VOXX INTERNATIONAL CORPORATION has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan VOXX INTERNATIONAL CORPORATION GROUP BENEFITS PLAN
401k plan membership statisitcs for VOXX INTERNATIONAL CORPORATION GROUP BENEFITS PLAN
| HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | X25001 |
| Policy instance | 5 |
| Insurance contract or identification number | X25001 | | Number of Individuals Covered | 728 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $3,250 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $32,499 | | Commission paid to Insurance Broker | USD $3,250 | | 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 | R0719922 |
| Policy instance | 9 |
| Insurance contract or identification number | R0719922 | | Number of Individuals Covered | 68 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2023-01-01 | | Total amount of commissions paid to insurance broker | USD $308 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | STD | | Welfare Benefit Premiums Paid to Carrier | USD $3,691 | | Commission paid to Insurance Broker | USD $6 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| METROPOLITAN PROPERTY AND CASUALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26298 ) |
| Policy contract number | 9900799 |
| Policy instance | 8 |
| Insurance contract or identification number | 9900799 | | Number of Individuals Covered | 15 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-09-30 | | Total amount of commissions paid to insurance broker | USD $321 | | Total amount of fees paid to insurance company | USD $38 | | Other welfare benefits provided | LEGAL | | Welfare Benefit Premiums Paid to Carrier | USD $3,150 | | Commission paid to Insurance Broker | USD $321 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 3342409 |
| Policy instance | 7 |
| Insurance contract or identification number | 3342409 | | Number of Individuals Covered | 689 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of fees paid to insurance company | USD $105,639 | | Welfare Benefit Premiums Paid to Carrier | USD $1,138,660 | | Amount paid for insurance broker fees | 105639 | | Additional information about fees paid to insurance broker | MEDICAL | | Insurance broker organization code? | 3 |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 07288R |
| Policy instance | 6 |
| Insurance contract or identification number | 07288R | | Insurance policy start date | 2021-10-01 | | Insurance policy end date | 2022-10-01 | | Total amount of fees paid to insurance company | USD $14 | | Other welfare benefits provided | LEGAL | | Amount paid for insurance broker fees | 7 | | Additional information about fees paid to insurance broker | UNALLOC GAINS | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0140630 |
| Policy instance | 4 |
| Insurance contract or identification number | 0140630 | | Number of Individuals Covered | 267 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $228,792 |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 0818735 |
| Policy instance | 3 |
| Insurance contract or identification number | 0818735 | | Number of Individuals Covered | 764 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $12,961 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $258,966 | | Commission paid to Insurance Broker | USD $12,961 | | Insurance broker organization code? | 3 |
|
| AMERICAN FAMILY LIFE INSURANCE COMPANY OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | AP622 |
| Policy instance | 2 |
| Insurance contract or identification number | AP622 | | Number of Individuals Covered | 5 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $439 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | CANCER PROTECTION PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $3,922 | | Commission paid to Insurance Broker | USD $8 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| AMERICAN FAMILY LIFE INSURANCE COMPANY OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | N9565 |
| Policy instance | 1 |
| Insurance contract or identification number | N9565 | | Number of Individuals Covered | 26 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $2,061 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | CANCER PROTECTION PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $20,850 | | Commission paid to Insurance Broker | USD $57 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 ) |
| Policy contract number | GMC 0BT2X |
| Policy instance | 21 |
| Insurance contract or identification number | GMC 0BT2X | | Number of Individuals Covered | 28 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2023-01-01 | | Total amount of commissions paid to insurance broker | USD $687 | | Other welfare benefits provided | SHORT TERM DISABILITY | | Welfare Benefit Premiums Paid to Carrier | USD $6,872 | | Commission paid to Insurance Broker | USD $687 | | Insurance broker organization code? | 3 |
|
| JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 ) |
| Policy contract number | 30502 |
| Policy instance | 10 |
