401k Plan data: MARKS PANETH LLP - GROUP LIFE, LONG-TERM DISABILITY, SHORT-TERM DISABILITY plan

MARKS PANETH LLP - GROUP LIFE, LONG-TERM DISABILITY, SHORT-TERM DISABILITY 401k Plan overview

Plan Name	MARKS PANETH LLP - GROUP LIFE, LONG-TERM DISABILITY, SHORT-TERM DISABILITY
Plan identification number	501

MARKS PANETH LLP - GROUP LIFE, LONG-TERM DISABILITY, SHORT-TERM DISABILITY Benefits

401k Plan Type	Welfare 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) Other welfare benefit cover

401k Sponsoring company profile

MARKS PANETH LLP has sponsored the creation of one or more 401k plans.

Company Name: MARKS PANETH LLP

Employer identification number (EIN): 113518842

NAIC Classification: 541211
NAIC Description: Offices of Certified Public Accountants

Additional information about MARKS PANETH LLP

Jurisdiction of Incorporation: New York Department of State

Incorporation Date: 1995-02-10

Company Identification Number: 1893675

Legal Registered Office Address: 685 THIRD AVENUE

NEW YORK
United States of America (USA)
10017

More information about MARKS PANETH LLP

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MARKS PANETH LLP - GROUP LIFE, LONG-TERM DISABILITY, SHORT-TERM DISABILITY

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2021-01-01 BRIAN FOX 2022-10-17 BRIAN FOX 2022-10-17
501 2020-01-01 BRIAN FOX 2021-10-04 BRIAN FOX 2021-10-04
501 2019-01-01 BRIAN FOX 2020-10-15 BRIAN FOX 2020-10-15
501 2018-01-01
501 2017-01-01 BRIAN FOX BRIAN FOX 2018-10-10
501 2016-01-01 BRIAN FOX BRIAN FOX 2017-10-13
501 2015-01-01 BRIAN FOX BRIAN FOX 2016-10-05
501 2014-01-01 BRIAN FOX BRIAN FOX 2015-07-29
501 2013-01-01 BRIAN FOX BRIAN FOX 2014-10-07
501 2012-01-01 BRIAN FOX BRIAN FOX 2013-08-30
501 2011-01-01 HARRY MOEHRINGER HARRY MOEHRINGER 2012-10-15
501 2009-01-01 ERIC MARKS ERIC MARKS 2010-10-15

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2021-01-01	BRIAN FOX	2022-10-17	BRIAN FOX	2022-10-17
501	2020-01-01	BRIAN FOX	2021-10-04	BRIAN FOX	2021-10-04
501	2019-01-01	BRIAN FOX	2020-10-15	BRIAN FOX	2020-10-15
501	2018-01-01
501	2017-01-01	BRIAN FOX		BRIAN FOX	2018-10-10
501	2016-01-01	BRIAN FOX		BRIAN FOX	2017-10-13
501	2015-01-01	BRIAN FOX		BRIAN FOX	2016-10-05
501	2014-01-01	BRIAN FOX		BRIAN FOX	2015-07-29
501	2013-01-01	BRIAN FOX		BRIAN FOX	2014-10-07
501	2012-01-01	BRIAN FOX		BRIAN FOX	2013-08-30
501	2011-01-01	HARRY MOEHRINGER		HARRY MOEHRINGER	2012-10-15
501	2009-01-01	ERIC MARKS		ERIC MARKS	2010-10-15

Plan Statistics for MARKS PANETH LLP - GROUP LIFE, LONG-TERM DISABILITY, SHORT-TERM DISABILITY

401k plan membership statisitcs for MARKS PANETH LLP - GROUP LIFE, LONG-TERM DISABILITY, SHORT-TERM DISABILITY

