered4714
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number681038G
Policy instance 3
Insurance contract or identification number681038G
Number of Individuals Covered7144
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $330,883
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedLIFE-BTRM
Welfare Benefit Premiums Paid to CarrierUSD $976,406
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $296,548
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number681038G
Policy instance 5
Insurance contract or identification number681038G
Number of Individuals Covered1964
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedLIFE-VOL
Welfare Benefit Premiums Paid to CarrierUSD $1,067,048
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number681038G
Policy instance 4
Insurance contract or identification number681038G
Number of Individuals Covered2729
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedLIFE-SDEP
Welfare Benefit Premiums Paid to CarrierUSD $433,932
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number681038G
Policy instance 6
Insurance contract or identification number681038G
Number of Individuals Covered6052
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedLTD-ABIL
Welfare Benefit Premiums Paid to CarrierUSD $3,063,451
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number0008528507
Policy instance 7
Insurance contract or identification number0008528507
Number of Individuals Covered1456
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $17,113
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedACCIDENT, CRITILLNES, ISWL STND
Welfare Benefit Premiums Paid to CarrierUSD $301,220
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,733
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number676472G
Policy instance 8
Insurance contract or identification number676472G
Number of Individuals Covered1144
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $147,079
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,524,330
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $130,874
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number676472G
Policy instance 12
Insurance contract or identification number676472G
Number of Individuals Covered1004
Insurance policy start date2017-08-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $2,838
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $94,595
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,838
Insurance broker nameHICKOK & BOARDMAN
FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )
Policy contract number120993
Policy instance 11
Insurance contract or identification number120993
Number of Individuals Covered13
Insurance policy start date2017-01-01
Insurance policy end date2017-08-01
Total amount of commissions paid to insurance brokerUSD $93
Total amount of fees paid to insurance companyUSD $11
Welfare Benefit Premiums Paid to CarrierUSD $553
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $93
Amount paid for insurance broker fees10
Insurance broker organization code?3
Insurance broker namePROSENTIAL GROUP LLC
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number0008528507
Policy instance 10
Insurance contract or identification number0008528507
Number of Individuals Covered1522
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $15,078
Total amount of fees paid to insurance companyUSD $5,708
Other welfare benefits providedACCIDENT, CRITILLNES, ISWL STND
Welfare Benefit Premiums Paid to CarrierUSD $343,970
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,357
Amount paid for insurance broker fees5708
Insurance broker organization code?3
Insurance broker namePANTALONE, JO, ANN
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number681038G
Policy instance 9
Insurance contract or identification number681038G
Number of Individuals Covered7551
Insurance policy start date2017-08-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedLTD-ABIL
Welfare Benefit Premiums Paid to CarrierUSD $115,430
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number681038G
Policy instance 8
Insurance contract or identification number681038G
Number of Individuals Covered218
Insurance policy start date2017-08-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedLIFE-VOL
Welfare Benefit Premiums Paid to CarrierUSD $71,397
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number681038G
Policy instance 7
Insurance contract or identification number681038G
Number of Individuals Covered2209
Insurance policy start date2017-08-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedLIFE-SDEP
Welfare Benefit Premiums Paid to CarrierUSD $35,703
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )
Policy contract number3336647
Policy instance 1
Insurance contract or identification number3336647
Number of Individuals Covered4
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
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 number579370
Policy instance 2
Insurance contract or identification number579370
Number of Individuals Covered993
Insurance policy start date2017-01-01
Insurance policy end date2017-08-01
Total amount of commissions paid to insurance brokerUSD $69,827
Total amount of fees paid to insurance companyUSD $30,612
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $1,557,818
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $69,827
Amount paid for insurance broker fees27262
Insurance broker organization code?3
Insurance broker namePROSENTIAL GROUP LLC
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number558975
Policy instance 3
Insurance contract or identification number558975
Number of Individuals Covered5662
Insurance policy start date2017-01-01
Insurance policy end date2017-08-01
Total amount of commissions paid to insurance brokerUSD $52,245
Total amount of fees paid to insurance companyUSD $45,714
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,344,491
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $52,245
Amount paid for insurance broker fees41029
Insurance broker organization code?3
Insurance broker namePROSENTIAL GROUP LLC
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number586641
Policy instance 4
Insurance contract or identification number586641
Number of Individuals Covered5991
Insurance policy start date2017-01-01
Insurance policy end date2017-08-01
Total amount of commissions paid to insurance brokerUSD $36,493
Total amount of fees paid to insurance companyUSD $21,287
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $1,092,233
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $36,493