| Insurance contract or identification number | 30502 | | Number of Individuals Covered | 8 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $201 | | Other welfare benefits provided | LONG-TERM CARE | | Welfare Benefit Premiums Paid to Carrier | USD $10,805 | | 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 | GCEL0BT2X |
| Policy instance | 11 |
| Insurance contract or identification number | GCEL0BT2X | | Number of Individuals Covered | 123 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2023-01-01 | | Total amount of commissions paid to insurance broker | USD $12,295 | | Total amount of fees paid to insurance company | USD $2,247 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $61,475 | | Commission paid to Insurance Broker | USD $12,295 | | Amount paid for insurance broker fees | 2247 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 ) |
| Policy contract number | GMDHOBT2X |
| Policy instance | 20 |
| Insurance contract or identification number | GMDHOBT2X | | Number of Individuals Covered | 59 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2023-01-01 | | Total amount of commissions paid to insurance broker | USD $1,227 | | Other welfare benefits provided | ACCIDENT ONLY VOLUNTARY | | Welfare Benefit Premiums Paid to Carrier | USD $12,265 | | Commission paid to Insurance Broker | USD $1,227 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 ) |
| Policy contract number | GMDE0BT2X |
| Policy instance | 19 |
| Insurance contract or identification number | GMDE0BT2X | | Number of Individuals Covered | 44 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2023-01-01 | | Total amount of commissions paid to insurance broker | USD $1,761 | | Other welfare benefits provided | CRITICAL ILLNESS VOLUNTARY | | Welfare Benefit Premiums Paid to Carrier | USD $17,613 | | Commission paid to Insurance Broker | USD $1,761 | | Insurance broker organization code? | 3 |
|
| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
| Policy contract number | 0011705540 |
| Policy instance | 18 |
| Insurance contract or identification number | 0011705540 | | Number of Individuals Covered | 12 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2023-01-01 | | Total amount of commissions paid to insurance broker | USD $108 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $807 | | Commission paid to Insurance Broker | USD $27 | | Insurance broker organization code? | 3 |
|
| METROPOLITAN GENERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 39950 ) |
| Policy contract number | 9900799 |
| Policy instance | 17 |
| Insurance contract or identification number | 9900799 | | Number of Individuals Covered | 15 | | Insurance policy start date | 2022-10-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $95 | | Other welfare benefits provided | LEGAL | | Welfare Benefit Premiums Paid to Carrier | USD $1,260 | | Commission paid to Insurance Broker | USD $95 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 ) |
| Policy contract number | MP 0BT2X |
| Policy instance | 16 |
| Insurance contract or identification number | MP 0BT2X | | Number of Individuals Covered | 557 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2023-01-01 | | Total amount of commissions paid to insurance broker | USD $1,328 | | Total amount of fees paid to insurance company | USD $382 | | Other welfare benefits provided | AD&D W LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $12,076 | | Commission paid to Insurance Broker | USD $1,328 | | Amount paid for insurance broker fees | 382 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 ) |
| Policy contract number | GMT 0BT2X |
| Policy instance | 15 |
| Insurance contract or identification number | GMT 0BT2X | | Number of Individuals Covered | 514 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2023-01-01 | | Total amount of commissions paid to insurance broker | USD $4,590 | | Total amount of fees paid to insurance company | USD $2,611 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $76,499 | | Commission paid to Insurance Broker | USD $4,590 | | Amount paid for insurance broker fees | 2611 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 ) |
| Policy contract number | GMG 0BT2X |
| Policy instance | 14 |
| Insurance contract or identification number | GMG 0BT2X | | Number of Individuals Covered | 514 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2023-01-01 | | Total amount of fees paid to insurance company | USD $2,285 | | Other welfare benefits provided | SHORT TERM DISABILITY | | Welfare Benefit Premiums Paid to Carrier | USD $51,884 | | Amount paid for insurance broker fees | 2285 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 ) |
| Policy contract number | GMAD0BT2X |
| Policy instance | 13 |
| Insurance contract or identification number | GMAD0BT2X | | Number of Individuals Covered | 123 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2023-01-01 | | Total amount of commissions paid to insurance broker | USD $797 | | Total amount of fees paid to insurance company | USD $146 | | Other welfare benefits provided | AD&D VOLUNTARY | | Welfare Benefit Premiums Paid to Carrier | USD $3,983 | | Commission paid to Insurance Broker | USD $797 | | Amount paid for insurance broker fees | 146 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| COMPANION LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62243 ) |