Measure Date Value
2021: MARKS PANETH LLP - GROUP LIFE, LONG-TERM DISABILITY, SHORT-TERM DISABILITY 2021 401k membership
Total participants, beginning-of-year 2021-01-01 599
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 568
Number of retired or separated participants receiving benefits 2021-01-01 23
Number of other retired or separated participants entitled to future benefits 2021-01-01 0
Total of all active and inactive participants 2021-01-01 591
2020: MARKS PANETH LLP - GROUP LIFE, LONG-TERM DISABILITY, SHORT-TERM DISABILITY 2020 401k membership
Total participants, beginning-of-year 2020-01-01 598
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 589
Number of retired or separated participants receiving benefits 2020-01-01 10
Number of other retired or separated participants entitled to future benefits 2020-01-01 0
Total of all active and inactive participants 2020-01-01 599
2019: MARKS PANETH LLP - GROUP LIFE, LONG-TERM DISABILITY, SHORT-TERM DISABILITY 2019 401k membership
Total participants, beginning-of-year 2019-01-01 618
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 585
Number of retired or separated participants receiving benefits 2019-01-01 13
Number of other retired or separated participants entitled to future benefits 2019-01-01 0
Total of all active and inactive participants 2019-01-01 598
2018: MARKS PANETH LLP - GROUP LIFE, LONG-TERM DISABILITY, SHORT-TERM DISABILITY 2018 401k membership
Total participants, beginning-of-year 2018-01-01 593
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 602
Number of retired or separated participants receiving benefits 2018-01-01 15
Number of other retired or separated participants entitled to future benefits 2018-01-01 0
Total of all active and inactive participants 2018-01-01 617
2017: MARKS PANETH LLP - GROUP LIFE, LONG-TERM DISABILITY, SHORT-TERM DISABILITY 2017 401k membership
Total participants, beginning-of-year 2017-01-01 607
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 583
Number of retired or separated participants receiving benefits 2017-01-01 10
Total of all active and inactive participants 2017-01-01 593
2016: MARKS PANETH LLP - GROUP LIFE, LONG-TERM DISABILITY, SHORT-TERM DISABILITY 2016 401k membership
Total participants, beginning-of-year 2016-01-01 492
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 591
Number of retired or separated participants receiving benefits 2016-01-01 16
Total of all active and inactive participants 2016-01-01 607
2015: MARKS PANETH LLP - GROUP LIFE, LONG-TERM DISABILITY, SHORT-TERM DISABILITY 2015 401k membership
Total participants, beginning-of-year 2015-01-01 483
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 476
Number of retired or separated participants receiving benefits 2015-01-01 16
Total of all active and inactive participants 2015-01-01 492
2014: MARKS PANETH LLP - GROUP LIFE, LONG-TERM DISABILITY, SHORT-TERM DISABILITY 2014 401k membership
Total participants, beginning-of-year 2014-01-01 467
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 462
Number of retired or separated participants receiving benefits 2014-01-01 21
Total of all active and inactive participants 2014-01-01 483
2013: MARKS PANETH LLP - GROUP LIFE, LONG-TERM DISABILITY, SHORT-TERM DISABILITY 2013 401k membership
Total participants, beginning-of-year 2013-01-01 436
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 439
Number of retired or separated participants receiving benefits 2013-01-01 28
Total of all active and inactive participants 2013-01-01 467
2012: MARKS PANETH LLP - GROUP LIFE, LONG-TERM DISABILITY, SHORT-TERM DISABILITY 2012 401k membership
Total participants, beginning-of-year 2012-01-01 456
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 408
Number of retired or separated participants receiving benefits 2012-01-01 28
Total of all active and inactive participants 2012-01-01 436
2011: MARKS PANETH LLP - GROUP LIFE, LONG-TERM DISABILITY, SHORT-TERM DISABILITY 2011 401k membership
Total participants, beginning-of-year 2011-01-01 459
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 433
Number of retired or separated participants receiving benefits 2011-01-01 23
Total of all active and inactive participants 2011-01-01 456
2009: MARKS PANETH LLP - GROUP LIFE, LONG-TERM DISABILITY, SHORT-TERM DISABILITY 2009 401k membership
Total participants, beginning-of-year 2009-01-01 443
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 418
Number of retired or separated participants receiving benefits 2009-01-01 15
Total of all active and inactive participants 2009-01-01 433

Measure	Date	Value
2021: MARKS PANETH LLP - GROUP LIFE, LONG-TERM DISABILITY, SHORT-TERM DISABILITY 2021 401k membership
Total participants, beginning-of-year	2021-01-01	599
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	568
Number of retired or separated participants receiving benefits	2021-01-01	23
Number of other retired or separated participants entitled to future benefits	2021-01-01	0
Total of all active and inactive participants	2021-01-01	591
2020: MARKS PANETH LLP - GROUP LIFE, LONG-TERM DISABILITY, SHORT-TERM DISABILITY 2020 401k membership
Total participants, beginning-of-year	2020-01-01	598
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	589
Number of retired or separated participants receiving benefits	2020-01-01	10
Number of other retired or separated participants entitled to future benefits	2020-01-01	0
Total of all active and inactive participants	2020-01-01	599
2019: MARKS PANETH LLP - GROUP LIFE, LONG-TERM DISABILITY, SHORT-TERM DISABILITY 2019 401k membership
Total participants, beginning-of-year	2019-01-01	618
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	585
Number of retired or separated participants receiving benefits	2019-01-01	13
Number of other retired or separated participants entitled to future benefits	2019-01-01	0
Total of all active and inactive participants	2019-01-01	598
2018: MARKS PANETH LLP - GROUP LIFE, LONG-TERM DISABILITY, SHORT-TERM DISABILITY 2018 401k membership
Total participants, beginning-of-year	2018-01-01	593
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	602
Number of retired or separated participants receiving benefits	2018-01-01	15
Number of other retired or separated participants entitled to future benefits	2018-01-01	0
Total of all active and inactive participants	2018-01-01	617
2017: MARKS PANETH LLP - GROUP LIFE, LONG-TERM DISABILITY, SHORT-TERM DISABILITY 2017 401k membership
Total participants, beginning-of-year	2017-01-01	607
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	583
Number of retired or separated participants receiving benefits	2017-01-01	10
Total of all active and inactive participants	2017-01-01	593
2016: MARKS PANETH LLP - GROUP LIFE, LONG-TERM DISABILITY, SHORT-TERM DISABILITY 2016 401k membership
Total participants, beginning-of-year	2016-01-01	492
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	591
Number of retired or separated participants receiving benefits	2016-01-01	16
Total of all active and inactive participants	2016-01-01	607
2015: MARKS PANETH LLP - GROUP LIFE, LONG-TERM DISABILITY, SHORT-TERM DISABILITY 2015 401k membership
Total participants, beginning-of-year	2015-01-01	483
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	476
Number of retired or separated participants receiving benefits	2015-01-01	16
Total of all active and inactive participants	2015-01-01	492
2014: MARKS PANETH LLP - GROUP LIFE, LONG-TERM DISABILITY, SHORT-TERM DISABILITY 2014 401k membership
Total participants, beginning-of-year	2014-01-01	467
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	462
Number of retired or separated participants receiving benefits	2014-01-01	21
Total of all active and inactive participants	2014-01-01	483
2013: MARKS PANETH LLP - GROUP LIFE, LONG-TERM DISABILITY, SHORT-TERM DISABILITY 2013 401k membership
Total participants, beginning-of-year	2013-01-01	436
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	439
Number of retired or separated participants receiving benefits	2013-01-01	28
Total of all active and inactive participants	2013-01-01	467
2012: MARKS PANETH LLP - GROUP LIFE, LONG-TERM DISABILITY, SHORT-TERM DISABILITY 2012 401k membership
Total participants, beginning-of-year	2012-01-01	456
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	408
Number of retired or separated participants receiving benefits	2012-01-01	28
Total of all active and inactive participants	2012-01-01	436
2011: MARKS PANETH LLP - GROUP LIFE, LONG-TERM DISABILITY, SHORT-TERM DISABILITY 2011 401k membership
Total participants, beginning-of-year	2011-01-01	459
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	433
Number of retired or separated participants receiving benefits	2011-01-01	23
Total of all active and inactive participants	2011-01-01	456
2009: MARKS PANETH LLP - GROUP LIFE, LONG-TERM DISABILITY, SHORT-TERM DISABILITY 2009 401k membership
Total participants, beginning-of-year	2009-01-01	443
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	418
Number of retired or separated participants receiving benefits	2009-01-01	15
Total of all active and inactive participants	2009-01-01	433