Amount paid for insurance broker fees21287
Insurance broker organization code?3
Insurance broker namePROSENTIAL GROUP LLC
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number12157661
Policy instance 5
Insurance contract or identification number12157661
Number of Individuals Covered4738
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number681038G
Policy instance 6
Insurance contract or identification number681038G
Number of Individuals Covered6830
Insurance policy start date2017-08-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $7,679
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedLIFE-BTRM
Welfare Benefit Premiums Paid to CarrierUSD $33,441
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,679
Insurance broker nameHICKOK & BOARDMAN FINANCIAL PLANNIN
CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )
Policy contract number3336647
Policy instance 1
Insurance contract or identification number3336647
Number of Individuals Covered4
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
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 number579370
Policy instance 2
Insurance contract or identification number579370
Number of Individuals Covered944
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $118,377
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $2,061,735
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $82,297
Insurance broker organization code?3
Additional information about fees paid to insurance brokerADDITIONAL PRODUCER COMPENSATION
Insurance broker nameHICKOK BOARDMAN FINANCIAL PLANNING&
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number558975
Policy instance 3
Insurance contract or identification number558975
Number of Individuals Covered7363
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $124,022
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,307,242
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $66,145
Insurance broker organization code?3
Additional information about fees paid to insurance brokerADDITIONAL PRODUCER COMPENSATION
Insurance broker nameHICKOK BOARDMAN FINANCIAL PLANNING
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number586641
Policy instance 4
Insurance contract or identification number586641
Number of Individuals Covered5936
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $71,596
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $1,507,287
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $45,219
Insurance broker organization code?3
Additional information about fees paid to insurance brokerADDITIONAL PRODUCER COMPENSATION
Insurance broker nameHICKOK & BOARDMAN FINANCIAL PLANNIN
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number12157661
Policy instance 5
Insurance contract or identification number12157661
Number of Individuals Covered4263
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
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 number558975
Policy instance 3
Insurance contract or identification number558975
Number of Individuals Covered7266
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $120,166
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,204,425
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $64,089
Insurance broker organization code?3
Additional information about fees paid to insurance brokerADDITIONAL PRODUCER COMPENSATION
Insurance broker nameHICKOK BOARDMAN FINANCIAL PLANNING
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number579370
Policy instance 2
Insurance contract or identification number579370
Number of Individuals Covered907
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $90,523
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $1,577,251
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $62,921
Insurance broker organization code?3
Additional information about fees paid to insurance brokerADDITIONAL PRODUCER COMPENSATION
Insurance broker nameHICKOK BOARDMAN FINANCIAL PLANNING&
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number586641
Policy instance 4
Insurance contract or identification number586641
Number of Individuals Covered5798
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $68,631
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $1,444,865
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $43,346
Insurance broker organization code?3
Additional information about fees paid to insurance brokerADDITIONAL PRODUCER COMPENSATION
Insurance broker nameHICKOK & BOARDMAN FINANCIAL PLANNIN
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number12157661
Policy instance 5
Insurance contract or identification number12157661
Number of Individuals Covered4067
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )
Policy contract number3336647
Policy instance 1
Insurance contract or identification number3336647
Number of Individuals Covered5
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )
Policy contract number3336647
Policy instance 1
Insurance contract or identification number3336647
Number of Individuals Covered3
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
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 number579370
Policy instance 2
Insurance contract or identification number579370
Number of Individuals Covered892
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $64,215
Total amount of fees paid to insurance companyUSD $28,170
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $1,609,734
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $64,215
Insurance broker organization code?3
Amount paid for insurance broker fees28170
Additional information about fees paid to insurance brokerADDITIONAL PRODUCER COMPENSATION
Insurance broker nameHICKOK BOARDMAN FINANCIAL PLANNING&
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number586641
Policy instance 4
Insurance contract or identification number586641
Number of Individuals Covered5779
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $45,853
Total amount of fees paid to insurance companyUSD $26,748
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $1,528,442
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $45,853
Amount paid for insurance broker fees26748
Additional information about fees paid to insurance brokerADDITIONAL PRODUCER COMPENSATION
Insurance broker organization code?3
Insurance broker nameHICKOK BOARDMAN FINANCIAL PLANNING
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number12157661
Policy instance 5
Insurance contract or identification number12157661
Number of Individuals Covered3977
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
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 number558975