| Policy contract number | GLCL0BT2X |
| Policy instance | 12 |
| Insurance contract or identification number | GLCL0BT2X | | Number of Individuals Covered | 557 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2023-01-01 | | Total amount of commissions paid to insurance broker | USD $19,652 | | Total amount of fees paid to insurance company | USD $5,735 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $178,652 | | Commission paid to Insurance Broker | USD $19,652 | | Amount paid for insurance broker fees | 5735 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| COMPANION LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62243 ) |
| Policy contract number | GLCL0BT2X |
| Policy instance | 12 |
| Insurance contract or identification number | GLCL0BT2X | | Number of Individuals Covered | 623 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2022-01-01 | | Total amount of commissions paid to insurance broker | USD $20,232 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $183,929 | | Commission paid to Insurance Broker | USD $20,232 | | Insurance broker organization code? | 3 |
|
| AMERICAN FAMILY LIFE INSURANCE COMPANY OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | AP622 |
| Policy instance | 2 |
| Insurance contract or identification number | AP622 | | 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 $464 | | Other welfare benefits provided | CANCER PROTECTION PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $4,249 | | Commission paid to Insurance Broker | USD $8 | | Insurance broker organization code? | 3 |
|
| AMERICAN FAMILY LIFE INSURANCE COMPANY OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | N9565 |
| Policy instance | 1 |
| Insurance contract or identification number | N9565 | | Number of Individuals Covered | 28 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $3,003 | | Other welfare benefits provided | CANCER PROTECTION PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $22,251 | | Commission paid to Insurance Broker | USD $72 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 ) |
| Policy contract number | GMT 0BT2X |
| Policy instance | 15 |
| Insurance contract or identification number | GMT 0BT2X | | Number of Individuals Covered | 578 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2022-01-01 | | Total amount of commissions paid to insurance broker | USD $4,710 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $78,495 | | Commission paid to Insurance Broker | USD $4,710 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 ) |
| Policy contract number | GMG 0BT2X |
| Policy instance | 14 |
| Insurance contract or identification number | GMG 0BT2X | | Number of Individuals Covered | 578 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2022-01-01 | | Other welfare benefits provided | SHORT TERM DISABILITY | | Welfare Benefit Premiums Paid to Carrier | USD $89,750 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 ) |
| Policy contract number | GMAD0BT2X |
| Policy instance | 13 |
| Insurance contract or identification number | GMAD0BT2X | | Number of Individuals Covered | 140 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2022-01-01 | | Total amount of commissions paid to insurance broker | USD $893 | | Other welfare benefits provided | AD&D VOLUNTARY | | Welfare Benefit Premiums Paid to Carrier | USD $4,463 | | Commission paid to Insurance Broker | USD $893 | | Insurance broker organization code? | 3 |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 0818735 |
| Policy instance | 3 |
| Insurance contract or identification number | 0818735 | | Number of Individuals Covered | 738 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $15,417 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $286,590 | | Commission paid to Insurance Broker | USD $15,417 | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0140630 |
| Policy instance | 4 |
| Insurance contract or identification number | 0140630 | | Number of Individuals Covered | 282 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $209,952 |
|
| HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | X25001 |
| Policy instance | 5 |
| Insurance contract or identification number | X25001 | | Number of Individuals Covered | 750 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $3,679 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $36,795 | | Commission paid to Insurance Broker | USD $3,679 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 ) |
| Policy contract number | MP 0BT2X |
| Policy instance | 16 |
| Insurance contract or identification number | MP 0BT2X | | Number of Individuals Covered | 622 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2022-01-01 | | Total amount of commissions paid to insurance broker | USD $1,349 | | Other welfare benefits provided | AD&D W LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $12,262 | | Commission paid to Insurance Broker | USD $1,349 | | Insurance broker organization code? | 3 |
|