Form 5500 Responses for MARKS PANETH LLP - GROUP LIFE, LONG-TERM DISABILITY, SHORT-TERM DISABILITY

2021: MARKS PANETH LLP - GROUP LIFE, LONG-TERM DISABILITY, SHORT-TERM DISABILITY 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	This submission is the final filing	Yes
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2020: MARKS PANETH LLP - GROUP LIFE, LONG-TERM DISABILITY, SHORT-TERM DISABILITY 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2019: MARKS PANETH LLP - GROUP LIFE, LONG-TERM DISABILITY, SHORT-TERM DISABILITY 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2018: MARKS PANETH LLP - GROUP LIFE, LONG-TERM DISABILITY, SHORT-TERM DISABILITY 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2017: MARKS PANETH LLP - GROUP LIFE, LONG-TERM DISABILITY, SHORT-TERM DISABILITY 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2016: MARKS PANETH LLP - GROUP LIFE, LONG-TERM DISABILITY, SHORT-TERM DISABILITY 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2015: MARKS PANETH LLP - GROUP LIFE, LONG-TERM DISABILITY, SHORT-TERM DISABILITY 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: MARKS PANETH LLP - GROUP LIFE, LONG-TERM DISABILITY, SHORT-TERM DISABILITY 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: MARKS PANETH LLP - GROUP LIFE, LONG-TERM DISABILITY, SHORT-TERM DISABILITY 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: MARKS PANETH LLP - GROUP LIFE, LONG-TERM DISABILITY, SHORT-TERM DISABILITY 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: MARKS PANETH LLP - GROUP LIFE, LONG-TERM DISABILITY, SHORT-TERM DISABILITY 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009: MARKS PANETH LLP - GROUP LIFE, LONG-TERM DISABILITY, SHORT-TERM DISABILITY 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	This submission is the final filing	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

FIDELITY SECURITY LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 67288 )

Policy contract number

98817231001

Policy instance

Insurance contract or identification number	98817231001
Number of Individuals Covered	494
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $3,691
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $34,040
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,691
Additional information about fees paid to insurance broker	COMMISSION
Insurance broker organization code?	3

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

0242452

Policy instance

Insurance contract or identification number	0242452
Number of Individuals Covered	757
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $236,005
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $6,831,998
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $170,793
Insurance broker organization code?	3

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

5751958

Policy instance

Insurance contract or identification number	5751958
Number of Individuals Covered	250
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $3,176
Total amount of fees paid to insurance company	USD $256
Other welfare benefits provided	ACCIDENTAL DEATH OR DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $20,699
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,963
Additional information about fees paid to insurance broker	BASE COMMISSION
Insurance broker organization code?	3
Amount paid for insurance broker fees	256

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

0144168

Policy instance

Insurance contract or identification number	0144168
Number of Individuals Covered	239
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $19,143
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $400,509
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $19,143
Additional information about fees paid to insurance broker	BASE COMMISSIONS
Insurance broker organization code?	3

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

423139

Policy instance

Insurance contract or identification number	423139
Number of Individuals Covered	134
Insurance policy start date	2021-01-01
Insurance policy end date	2022-01-01
Total amount of commissions paid to insurance broker	USD $16,463
Total amount of fees paid to insurance company	USD $1,921
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	SHORT-TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $109,756
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16,463
Insurance broker organization code?	3
Amount paid for insurance broker fees	1921

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

423140

Policy instance

Insurance contract or identification number	423140
Number of Individuals Covered	498
Insurance policy start date	2021-01-01
Insurance policy end date	2022-01-01
Total amount of commissions paid to insurance broker	USD $9,229
Total amount of fees paid to insurance company	USD $3,679
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $210,205
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,229
Insurance broker organization code?	3
Amount paid for insurance broker fees	3679

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

423138

Policy instance

Insurance contract or identification number	423138
Number of Individuals Covered	555
Insurance policy start date	2021-01-01
Insurance policy end date	2022-01-01
Total amount of commissions paid to insurance broker	USD $10,549
Total amount of fees paid to insurance company	USD $6,431
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH OR DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $367,466
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,549
Insurance broker organization code?	3
Amount paid for insurance broker fees	6431

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

913121

Policy instance

Insurance contract or identification number	913121
Number of Individuals Covered	589
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $7,121
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $308,702
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,121
Insurance broker organization code?	3

FIDELITY SECURITY LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 67288 )

Policy contract number

99409091001

Policy instance

Insurance contract or identification number	99409091001
Number of Individuals Covered	5
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $88
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Other welfare benefits provided	COBRA VISION
Welfare Benefit Premiums Paid to Carrier	USD $723
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $88
Additional information about fees paid to insurance broker	COMMISSION
Insurance broker organization code?	3

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

R0670646

Policy instance

Insurance contract or identification number	R0670646
Number of Individuals Covered	110
Insurance policy start date	2021-01-01
Insurance policy end date	2022-01-01
Total amount of commissions paid to insurance broker	USD $2,567
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	ACCIDENT AND CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $31,467
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,719
Insurance broker organization code?	3

