COMPONENT ASSEMBLY SYSTEMS (AD&D/LIFE) has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan COMPONENT ASSEMBLY SYSTEMS, INC. AD&D PLAN & LIFE INSURANCE PLAN
401k plan membership statisitcs for COMPONENT ASSEMBLY SYSTEMS, INC. AD&D PLAN & LIFE INSURANCE PLAN
| Measure | Date | Value |
|---|
| 2022: COMPONENT ASSEMBLY SYSTEMS, INC. AD&D PLAN & LIFE INSURANCE PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-03-01 | 143 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-03-01 | 137 |
| Total of all active and inactive participants | 2022-03-01 | 137 |
| 2021: COMPONENT ASSEMBLY SYSTEMS, INC. AD&D PLAN & LIFE INSURANCE PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-03-01 | 142 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-03-01 | 143 |
| Total of all active and inactive participants | 2021-03-01 | 143 |
| 2020: COMPONENT ASSEMBLY SYSTEMS, INC. AD&D PLAN & LIFE INSURANCE PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-03-01 | 131 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-03-01 | 142 |
| Total of all active and inactive participants | 2020-03-01 | 142 |
| 2019: COMPONENT ASSEMBLY SYSTEMS, INC. AD&D PLAN & LIFE INSURANCE PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-03-01 | 114 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-03-01 | 131 |
| Total of all active and inactive participants | 2019-03-01 | 131 |
| 2018: COMPONENT ASSEMBLY SYSTEMS, INC. AD&D PLAN & LIFE INSURANCE PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-03-01 | 117 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-03-01 | 114 |
| Total of all active and inactive participants | 2018-03-01 | 114 |
| 2017: COMPONENT ASSEMBLY SYSTEMS, INC. AD&D PLAN & LIFE INSURANCE PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-03-01 | 114 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-03-01 | 117 |
| Total of all active and inactive participants | 2017-03-01 | 117 |
| 2016: COMPONENT ASSEMBLY SYSTEMS, INC. AD&D PLAN & LIFE INSURANCE PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-03-01 | 116 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-03-01 | 114 |
| Total of all active and inactive participants | 2016-03-01 | 114 |
| 2015: COMPONENT ASSEMBLY SYSTEMS, INC. AD&D PLAN & LIFE INSURANCE PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-03-01 | 109 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-03-01 | 116 |
| Total of all active and inactive participants | 2015-03-01 | 116 |
| 2014: COMPONENT ASSEMBLY SYSTEMS, INC. AD&D PLAN & LIFE INSURANCE PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-03-01 | 106 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-03-01 | 109 |
| Total of all active and inactive participants | 2014-03-01 | 109 |
| 2013: COMPONENT ASSEMBLY SYSTEMS, INC. AD&D PLAN & LIFE INSURANCE PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-03-01 | 105 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-03-01 | 106 |
| Total of all active and inactive participants | 2013-03-01 | 106 |
| 2012: COMPONENT ASSEMBLY SYSTEMS, INC. AD&D PLAN & LIFE INSURANCE PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-03-01 | 103 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-03-01 | 105 |
| Total of all active and inactive participants | 2012-03-01 | 105 |
| 2011: COMPONENT ASSEMBLY SYSTEMS, INC. AD&D PLAN & LIFE INSURANCE PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-03-01 | 106 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-03-01 | 103 |
| Total of all active and inactive participants | 2011-03-01 | 103 |
| 2010: COMPONENT ASSEMBLY SYSTEMS, INC. AD&D PLAN & LIFE INSURANCE PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-03-01 | 113 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-03-01 | 106 |
| Total of all active and inactive participants | 2010-03-01 | 106 |
| 2009: COMPONENT ASSEMBLY SYSTEMS, INC. AD&D PLAN & LIFE INSURANCE PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-03-01 | 122 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-03-01 | 113 |
| Total of all active and inactive participants | 2009-03-01 | 113 |
| 2022: COMPONENT ASSEMBLY SYSTEMS, INC. AD&D PLAN & LIFE INSURANCE PLAN 2022 form 5500 responses |
|---|
| 2022-03-01 | Type of plan entity | Single employer plan |
| 2022-03-01 | Plan funding arrangement – Insurance | Yes |
| 2022-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2021: COMPONENT ASSEMBLY SYSTEMS, INC. AD&D PLAN & LIFE INSURANCE PLAN 2021 form 5500 responses |
|---|
| 2021-03-01 | Type of plan entity | Single employer plan |
| 2021-03-01 | Plan funding arrangement – Insurance | Yes |
| 2021-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: COMPONENT ASSEMBLY SYSTEMS, INC. AD&D PLAN & LIFE INSURANCE PLAN 2020 form 5500 responses |
|---|
| 2020-03-01 | Type of plan entity | Single employer plan |
| 2020-03-01 | Plan funding arrangement – Insurance | Yes |
| 2020-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: COMPONENT ASSEMBLY SYSTEMS, INC. AD&D PLAN & LIFE INSURANCE PLAN 2019 form 5500 responses |
|---|
| 2019-03-01 | Type of plan entity | Single employer plan |
| 2019-03-01 | Plan funding arrangement – Insurance | Yes |