| COMPANION LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62243 ) |
| Policy contract number | GCEL0BT2X |
| Policy instance | 11 |
| Insurance contract or identification number | GCEL0BT2X | | Number of Individuals Covered | 140 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2022-01-01 | | Total amount of commissions paid to insurance broker | USD $11,975 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $59,875 | | Commission paid to Insurance Broker | USD $11,975 | | Insurance broker organization code? | 3 |
|
| JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 ) |
| Policy contract number | 30502 |
| Policy instance | 10 |
| Insurance contract or identification number | 30502 | | Number of Individuals Covered | 8 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $201 | | Other welfare benefits provided | LONG-TERM CARE | | Welfare Benefit Premiums Paid to Carrier | USD $10,805 | | Commission paid to Insurance Broker | USD $201 | | Insurance broker organization code? | 3 |
|
| FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 ) |
| Policy contract number | R0719922 |
| Policy instance | 9 |
| Insurance contract or identification number | R0719922 | | Number of Individuals Covered | 81 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2022-01-01 | | Total amount of commissions paid to insurance broker | USD $2,034 | | Other welfare benefits provided | STD | | Welfare Benefit Premiums Paid to Carrier | USD $23,418 | | Commission paid to Insurance Broker | USD $329 | | Insurance broker organization code? | 3 |
|
| METROPOLITAN PROPERTY AND CASUALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26298 ) |
| Policy contract number | 9900799 |
| Policy instance | 8 |
| Insurance contract or identification number | 9900799 | | Number of Individuals Covered | 16 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $384 | | Total amount of fees paid to insurance company | USD $50 | | Other welfare benefits provided | LEGAL | | Welfare Benefit Premiums Paid to Carrier | USD $3,486 | | Commission paid to Insurance Broker | USD $384 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 50 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 3342409 |
| Policy instance | 7 |
| Insurance contract or identification number | 3342409 | | Number of Individuals Covered | 696 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of fees paid to insurance company | USD $106,859 | | Welfare Benefit Premiums Paid to Carrier | USD $1,079,745 | | Amount paid for insurance broker fees | 106859 | | Additional information about fees paid to insurance broker | MEDICAL | | Insurance broker organization code? | 3 |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 07288R |
| Policy instance | 6 |
| Insurance contract or identification number | 07288R | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2021-10-01 | | Total amount of fees paid to insurance company | USD $14 | | Other welfare benefits provided | LEGAL | | Amount paid for insurance broker fees | 7 | | Additional information about fees paid to insurance broker | UNALLOC GAINS | | Insurance broker organization code? | 3 |
|
| HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | X25001 |
| Policy instance | 6 |
| Insurance contract or identification number | X25001 | | Number of Individuals Covered | 741 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $3,304 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $33,037 | | Commission paid to Insurance Broker | USD $3,304 | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0140630 |
| Policy instance | 5 |
| Insurance contract or identification number | 0140630 | | Number of Individuals Covered | 277 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $206,357 |
|
| FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 ) |
| Policy contract number | 223166 |
| Policy instance | 4 |
| Insurance contract or identification number | 223166 | | Number of Individuals Covered | 506 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $3,888 | | Total amount of fees paid to insurance company | USD $1,172 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $93,779 | | Commission paid to Insurance Broker | USD $3,888 | | Amount paid for insurance broker fees | 1172 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| AMERICAN FAMILY LIFE INSURANCE COMPANY OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | AP622 |
| Policy instance | 2 |
| Insurance contract or identification number | AP622 | | Number of Individuals Covered | 5 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $452 | | Other welfare benefits provided | CANCER PROTECTION PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $3,955 | | Commission paid to Insurance Broker | USD $5 | | Insurance broker organization code? | 3 |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 0818735 |
| Policy instance | 3 |
| Insurance contract or identification number | 0818735 | | Number of Individuals Covered | 752 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $13,448 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $259,518 | | Commission paid to Insurance Broker | USD $13,448 | | Insurance broker organization code? | 3 |