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

5751958

Policy instance

Insurance contract or identification number	5751958
Number of Individuals Covered	246
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $2,864
Total amount of fees paid to insurance company	USD $111
Other welfare benefits provided	ACCIDENTAL DEATH OR DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $22,912
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,807
Insurance broker organization code?	3
Amount paid for insurance broker fees	93

FIDELITY SECURITY LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 67288 )

Policy contract number

98817231001

Policy instance

Insurance contract or identification number	98817231001
Number of Individuals Covered	530
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $3,683
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $36,725
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,683
Insurance broker organization code?	3

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

0144168

Policy instance

Insurance contract or identification number	0144168
Number of Individuals Covered	239
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $23,943
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $392,097
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $23,943
Insurance broker organization code?	3

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

423139

Policy instance

Insurance contract or identification number	423139
Number of Individuals Covered	150
Insurance policy start date	2020-01-01
Insurance policy end date	2021-01-01
Total amount of commissions paid to insurance broker	USD $21,544
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	SHORT-TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $117,996
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $19,293
Insurance broker organization code?	3

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

423138

Policy instance

Insurance contract or identification number	423138
Number of Individuals Covered	580
Insurance policy start date	2020-01-01
Insurance policy end date	2021-01-01
Total amount of commissions paid to insurance broker	USD $15,452
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH OR DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $283,361
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,042
Insurance broker organization code?	3

FIDELITY SECURITY LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 67288 )

Policy contract number

99409091001

Policy instance

Insurance contract or identification number	99409091001
Number of Individuals Covered	2
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $49
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Other welfare benefits provided	COBRA VISION
Welfare Benefit Premiums Paid to Carrier	USD $356
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $49
Insurance broker organization code?	3

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

913121

Policy instance

Insurance contract or identification number	913121
Number of Individuals Covered	621
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $6,723
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $283,835
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,723
Insurance broker organization code?	3

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

423140

Policy instance

Insurance contract or identification number	423140
Number of Individuals Covered	507
Insurance policy start date	2020-01-01
Insurance policy end date	2021-01-01
Total amount of commissions paid to insurance broker	USD $9,842
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $106,053
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,920
Insurance broker organization code?	3

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

0242452

Policy instance

Insurance contract or identification number	0242452
Number of Individuals Covered	425
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $208,441
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $6,207,374
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $142,361
Insurance broker organization code?	3

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

R0670646

Policy instance

Insurance contract or identification number	R0670646
Number of Individuals Covered	101
Insurance policy start date	2020-02-01
Insurance policy end date	2021-01-31
Total amount of commissions paid to insurance broker	USD $1,611
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	ACCIDENT AND CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $28,252
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $927
Insurance broker organization code?	3

FIDELITY SECURITY LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 67288 )

Policy contract number

98817231001

Policy instance

Insurance contract or identification number	98817231001
Number of Individuals Covered	545
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $3,187
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $32,036
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,187
Insurance broker organization code?	3

OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

MP23686

Policy instance

Insurance contract or identification number	MP23686
Number of Individuals Covered	790
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $109,984
Total amount of fees paid to insurance company	USD $12,355
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $7,959,273
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $109,984
Additional information about fees paid to insurance broker	BONUS/ADMINISTRATIVE SERVICES
Insurance broker organization code?	3
Amount paid for insurance broker fees	12355

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

5751958

Policy instance

Insurance contract or identification number	5751958
Number of Individuals Covered	235
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $3,001
Total amount of fees paid to insurance company	USD $265
Other welfare benefits provided	ACCIDENTAL DEATH OR DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $20,996
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,041
Insurance broker organization code?	3
Amount paid for insurance broker fees	152

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

R0670646

Policy instance

Insurance contract or identification number	R0670646
Number of Individuals Covered	106
Insurance policy start date	2019-02-01
Insurance policy end date	2020-01-31
Total amount of commissions paid to insurance broker	USD $3,770
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	ACCIDENT AND CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $34,429
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,864
Insurance broker organization code?	3

FIDELITY SECURITY LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 67288 )

Policy contract number

99409091001

Policy instance

Insurance contract or identification number	99409091001
Number of Individuals Covered	7
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $54
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Other welfare benefits provided	COBRA VISION
Welfare Benefit Premiums Paid to Carrier	USD $655
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $54
Insurance broker organization code?	3

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

913121

Policy instance

Insurance contract or identification number	913121
Number of Individuals Covered	336
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $4,273
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $285,656
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,273
Insurance broker organization code?	3

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

423138

Policy instance

Insurance contract or identification number	423138
Number of Individuals Covered	603
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $9,917
Total amount of fees paid to insurance company	USD $5,192
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH OR DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $297,715
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,917
Insurance broker organization code?	3
Amount paid for insurance broker fees	5192
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

423140

Policy instance

Insurance contract or identification number	423140
Number of Individuals Covered	525
Insurance policy start date	2019-01-01
Insurance policy end date	2020-01-01
Total amount of commissions paid to insurance broker	USD $7,763
Total amount of fees paid to insurance company	USD $1,456
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $80,475
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,763
Insurance broker organization code?	3
Amount paid for insurance broker fees	1456
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

423139

Policy instance

Insurance contract or identification number	423139
Number of Individuals Covered	159
Insurance policy start date	2019-01-01
Insurance policy end date	2020-01-01
Total amount of commissions paid to insurance broker	USD $18,516
Total amount of fees paid to insurance company	USD $2,160
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	SHORT-TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $123,497
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,516
Insurance broker organization code?	3
Amount paid for insurance broker fees	2160
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

0144168

Policy instance

Insurance contract or identification number	0144168
Number of Individuals Covered	235
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $19,940
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $451,258
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $19,940
Insurance broker organization code?	3

OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

MP23686

Policy instance

Insurance contract or identification number	MP23686
Number of Individuals Covered	808
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $236,297
Total amount of fees paid to insurance company	USD $2,000
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,392,256
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $236,297
Amount paid for insurance broker fees	2000
Additional information about fees paid to insurance broker	BONUS/ADMINISTRATIVE SERVICES
Insurance broker organization code?	3

FIDELITY SECURITY LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 67288 )

Policy contract number

98817231001

Policy instance

Insurance contract or identification number	98817231001
Number of Individuals Covered	511
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $3,301
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $33,121
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,301
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

TM05751958

Policy instance

Insurance contract or identification number	TM05751958
Number of Individuals Covered	233
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $2,377
Total amount of fees paid to insurance company	USD $387
Other welfare benefits provided	ACCIDENTAL DEATH OR DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $19,580
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,483
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

0144168

Policy instance

Insurance contract or identification number	0144168
Number of Individuals Covered	237
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $17,857
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $375,902
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $17,857
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

423139

Policy instance

Insurance contract or identification number	423139
Number of Individuals Covered	159
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $18,107
Total amount of fees paid to insurance company	USD $2,333
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	SHORT-TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $121,470
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,107
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

423140

Policy instance

Insurance contract or identification number	423140
Number of Individuals Covered	549
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $7,122
Total amount of fees paid to insurance company	USD $2,016
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $62,316
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,122
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

423138

Policy instance

Insurance contract or identification number	423138
Number of Individuals Covered	613
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $9,877
Total amount of fees paid to insurance company	USD $5,662
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH OR DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $293,418
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,877
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

0913121

Policy instance

Insurance contract or identification number	0913121
Number of Individuals Covered	327
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $6,234
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $273,878
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,234
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

R0670646

Policy instance

Insurance contract or identification number	R0670646
Number of Individuals Covered	123
Insurance policy start date	2018-02-01
Insurance policy end date	2019-01-31
Total amount of commissions paid to insurance broker	USD $7,650
Total amount of fees paid to insurance company	USD $325
Other welfare benefits provided	ACCIDENT AND CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $41,584
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,825
Amount paid for insurance broker fees	325
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

FIDELITY SECURITY LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 67288 )

Policy contract number

99409091001

Policy instance

Insurance contract or identification number	99409091001
Number of Individuals Covered	10
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $53
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Other welfare benefits provided	COBRA VISION
Welfare Benefit Premiums Paid to Carrier	USD $491
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $53
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

0144168

Policy instance

Insurance contract or identification number	0144168
Number of Individuals Covered	239
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $19,303
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $372,169
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $19,303
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

423138

Policy instance

Insurance contract or identification number	423138
Number of Individuals Covered	596
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $10,019
Total amount of fees paid to insurance company	USD $10,674
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH OR DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $290,888
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	10674
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	RSC INSURANCE BROKERAGE

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

423140

Policy instance

Insurance contract or identification number	423140
Number of Individuals Covered	579
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $2,969
Total amount of fees paid to insurance company	USD $807
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $20,187
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,969
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker name	RSC INSURANCE BROKERAGE

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

423139

Policy instance

Insurance contract or identification number	423139
Number of Individuals Covered	152
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $16,261
Total amount of fees paid to insurance company	USD $4,283
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	SHORT-TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $116,878
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16,261
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker name	RSC INSURANCE BROKERAGE

FIDELITY SECURITY LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 67288 )

Policy contract number

98817231001

Policy instance

Insurance contract or identification number	98817231001
Number of Individuals Covered	489
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $3,581
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $35,864
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,960
Insurance broker name	RSC INSURANCE BROKERAGE

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

TM05751958

Policy instance

Insurance contract or identification number	TM05751958
Number of Individuals Covered	241
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $1,761
Total amount of fees paid to insurance company	USD $214
Other welfare benefits provided	ACCIDENTAL DEATH OR DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $20,244
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,761
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker name	RSC INSURANCE BROKERAGE

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

3329551

Policy instance

Insurance contract or identification number	3329551
Number of Individuals Covered	802
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $174,242
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Other welfare benefits provided	PREPAID DENTAL
Welfare Benefit Premiums Paid to Carrier	USD $1,064,832
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $174,242
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	RSC INSURANCE BROKERAGE

LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )

Policy contract number

000010123487

Policy instance

Insurance contract or identification number	000010123487
Number of Individuals Covered	355
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $3,288
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH OR DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $75,212
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,206
Insurance broker organization code?	3
Insurance broker name	DEWITT STERN GRP PLANNING SVCS

LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )

Policy contract number

000000001106

Policy instance

Insurance contract or identification number	000000001106
Number of Individuals Covered	1571
Insurance policy start date	2015-07-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $2,118
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	SHORT-TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $15,257
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,118
Insurance broker organization code?	3
Insurance broker name	7SC INSURANCE BROKERAGE INC

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

3329551

Policy instance

Insurance contract or identification number	3329551
Number of Individuals Covered	735
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $158,300
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Other welfare benefits provided	PREPAID DENTAL
Welfare Benefit Premiums Paid to Carrier	USD $731,080
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $158,300
Insurance broker organization code?	3
Insurance broker name	DEWITT STERN GRP PLANNING SVCS

LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )

Policy contract number

000010123488

Policy instance

Insurance contract or identification number	000010123488
Number of Individuals Covered	476
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $5,131
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $116,614
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,036
Insurance broker organization code?	3
Insurance broker name	DEWITT STERN GRP PLANNING SVCS

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

TM05751958

Policy instance

Insurance contract or identification number	TM05751958
Number of Individuals Covered	195
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $1,576
Total amount of fees paid to insurance company	USD $261
Other welfare benefits provided	ACCIDENTAL DEATH OR DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $17,857
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,576
Insurance broker organization code?	3
Amount paid for insurance broker fees	261
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker name	RSC INSURANCE BROKERAGE

LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )

Policy contract number

000010115728

Policy instance

Insurance contract or identification number	000010115728
Number of Individuals Covered	135
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $16,772
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	WEEKLY INCOME
Welfare Benefit Premiums Paid to Carrier	USD $111,814
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $15,658
Insurance broker organization code?	3
Insurance broker name	DEWITT STERN GRP PLANNING SVCS

FIDELITY SECURITY LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 67288 )

Policy contract number

9940909

Policy instance

Insurance contract or identification number	9940909
Number of Individuals Covered	2
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $9
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $122
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9
Insurance broker organization code?	3
Insurance broker name	DEWITT STERN GRP PLANNING SVCS

FIDELITY SECURITY LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 67288 )

Policy contract number

9881723

Policy instance

Insurance contract or identification number	9881723
Number of Individuals Covered	383
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $2,355
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $23,628
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,355
Insurance broker organization code?	3
Insurance broker name	DEWITT STERN GRP PLANNING SVCS

WESCO INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 25011 )

Policy contract number

0990954

Policy instance

Insurance contract or identification number	0990954
Number of Individuals Covered	515
Insurance policy start date	2015-01-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $2,726
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	SHORT-TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $23,942
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,726
Insurance broker organization code?	3
Insurance broker name	DEWITT STERN GRP PLANNING SVCS

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

0144168

Policy instance

Insurance contract or identification number	0144168
Number of Individuals Covered	195
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $14,566
Total amount of fees paid to insurance company	USD $4,723
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $285,251
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,566
Amount paid for insurance broker fees	4723
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	CETERA ADVISOR NETWORKS LLC

WESCO INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 25011 )

Policy contract number

0990954,001

Policy instance

Insurance contract or identification number	0990954,001
Number of Individuals Covered	2755
Insurance policy start date	2014-08-02
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $2,846
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	SHORT-TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $7,434
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,846
Insurance broker organization code?	3
Insurance broker name	DEWITT STERN GRP PLANNING SVCS

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

0144168

Policy instance

Insurance contract or identification number	0144168
Number of Individuals Covered	193
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $10,143
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $233,898
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,143
Insurance broker organization code?	3
Insurance broker name	CETERA ADVISOR NETWORKS LLC

LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )

Policy contract number

000010123488

Policy instance

Insurance contract or identification number	000010123488
Number of Individuals Covered	462
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $4,973
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $98,802
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,973
Insurance broker organization code?	3
Insurance broker name	DEWITT STERN GRP PLANNING SVCS

LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )

Policy contract number

000010123487

Policy instance

Insurance contract or identification number	000010123487
Number of Individuals Covered	341
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $3,128
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH OR DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $64,535
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,128
Insurance broker organization code?	3
Insurance broker name	DEWITT STERN GRP PLANNING SVCS

FIDELITY SECURITY LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 67288 )

Policy contract number

9881723

Policy instance

Insurance contract or identification number	9881723
Number of Individuals Covered	376
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $2,728
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $19,888
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,728
Insurance broker organization code?	3
Insurance broker name	DEWITT STERN GRP PLANNING SVCS

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

3329551

Policy instance

Insurance contract or identification number	3329551
Number of Individuals Covered	750
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $170,046
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Other welfare benefits provided	PREPAID DENTAL
Welfare Benefit Premiums Paid to Carrier	USD $638,065
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $170,046
Insurance broker organization code?	3
Insurance broker name	DEWITT STERN GRP PLANNING SVCS

NATIONAL BENEFIT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61409 )

Policy contract number

8-910-0990954

Policy instance

Insurance contract or identification number	8-910-0990954
Number of Individuals Covered	437
Insurance policy start date	2014-01-01
Insurance policy end date	2014-08-01
Total amount of commissions paid to insurance broker	USD $971
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	SHORT-TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $21,424
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $971
Insurance broker organization code?	3
Insurance broker name	DEWITT STERN GRP PLANNING SVCS

LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )

Policy contract number

000010115728

Policy instance

Insurance contract or identification number	000010115728
Number of Individuals Covered	144
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $16,637
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	WEEKLY INCOME
Welfare Benefit Premiums Paid to Carrier	USD $110,912
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16,637
Insurance broker organization code?	3
Insurance broker name	DEWITT STERN GRP PLANNING SVCS

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

TM05751958

Policy instance

Insurance contract or identification number	TM05751958
Number of Individuals Covered	182
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $1,497
Total amount of fees paid to insurance company	USD $17
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	ACCIDENTAL DEATH OR DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $15,179
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,497
Amount paid for insurance broker fees	17
Additional information about fees paid to insurance broker	NON-MONETARY COMPENSATION
Insurance broker organization code?	3
Insurance broker name	DEWITT STERN GRP PLANNING SVCS

NATIONAL BENEFIT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61409 )

Policy contract number

0990954

Policy instance

Insurance contract or identification number	0990954
Number of Individuals Covered	370
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $2,589
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	SHORT-TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $21,989
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,589
Insurance broker organization code?	3
Insurance broker name	DEWITT STERN GRP PLANNING SVCS

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

3329551

Policy instance

Insurance contract or identification number	3329551
Number of Individuals Covered	703
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $140,254
Total amount of fees paid to insurance company	USD $24,675
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Other welfare benefits provided	PREPAID DENTAL
Were dividends or retroactive rate refunds paid in cash?	Yes
Were dividends or retroactive rate refunds paid as a credit?	Yes
Welfare Benefit Premiums Paid to Carrier	USD $535,327
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $139,722
Amount paid for insurance broker fees	24675
Additional information about fees paid to insurance broker	GENERAL AGENT PAYMENTS
Insurance broker organization code?	3
Insurance broker name	BWD AGENCY INC.

LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )

Policy contract number

000010115728

Policy instance

Insurance contract or identification number	000010115728
Number of Individuals Covered	149
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $13,260
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	WEEKLY INCOME
Welfare Benefit Premiums Paid to Carrier	USD $88,399
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,260
Insurance broker organization code?	3
Insurance broker name	DEWITT STERN GRP PLANNING SVCS

STANDARD SECURITY LIFE (National Association of Insurance Commissioners NAIC id number: 69078 )

Policy contract number

9754912

Policy instance

Insurance contract or identification number	9754912
Number of Individuals Covered	322
Insurance policy start date	2013-01-01
Insurance policy end date	2013-05-31
Total amount of commissions paid to insurance broker	USD $1,149
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $8,882
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,149
Insurance broker organization code?	3
Insurance broker name	DEWITT STERN GRP PLANNING SVCS

LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )

Policy contract number

000010123488

Policy instance

Insurance contract or identification number	000010123488
Number of Individuals Covered	448
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $5,001
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $103,470
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,001
Insurance broker organization code?	3
Insurance broker name	DEWITT STERN GRP PLANNING SVCS

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

TM05751958

Policy instance

Insurance contract or identification number	TM05751958
Number of Individuals Covered	169
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $1,466
Total amount of fees paid to insurance company	USD $10
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	ACCIDENTAL DEATH OR DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $14,340
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,466
Amount paid for insurance broker fees	10
Additional information about fees paid to insurance broker	NON-MONETARY COMPENSATION
Insurance broker organization code?	3
Insurance broker name	DEWITT STERN GRP PLANNING SVCS

FIDELITY SECURITY LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 67288 )

Policy contract number

9881723

Policy instance

Insurance contract or identification number	9881723
Number of Individuals Covered	322
Insurance policy start date	2013-06-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $9,350
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

0144168

Policy instance

Insurance contract or identification number	0144168
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $18,520
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $354,025
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,745
Insurance broker organization code?	3
Insurance broker name	CETERA ADVISOR NETWORKS LLC

LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )

Policy contract number

000010123487

Policy instance

Insurance contract or identification number	000010123487
Number of Individuals Covered	336
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $3,069
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH OR DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $60,633
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,069
Insurance broker organization code?	3
Insurance broker name	DEWITT STERN GRP PLANNING SVCS

OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

MP2809

Policy instance

Insurance contract or identification number	MP2809
Number of Individuals Covered	699
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $165,005
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,181,835
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $110,968
Insurance broker name	DEWITT STERN GRP PLANNING SVCS

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

0144168

Policy instance

Insurance contract or identification number	0144168
Number of Individuals Covered	171
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $5,753
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $362,047
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,753
Insurance broker organization code?	3
Insurance broker name	TOWER SQUARE SECURITIES INC

LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )

Policy contract number

000010123487

Policy instance

Insurance contract or identification number	000010123487
Number of Individuals Covered	292
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $2,949
Total amount of fees paid to insurance company	USD $1,879
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH OR DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $52,571
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,589
Amount paid for insurance broker fees	1879
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	DEWITT STERN GRP PLANNING SVCS

NATIONAL BENEFIT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61409 )

Policy contract number

8-910-0990954

Policy instance

Insurance contract or identification number	8-910-0990954
Number of Individuals Covered	363
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $2,560
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	SHORT-TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $21,577
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,560
Insurance broker organization code?	3
Insurance broker name	BWD AGENCY INC.

LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )

Policy contract number

000010123488

Policy instance

Insurance contract or identification number	000010123488
Number of Individuals Covered	396
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $4,980
Total amount of fees paid to insurance company	USD $3,514
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $97,950
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,627
Amount paid for insurance broker fees	3514
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	DEWITT STERN GRP PLANNING SVCS

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

TM05751958

Policy instance

Insurance contract or identification number	TM05751958
Number of Individuals Covered	157
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $1,471
Total amount of fees paid to insurance company	USD $274
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	ACCIDENTAL DEATH OR DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $14,287
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,203
Amount paid for insurance broker fees	261
Additional information about fees paid to insurance broker	SUPLEMENTAL AND NON-MONETARY COMPENSATION
Insurance broker organization code?	3
Insurance broker name	DEWITT STERN GRP PLANNING SVCS

CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )

Policy contract number

3329551

Policy instance

Insurance contract or identification number	3329551
Number of Individuals Covered	256
Insurance policy start date	2011-06-01
Insurance policy end date	2012-05-31
Total amount of commissions paid to insurance broker	USD $6,408
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $161,661
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,408
Insurance broker organization code?	3
Insurance broker name	BWD AGENCY INC.

LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )

Policy contract number

000010115728

Policy instance

Insurance contract or identification number	000010115728
Number of Individuals Covered	142
Insurance policy start date	2011-06-01
Insurance policy end date	2012-05-31
Total amount of commissions paid to insurance broker	USD $12,680
Total amount of fees paid to insurance company	USD $914
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	WEEKLY INCOME
Welfare Benefit Premiums Paid to Carrier	USD $84,535
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,680
Amount paid for insurance broker fees	914
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	BWD AGENCY INC.