| 2019-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: COMPONENT ASSEMBLY SYSTEMS, INC. AD&D PLAN & LIFE INSURANCE PLAN 2018 form 5500 responses |
|---|
| 2018-03-01 | Type of plan entity | Single employer plan |
| 2018-03-01 | Plan funding arrangement – Insurance | Yes |
| 2018-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: COMPONENT ASSEMBLY SYSTEMS, INC. AD&D PLAN & LIFE INSURANCE PLAN 2017 form 5500 responses |
|---|
| 2017-03-01 | Type of plan entity | Single employer plan |
| 2017-03-01 | Plan funding arrangement – Insurance | Yes |
| 2017-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: COMPONENT ASSEMBLY SYSTEMS, INC. AD&D PLAN & LIFE INSURANCE PLAN 2016 form 5500 responses |
|---|
| 2016-03-01 | Type of plan entity | Single employer plan |
| 2016-03-01 | Plan funding arrangement – Insurance | Yes |
| 2016-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: COMPONENT ASSEMBLY SYSTEMS, INC. AD&D PLAN & LIFE INSURANCE PLAN 2015 form 5500 responses |
|---|
| 2015-03-01 | Type of plan entity | Single employer plan |
| 2015-03-01 | Plan funding arrangement – Insurance | Yes |
| 2015-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: COMPONENT ASSEMBLY SYSTEMS, INC. AD&D PLAN & LIFE INSURANCE PLAN 2014 form 5500 responses |
|---|
| 2014-03-01 | Type of plan entity | Single employer plan |
| 2014-03-01 | Plan funding arrangement – Insurance | Yes |
| 2014-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: COMPONENT ASSEMBLY SYSTEMS, INC. AD&D PLAN & LIFE INSURANCE PLAN 2013 form 5500 responses |
|---|
| 2013-03-01 | Type of plan entity | Single employer plan |
| 2013-03-01 | Plan funding arrangement – Insurance | Yes |
| 2013-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: COMPONENT ASSEMBLY SYSTEMS, INC. AD&D PLAN & LIFE INSURANCE PLAN 2012 form 5500 responses |
|---|
| 2012-03-01 | Type of plan entity | Single employer plan |
| 2012-03-01 | Plan funding arrangement – Insurance | Yes |
| 2012-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: COMPONENT ASSEMBLY SYSTEMS, INC. AD&D PLAN & LIFE INSURANCE PLAN 2011 form 5500 responses |
|---|
| 2011-03-01 | Type of plan entity | Single employer plan |
| 2011-03-01 | Plan funding arrangement – Insurance | Yes |
| 2011-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2010: COMPONENT ASSEMBLY SYSTEMS, INC. AD&D PLAN & LIFE INSURANCE PLAN 2010 form 5500 responses |
|---|
| 2010-03-01 | Type of plan entity | Single employer plan |
| 2010-03-01 | Plan funding arrangement – Insurance | Yes |
| 2010-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: COMPONENT ASSEMBLY SYSTEMS, INC. AD&D PLAN & LIFE INSURANCE PLAN 2009 form 5500 responses |
|---|
| 2009-03-01 | Type of plan entity | Single employer plan |
| 2009-03-01 | This submission is the final filing | No |
| 2009-03-01 | Plan funding arrangement – Insurance | Yes |
| 2009-03-01 | Plan benefit arrangement – Insurance | Yes |
| COMPANION LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62243 ) |
| Policy contract number | G000AGW3 |
| Policy instance | 2 |
| Insurance contract or identification number | G000AGW3 | | Number of Individuals Covered | 137 | | Insurance policy start date | 2022-03-01 | | Insurance policy end date | 2023-02-28 | | Total amount of commissions paid to insurance broker | USD $2,145 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $21,451 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,145 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 ) |
| Policy contract number | G000AGW3 |
| Policy instance | 1 |
| Insurance contract or identification number | G000AGW3 | | Number of Individuals Covered | 137 | | Insurance policy start date | 2022-03-01 | | Insurance policy end date | 2023-02-28 | | Total amount of commissions paid to insurance broker | USD $238 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,384 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $238 | | Insurance broker organization code? | 3 |
|
| COMPANION LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62243 ) |
| Policy contract number | G000AGW3 |
| Policy instance | 2 |
| Insurance contract or identification number | G000AGW3 | | Number of Individuals Covered | 143 | | Insurance policy start date | 2021-03-01 | | Insurance policy end date | 2022-02-28 | | Total amount of commissions paid to insurance broker | USD $2,173 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $21,735 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,173 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 ) |
| Policy contract number | G000AGW3 |
| Policy instance | 1 |
| Insurance contract or identification number | G000AGW3 | | Number of Individuals Covered | 143 | | Insurance policy start date | 2021-03-01 | | Insurance policy end date | 2022-02-28 | | Total amount of commissions paid to insurance broker | USD $242 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,416 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $242 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 ) |
| Policy contract number | G000AGW3 |
| Policy instance | 1 |