|
| AMERICAN FAMILY LIFE INSURANCE COMPANY OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | N9565 |
| Policy instance | 1 |
| Insurance contract or identification number | N9565 | | Number of Individuals Covered | 29 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $2,935 | | Other welfare benefits provided | CANCER PROTECTION PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $20,428 | | Commission paid to Insurance Broker | USD $79 | | Insurance broker organization code? | 3 |
|
| FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 ) |
| Policy contract number | 213796 |
| Policy instance | 7 |
| Insurance contract or identification number | 213796 | | Number of Individuals Covered | 144 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2021-01-01 | | Total amount of commissions paid to insurance broker | USD $4,928 | | Total amount of fees paid to insurance company | USD $439 | | Other welfare benefits provided | DBL | | Welfare Benefit Premiums Paid to Carrier | USD $35,129 | | Commission paid to Insurance Broker | USD $4,928 | | Amount paid for insurance broker fees | 439 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 ) |
| Policy contract number | 426536 |
| Policy instance | 8 |
| Insurance contract or identification number | 426536 | | Number of Individuals Covered | 113 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2021-01-01 | | Total amount of commissions paid to insurance broker | USD $4,725 | | Total amount of fees paid to insurance company | USD $591 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $47,250 | | Commission paid to Insurance Broker | USD $4,725 | | Amount paid for insurance broker fees | 591 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 ) |
| Policy contract number | 223165 0001 |
| Policy instance | 9 |
| Insurance contract or identification number | 223165 0001 | | Number of Individuals Covered | 494 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2021-01-01 | | Total amount of commissions paid to insurance broker | USD $14,456 | | Total amount of fees paid to insurance company | USD $2,532 | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | STD | | Welfare Benefit Premiums Paid to Carrier | USD $193,945 | | Commission paid to Insurance Broker | USD $14,456 | | Amount paid for insurance broker fees | 2532 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 ) |
| Policy contract number | 30502 |
| Policy instance | 15 |
| Insurance contract or identification number | 30502 | | Number of Individuals Covered | 8 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $213 | | Other welfare benefits provided | LONG-TERM CARE | | Welfare Benefit Premiums Paid to Carrier | USD $11,807 | | Commission paid to Insurance Broker | USD $213 | | Insurance broker organization code? | 3 |
|
| FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 ) |
| Policy contract number | R0719922 |
| Policy instance | 14 |
| Insurance contract or identification number | R0719922 | | Number of Individuals Covered | 83 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2021-01-01 | | Total amount of commissions paid to insurance broker | USD $1,311 | | Other welfare benefits provided | STD | | Welfare Benefit Premiums Paid to Carrier | USD $16,232 | | Commission paid to Insurance Broker | USD $911 | | Insurance broker organization code? | 3 |
|
| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
| Policy contract number | 11705540 |
| Policy instance | 13 |
| Insurance contract or identification number | 11705540 | | Number of Individuals Covered | 27 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2021-01-01 | | Total amount of commissions paid to insurance broker | USD $238 | | Other welfare benefits provided | STD | | Welfare Benefit Premiums Paid to Carrier | USD $4,088 | | Commission paid to Insurance Broker | USD $177 | | Insurance broker organization code? | 3 |
|
| METROPOLITAN PROPERTY AND CASUALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26298 ) |
| Policy contract number | 9900799 |
| Policy instance | 12 |
| Insurance contract or identification number | 9900799 | | Number of Individuals Covered | 15 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $374 | | Total amount of fees paid to insurance company | USD $7 | | Other welfare benefits provided | LEGAL | | Welfare Benefit Premiums Paid to Carrier | USD $3,696 | | Commission paid to Insurance Broker | USD $374 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 7 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 3342409 |
| Policy instance | 11 |
| Insurance contract or identification number | 3342409 | | Number of Individuals Covered | 709 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of fees paid to insurance company | USD $100,591 | | Welfare Benefit Premiums Paid to Carrier | USD $1,084,120 | | Amount paid for insurance broker fees | 100591 | | Additional information about fees paid to insurance broker | MEDICAL | | Insurance broker organization code? | 3 |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 07288R |