Policy instance 3
Insurance contract or identification number558975
Number of Individuals Covered7287
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $61,686
Total amount of fees paid to insurance companyUSD $53,975
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,084,301
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $61,686
Insurance broker organization code?3
Amount paid for insurance broker fees53975
Additional information about fees paid to insurance brokerADDITIONAL PRODUCER COMPENSATION
Insurance broker nameHICKOK BOARDMAN FINANCIAL PLANNING
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number12157661
Policy instance 5
Insurance contract or identification number12157661
Number of Individuals Covered3822
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
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 number586641
Policy instance 4
Insurance contract or identification number586641
Number of Individuals Covered5592
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $45,711
Total amount of fees paid to insurance companyUSD $26,665
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $2,633,539
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $45,711
Amount paid for insurance broker fees26665
Additional information about fees paid to insurance brokerADDITIONAL PRODUCER COMPENSATION
Insurance broker organization code?3
Insurance broker nameHICKOK BOARDMAN FINANCIAL PLANNING
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number558975
Policy instance 3
Insurance contract or identification number558975
Number of Individuals Covered7083
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $50,872
Total amount of fees paid to insurance companyUSD $44,512
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,543,576
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $50,872
Insurance broker organization code?3
Amount paid for insurance broker fees44512
Additional information about fees paid to insurance brokerADDITIONAL PRODUCER COMPENSATION
Insurance broker nameHICKOK BOARDMAN FINANCIAL PLANNING
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number579370
Policy instance 2
Insurance contract or identification number579370
Number of Individuals Covered864
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $56,110
Total amount of fees paid to insurance companyUSD $24,914
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $2,383,183
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $56,110
Insurance broker organization code?3
Amount paid for insurance broker fees24914
Additional information about fees paid to insurance brokerADDITIONAL PRODUCER COMPENSATION
Insurance broker nameHICKOK BOARDMAN FINANCIAL PLANNING&
CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )
Policy contract number3213296
Policy instance 1
Insurance contract or identification number3213296
Number of Individuals Covered5
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )
Policy contract number3213296
Policy instance 1
Insurance contract or identification number3213296
Number of Individuals Covered5
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
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 number579370
Policy instance 2
Insurance contract or identification number579370
Number of Individuals Covered850
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $57,130
Total amount of fees paid to insurance companyUSD $17,900
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $1,432,015
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 number586641
Policy instance 4
Insurance contract or identification number586641
Number of Individuals Covered5378
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $48,071
Total amount of fees paid to insurance companyUSD $20,024
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $1,602,368
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 number558975
Policy instance 3
Insurance contract or identification number558975
Number of Individuals Covered6886
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $48,499
Total amount of fees paid to insurance companyUSD $30,312
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,424,959
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 number12157661
Policy instance 5
Insurance contract or identification number12157661
Number of Individuals Covered3684
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )
Policy contract number3213296
Policy instance 1
Insurance contract or identification number3213296
Number of Individuals Covered6
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
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 number579370
Policy instance 2
Insurance contract or identification number579370
Number of Individuals Covered824
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $71,106
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $1,425,167
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $56,854
Additional information about fees paid to insurance brokerADDITIONAL PRODUCER COMPENSATION
Insurance broker organization code?3
Insurance broker nameHICKOK BOARDMAN FINANCIAL PLANNING&
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number558975
Policy instance 3
Insurance contract or identification number558975
Number of Individuals Covered6910
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $72,831
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,427,680
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $48,554
Additional information about fees paid to insurance brokerADDITIONAL PRODUCER COMPENSATION
Insurance broker organization code?3
Insurance broker nameHICKOK BOARDMAN FINANCIAL PLANNING
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number586641
Policy instance 4
Insurance contract or identification number586641
Number of Individuals Covered5425
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $49,905
Total amount of fees paid to insurance companyUSD $16,835
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $1,663,486
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $49,905
Amount paid for insurance broker fees16835
Additional information about fees paid to insurance brokerADDITIONAL PRODUCER COMPENSATION
Insurance broker organization code?3
Insurance broker nameHICKOK BOARDMAN FINANCIAL PLANNING
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number12157661
Policy instance 5
Insurance contract or identification number12157661
Number of Individuals Covered3442
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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