| Insurance contract or identification number | G000AGW3 | | Number of Individuals Covered | 142 | | Insurance policy start date | 2020-03-01 | | Insurance policy end date | 2021-02-28 | | Total amount of commissions paid to insurance broker | USD $231 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,312 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $231 | | Insurance broker organization code? | 3 |
|
| COMPANION LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62243 ) |
| Policy contract number | G000AGW3 |
| Policy instance | 2 |
| Insurance contract or identification number | G000AGW3 | | Number of Individuals Covered | 142 | | Insurance policy start date | 2020-03-01 | | Insurance policy end date | 2021-02-28 | | Total amount of commissions paid to insurance broker | USD $2,080 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $20,804 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,080 | | Insurance broker organization code? | 3 |
|
| COMPANION LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62243 ) |
| Policy contract number | G000AGW3 |
| Policy instance | 2 |
| Insurance contract or identification number | G000AGW3 | | Number of Individuals Covered | 131 | | Insurance policy start date | 2019-03-01 | | Insurance policy end date | 2020-02-29 | | Total amount of commissions paid to insurance broker | USD $1,811 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $18,113 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,811 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 ) |
| Policy contract number | G000AGW3 |
| Policy instance | 1 |
| Insurance contract or identification number | G000AGW3 | | Number of Individuals Covered | 131 | | Insurance policy start date | 2019-03-01 | | Insurance policy end date | 2020-02-29 | | Total amount of commissions paid to insurance broker | USD $201 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,013 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $201 | | Insurance broker organization code? | 3 |
|
| COMPANION LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62243 ) |
| Policy contract number | G000AGW3 |
| Policy instance | 2 |
| Insurance contract or identification number | G000AGW3 | | Number of Individuals Covered | 114 | | Insurance policy start date | 2018-03-01 | | Insurance policy end date | 2019-02-28 | | Total amount of commissions paid to insurance broker | USD $1,656 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $16,557 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,656 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 ) |
| Policy contract number | G000AGW3 |
| Policy instance | 1 |
| Insurance contract or identification number | G000AGW3 | | Number of Individuals Covered | 114 | | Insurance policy start date | 2018-03-01 | | Insurance policy end date | 2019-02-28 | | Total amount of commissions paid to insurance broker | USD $184 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,840 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $184 | | Insurance broker organization code? | 3 |
|
| COMPANION LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62243 ) |
| Policy contract number | G000AGW3 |
| Policy instance | 2 |
| Insurance contract or identification number | G000AGW3 | | Number of Individuals Covered | 117 | | Insurance policy start date | 2017-03-01 | | Insurance policy end date | 2018-02-28 | | Total amount of commissions paid to insurance broker | USD $1,725 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $17,246 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,725 | | Insurance broker organization code? | 3 | | Insurance broker name | AXIS BENEFITS GROUP, INC. |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 ) |
| Policy contract number | G000AGW3 |
| Policy instance | 1 |
| Insurance contract or identification number | G000AGW3 | | Number of Individuals Covered | 117 | | Insurance policy start date | 2017-03-01 | | Insurance policy end date | 2018-02-28 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $192 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,917 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 192 | | Insurance broker organization code? | 3 | | Insurance broker name | AXIS BENEFITS GROUP, INC. |
|
| COMPANION LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62243 ) |
| Policy contract number | G000AGW3 |
| Policy instance | 2 |
| Insurance contract or identification number | G000AGW3 | | Number of Individuals Covered | 116 | | Insurance policy start date | 2015-03-01 | | Insurance policy end date | 2016-02-28 | | Total amount of commissions paid to insurance broker | USD $1,458 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $14,580 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,458 | | Insurance broker organization code? | 3 | | Insurance broker name | AXIS BENEFITS GROUP, INC. |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 ) |
| Policy contract number | G000AGW3 |
| Policy instance | 1 |
| Insurance contract or identification number | G000AGW3 | | Number of Individuals Covered | 116 | | Insurance policy start date | 2015-03-01 | | Insurance policy end date | 2016-02-28 | | Total amount of commissions paid to insurance broker | USD $186 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,856 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $186 | | Insurance broker organization code? | 3 | | Insurance broker name | AXIS BENEFITS GROUP, INC. |