| Policy instance | 10 |
| Insurance contract or identification number | 07288R | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-10-01 | | Total amount of fees paid to insurance company | USD $14 | | Other welfare benefits provided | LEGAL | | Amount paid for insurance broker fees | 7 | | Additional information about fees paid to insurance broker | UNALLOC GAINS | | Insurance broker organization code? | 3 |
|
| AMERICAN FAMILY LIFE INSURANCE COMPANY OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | N9565 |
| Policy instance | 1 |
| Insurance contract or identification number | N9565 | | Number of Individuals Covered | 35 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $4,482 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | CANCER PROTECTION PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $35,231 | | Commission paid to Insurance Broker | USD $140 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| AMERICAN FAMILY LIFE INSURANCE COMPANY OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | AP622 |
| Policy instance | 2 |
| Insurance contract or identification number | AP622 | | Number of Individuals Covered | 5 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $646 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | CANCER PROTECTION PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $5,651 | | Commission paid to Insurance Broker | USD $1 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 0818735 |
| Policy instance | 3 |
| Insurance contract or identification number | 0818735 | | Number of Individuals Covered | 723 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $15,222 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $277,122 | | Commission paid to Insurance Broker | USD $15,222 | | 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 | 223166 |
| Policy instance | 4 |
| Insurance contract or identification number | 223166 | | Number of Individuals Covered | 490 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2020-01-01 | | Total amount of commissions paid to insurance broker | USD $3,588 | | Total amount of fees paid to insurance company | USD $797 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $63,760 | | Commission paid to Insurance Broker | USD $0 | | 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 | 0140630 |
| Policy instance | 5 |
| Insurance contract or identification number | 0140630 | | Number of Individuals Covered | 235 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $157,329 |
|
| HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | X25001 |
| Policy instance | 6 |
| Insurance contract or identification number | X25001 | | Number of Individuals Covered | 775 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $3,445 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $34,448 | | Commission paid to Insurance Broker | USD $3,445 | | 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 | 213796 |
| Policy instance | 7 |
| Insurance contract or identification number | 213796 | | Number of Individuals Covered | 157 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2020-01-01 | | Total amount of commissions paid to insurance broker | USD $3,246 | | Total amount of fees paid to insurance company | USD $284 | | Other welfare benefits provided | DBL | | Welfare Benefit Premiums Paid to Carrier | USD $21,642 | | Commission paid to Insurance Broker | USD $3,246 | | Amount paid for insurance broker fees | 284 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 ) |
| Policy contract number | 426536 |
| Policy instance | 8 |
| Insurance contract or identification number | 426536 | | Number of Individuals Covered | 109 | | Insurance policy start date | 2019-03-01 | | Insurance policy end date | 2020-01-01 | | Total amount of commissions paid to insurance broker | USD $5,393 | | Total amount of fees paid to insurance company | USD $871 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $38,178 | | Commission paid to Insurance Broker | USD $5,393 | | Amount paid for insurance broker fees | 871 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION |
|
| FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 ) |
| Policy contract number | 223165 0001 |
| Policy instance | 9 |
| Insurance contract or identification number | 223165 0001 | | Number of Individuals Covered | 431 | | Insurance policy start date | 2019-03-01 | | Insurance policy end date | 2020-01-01 | | Total amount of commissions paid to insurance broker | USD $11,112 | | Total amount of fees paid to insurance company | USD $1,498 | | Other welfare benefits provided | STD | | Welfare Benefit Premiums Paid to Carrier | USD $119,878 | | Commission paid to Insurance Broker | USD $11,112 | | Amount paid for insurance broker fees | 1498 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 07288R |
| Policy instance | 10 |
| Insurance contract or identification number | 07288R | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-10-01 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $14 | | Commission paid to Insurance Broker | USD $0 | | Amount paid for insurance broker fees | 7 | | Additional information about fees paid to insurance broker | UNALLOC GAINS | | Insurance broker organization code? | 3 |