STANDARD SECURITY LIFE (National Association of Insurance Commissioners NAIC id number: 69078 )

Policy contract number

9754912

Policy instance

Insurance contract or identification number	9754912
Number of Individuals Covered	262
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $1,583
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $15,770
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,189
Insurance broker organization code?	3
Insurance broker name	DEWITT STERN GRP PLANNING SVCS

OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

MP2809

Policy instance

Insurance contract or identification number	MP2809
Number of Individuals Covered	736
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $150,775
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,771,186
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

STANDARD SECURITY LIFE (National Association of Insurance Commissioners NAIC id number: 69078 )

Policy contract number

9754912

Policy instance

Insurance contract or identification number	9754912
Number of Individuals Covered	272
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $1,454
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $14,785
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

0144168

Policy instance

Insurance contract or identification number	0144168
Number of Individuals Covered	168
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $322,171
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )

Policy contract number

000010123487

Policy instance

Insurance contract or identification number	000010123487
Number of Individuals Covered	314
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $3,257
Total amount of fees paid to insurance company	USD $1,071
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH OR DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $62,647
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

NATIONAL BENEFIT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61409 )

Policy contract number

8-910-0990954

Policy instance

Insurance contract or identification number	8-910-0990954
Number of Individuals Covered	370
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $2,724
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	SHORT-TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $23,908
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )

Policy contract number

000010123488

Policy instance

Insurance contract or identification number	000010123488
Number of Individuals Covered	420
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $5,086
Total amount of fees paid to insurance company	USD $2,068
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $117,118
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )

Policy contract number

000010115728

Policy instance

Insurance contract or identification number	000010115728
Number of Individuals Covered	154
Insurance policy start date	2010-06-01
Insurance policy end date	2011-05-31
Total amount of commissions paid to insurance broker	USD $7,287
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	WEEKLY INCOME
Welfare Benefit Premiums Paid to Carrier	USD $48,582
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 number

3329551

Policy instance

Insurance contract or identification number	3329551
Number of Individuals Covered	259
Insurance policy start date	2010-06-01
Insurance policy end date	2011-05-31
Total amount of commissions paid to insurance broker	USD $6,465
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $163,145
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

TM05751958

Policy instance

Insurance contract or identification number	TM05751958
Number of Individuals Covered	162
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $1,492
Total amount of fees paid to insurance company	USD $310
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH OR DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $14,932
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )

Policy contract number

000064774481

Policy instance

Insurance contract or identification number	000064774481
Number of Individuals Covered	416
Insurance policy start date	2009-04-30
Insurance policy end date	2010-04-30
Total amount of commissions paid to insurance broker	USD $225
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH OR DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $1,500
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $225
Insurance broker organization code?	3
Insurance broker name	BWD GROUP LLC

THE FIRST REHABILITATION LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 81434 )

Policy contract number

D316512

Policy instance

Insurance contract or identification number	D316512
Number of Individuals Covered	365
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $419
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	GROUP DISABILITY PLAN
Welfare Benefit Premiums Paid to Carrier	USD $9,273
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $419
Insurance broker organization code?	3
Insurance broker name	BWD AGENCY INC.

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

0144168

Policy instance

Insurance contract or identification number	0144168
Number of Individuals Covered	154
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $266,689
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )

Policy contract number

000010123487

Policy instance

Insurance contract or identification number	000010123487
Number of Individuals Covered	307
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $2,963
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH OR DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $53,540
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,963
Insurance broker organization code?	3
Insurance broker name	BWD AGENCY INC.

NATIONAL BENEFIT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61409 )

Policy contract number

0990954

Policy instance

Insurance contract or identification number	0990954
Number of Individuals Covered	399
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $1,755
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	SHORT-TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $10,067
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,755
Insurance broker organization code?	3
Insurance broker name	BWD GROUP LLC

LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )

Policy contract number

000010123488

Policy instance

Insurance contract or identification number	000010123488
Number of Individuals Covered	406
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $5,017
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $103,388
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,017
Insurance broker organization code?	3
Insurance broker name	BWD AGENCY INC.

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

TM05751958

Policy instance

Insurance contract or identification number	TM05751958
Number of Individuals Covered	150
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $1,301
Total amount of fees paid to insurance company	USD $110
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH OR DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $13,694
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,301
Amount paid for insurance broker fees	110
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	BWD AGENCY INC.

STANDARD SECURITY LIFE (National Association of Insurance Commissioners NAIC id number: 69078 )

Policy contract number

9754912

Policy instance

Insurance contract or identification number	9754912
Number of Individuals Covered	227
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $1,325
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $13,505
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,325
Insurance broker organization code?	3
Insurance broker name	BWD AGENCY INC.

LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )

Policy contract number

000010115728

Policy instance

Insurance contract or identification number	000010115728
Number of Individuals Covered	140
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $6,855
Total amount of fees paid to insurance company	USD $567
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	WEEKLY INCOME
Welfare Benefit Premiums Paid to Carrier	USD $45,699
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,855
Amount paid for insurance broker fees	567
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	BWD AGENCY INC.

CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )

Policy contract number

3329551

Policy instance

Insurance contract or identification number	3329551
Number of Individuals Covered	252
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $6,500
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $164,051
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,500
Additional information about fees paid to insurance broker	GENERAL AGENT PAYMENTS
Insurance broker organization code?	3
Insurance broker name	BWD AGENCY INC.

OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

MP2809

Policy instance

Insurance contract or identification number	MP2809
Number of Individuals Covered	742
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $150,254
Total amount of fees paid to insurance company	USD $107
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,776,804
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $150,254
Amount paid for insurance broker fees	107
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3
Insurance broker name	BWD AGENCY INC.

THE FIRST REHABILITATION LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 81434 )

Policy contract number

GMNY5906

Policy instance

Insurance contract or identification number	GMNY5906
Number of Individuals Covered	35
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $2,942
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	GROUP MEDICAL REIMBURSEMENT PLAN
Welfare Benefit Premiums Paid to Carrier	USD $150,811
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,942
Insurance broker organization code?	3
Insurance broker name	BWD AGENCY INC.

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Company Name:	MARKS PANETH LLP
Employer identification number (EIN):	113518842
NAIC Classification:	541211
NAIC Description:	Offices of Certified Public Accountants

Jurisdiction of Incorporation:	New York Department of State
Incorporation Date:	1995-02-10
Company Identification Number:	1893675
Legal Registered Office Address:	685 THIRD AVENUE NEW YORK United States of America (USA) 10017