|
| COMPANION LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62243 ) |
| Policy contract number | G000AGW3 |
| Policy instance | 2 |
| Insurance contract or identification number | G000AGW3 | | Insurance policy start date | 2014-03-01 | | Insurance policy end date | 2015-02-28 | | Total amount of commissions paid to insurance broker | USD $1,146 | | 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 $11,461 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,146 | | Insurance broker organization code? | 3 | | Insurance broker name | AXIS BENEFITS GROUP, INC. |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 ) |
| Policy contract number | G000AGW3 |
| Policy instance | 1 |
| Insurance contract or identification number | G000AGW3 | | Number of Individuals Covered | 109 | | Insurance policy start date | 2014-03-01 | | Insurance policy end date | 2015-02-28 | | Total amount of commissions paid to insurance broker | USD $172 | | 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 $1,720 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $172 | | Insurance broker organization code? | 3 | | Insurance broker name | AXIS BENEFITS GROUP, INC. |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 ) |
| Policy contract number | G000AGW3 |
| Policy instance | 1 |
| Insurance contract or identification number | G000AGW3 | | Number of Individuals Covered | 106 | | Insurance policy start date | 2013-03-01 | | Insurance policy end date | 2014-02-28 | | Total amount of commissions paid to insurance broker | USD $169 | | 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 $1,695 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $169 | | Insurance broker organization code? | 3 | | Insurance broker name | AXIS BENEFITS GROUP, INC. |
|
| COMPANION LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62243 ) |
| Policy contract number | G000AGW3 |
| Policy instance | 2 |
| Insurance contract or identification number | G000AGW3 | | Number of Individuals Covered | 106 | | Insurance policy start date | 2013-03-01 | | Insurance policy end date | 2014-02-28 | | Total amount of commissions paid to insurance broker | USD $1,129 | | 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 $11,294 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,129 | | Insurance broker organization code? | 3 | | Insurance broker name | AXIS BENEFITS GROUP, INC. |
|
| COMPANION LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62243 ) |
| Policy contract number | G000AGW3 |
| Policy instance | 2 |
| Insurance contract or identification number | G000AGW3 | | Number of Individuals Covered | 105 | | Insurance policy start date | 2012-03-01 | | Insurance policy end date | 2013-02-28 | | Total amount of commissions paid to insurance broker | USD $1,141 | | 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 $11,408 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,141 | | Insurance broker organization code? | 3 | | Insurance broker name | AXIS BENEFITS GROUP, INC. |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 ) |
| Policy contract number | G000AGW3 |
| Policy instance | 1 |
| Insurance contract or identification number | G000AGW3 | | Number of Individuals Covered | 105 | | Insurance policy start date | 2012-03-01 | | Insurance policy end date | 2013-02-28 | | Total amount of commissions paid to insurance broker | USD $171 | | 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 $1,712 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $171 | | Insurance broker organization code? | 3 | | Insurance broker name | AXIS BENEFITS GROUP, INC. |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 ) |
| Policy contract number | G000AGW3 |
| Policy instance | 1 |
| Insurance contract or identification number | G000AGW3 | | Number of Individuals Covered | 103 | | Insurance policy start date | 2011-03-01 | | Insurance policy end date | 2012-02-29 | | Total amount of commissions paid to insurance broker | USD $212 | | 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 $1,710 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| COMPANION LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62243 ) |
| Policy contract number | G000AGW3 |
| Policy instance | 2 |
| Insurance contract or identification number | G000AGW3 | | Number of Individuals Covered | 103 | | Insurance policy start date | 2011-03-01 | | Insurance policy end date | 2012-02-29 | | Total amount of commissions paid to insurance broker | USD $1,410 | | 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 $11,396 | | 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 | 000010049980 |
| Policy instance | 1 |
| Insurance contract or identification number | 000010049980 | | Number of Individuals Covered | 106 | | Insurance policy start date | 2010-03-01 | | Insurance policy end date | 2011-02-28 | | Total amount of commissions paid to insurance broker | USD $1,657 | | 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 $13,472 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