|
| METROPOLITAN PROPERTY AND CASUALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26298 ) |
| Policy contract number | 9900799 |
| Policy instance | 11 |
| Insurance contract or identification number | 9900799 | | Number of Individuals Covered | 22 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $557 | | Total amount of fees paid to insurance company | USD $45 | | Other welfare benefits provided | LEGAL | | Welfare Benefit Premiums Paid to Carrier | USD $6,573 | | Commission paid to Insurance Broker | USD $557 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 3342409 |
| Policy instance | 12 |
| Insurance contract or identification number | 3342409 | | Number of Individuals Covered | 713 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $757,787 |
|
| FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 ) |
| Policy contract number | 223165 0001 |
| Policy instance | 13 |
| Insurance contract or identification number | 223165 0001 | | Number of Individuals Covered | 517 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2019-01-01 | | Total amount of commissions paid to insurance broker | USD $9,249 | | Total amount of fees paid to insurance company | USD $1,093 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $87,473 | | Amount paid for insurance broker fees | 731 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 | | Commission paid to Insurance Broker | USD $1,738 |
|
| FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 ) |
| Policy contract number | 223165 0001 |
| Policy instance | 12 |
| Insurance contract or identification number | 223165 0001 | | Number of Individuals Covered | 517 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2019-01-01 | | Total amount of commissions paid to insurance broker | USD $3,831 | | Total amount of fees paid to insurance company | USD $1,102 | | Other welfare benefits provided | STD | | Welfare Benefit Premiums Paid to Carrier | USD $88,098 | | Amount paid for insurance broker fees | 737 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 | | Commission paid to Insurance Broker | USD $292 |
|
| FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 ) |
| Policy contract number | 426536 |
| Policy instance | 11 |
| Insurance contract or identification number | 426536 | | Number of Individuals Covered | 136 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2019-01-01 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $50,538 |
|
| AMERICAN FAMILY LIFE INSURANCE COMPANY OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | N9565 |
| Policy instance | 1 |
| Insurance contract or identification number | N9565 | | Number of Individuals Covered | 42 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $3,829 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | CANCER PROTECTION PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $29,453 | | Commission paid to Insurance Broker | USD $126 | | Insurance broker organization code? | 3 |
|
| AMERICAN FAMILY LIFE INSURANCE COMPANY OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | AP622 |
| Policy instance | 2 |
| Insurance contract or identification number | AP622 | | Number of Individuals Covered | 13 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $1,080 | | Other welfare benefits provided | CANCER PROTECTION PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $9,426 | | Commission paid to Insurance Broker | USD $31 | | Insurance broker organization code? | 3 |
|
| EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 ) |
| Policy contract number | 377193 |
| Policy instance | 3 |
| Insurance contract or identification number | 377193 | | Number of Individuals Covered | 328 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $864,645 |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 0818735 |
| Policy instance | 4 |
| Insurance contract or identification number | 0818735 | | Number of Individuals Covered | 800 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $14,532 | | Total amount of fees paid to insurance company | USD $3,276 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $314,276 | | Commission paid to Insurance Broker | USD $8,156 | | Amount paid for insurance broker fees | 3276 | | Additional information about fees paid to insurance broker | 2017 PPP ENGAGEMENT CREDIT DENTAL RETENTION | | Insurance broker organization code? | 3 |
|
| JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 ) |
| Policy contract number | 30502 |
| Policy instance | 5 |
| Insurance contract or identification number | 30502 | | Number of Individuals Covered | 11 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $539 | | Other welfare benefits provided | GROUP LONG-TERM CARE INSURANCE | | Welfare Benefit Premiums Paid to Carrier | USD $14,156 | | Commission paid to Insurance Broker | USD $539 | | Insurance broker organization code? | 3 |
|
| FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 ) |
| Policy contract number | 223165 0003 |
| Policy instance | 6 |
| Insurance contract or identification number | 223165 0003 | | Number of Individuals Covered | 45 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2019-01-01 | | Total amount of commissions paid to insurance broker | USD $199 | | Total amount of fees paid to insurance company | USD $42 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,315 | | Amount paid for insurance broker fees | 28 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 | | Commission paid to Insurance Broker | USD $133 |
|
| FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 ) |
| Policy contract number | 223166 |
| Policy instance | 7 |
| Insurance contract or identification number | 223166 | | Number of Individuals Covered | 589 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2019-01-01 | | Total amount of commissions paid to insurance broker | USD $4,218 | | Total amount of fees paid to insurance company | USD $1,455 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $86,840 | | Amount paid for insurance broker fees | 717 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 | | Commission paid to Insurance Broker | USD $3,923 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0140630 |
| Policy instance | 8 |
| Insurance contract or identification number | 0140630 | | Number of Individuals Covered | 265 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $4,528 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $170,190 | | Commission paid to Insurance Broker | USD $4,528 | | Insurance broker organization code? | 3 |
|
| HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | X25001 |
| Policy instance | 9 |
| Insurance contract or identification number | X25001 | | Number of Individuals Covered | 835 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $3,869 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $38,688 | | Commission paid to Insurance Broker | USD $1,997 | | Insurance broker organization code? | 3 |
|
| FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 ) |
| Policy contract number | 213796 |
| Policy instance | 10 |
| Insurance contract or identification number | 213796 | | Number of Individuals Covered | 179 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2019-01-01 | | Total amount of commissions paid to insurance broker | USD $3,133 | | Total amount of fees paid to insurance company | USD $397 | | Other welfare benefits provided | DBL | | Welfare Benefit Premiums Paid to Carrier | USD $20,886 | | Amount paid for insurance broker fees | 286 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 | | Commission paid to Insurance Broker | USD $2,255 |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 07288R |
| Policy instance | 4 |
| Insurance contract or identification number | 07288R | | Number of Individuals Covered | 2 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-10-01 | | Other welfare benefits provided | STATUTORY DISABILITY |
|
| EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 ) |
| Policy contract number | 377193 |
| Policy instance | 3 |
| Insurance contract or identification number | 377193 | | Number of Individuals Covered | 361 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $693,814 |
|
| AMERICAN FAMILY LIFE INSURANCE COMPANY OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | AP622 |
| Policy instance | 2 |
| Insurance contract or identification number | AP622 | | Number of Individuals Covered | 16 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $1,601 | | Other welfare benefits provided | CANCER PROTECTION PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $14,734 | | Commission paid to Insurance Broker | USD $41 | | Insurance broker organization code? | 3 | | Insurance broker name | GREGORY MEYER |
|
| AMERICAN FAMILY LIFE INSURANCE COMPANY OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | N9565 |
| Policy instance | 1 |
| Insurance contract or identification number | N9565 | | Number of Individuals Covered | 48 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $5,399 | | Other welfare benefits provided | CANCER PROTECTION PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $41,395 | | Commission paid to Insurance Broker | USD $175 | | Insurance broker organization code? | 3 | | Insurance broker name | ROBERT NIVEYRO |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 0818735 |
| Policy instance | 5 |
| Insurance contract or identification number | 0818735 | | Number of Individuals Covered | 872 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $16,865 | | Total amount of fees paid to insurance company | USD $2,538 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $340,689 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $16,865 | | Amount paid for insurance broker fees | 2538 | | Insurance broker organization code? | 3 | | Insurance broker name | GALLAGHER BENEFIT SERVICES |
|
| FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 ) |
| Policy contract number | 223165 |
| Policy instance | 7 |
| Insurance contract or identification number | 223165 | | Number of Individuals Covered | 326 | | Insurance policy start date | 2017-03-01 | | Insurance policy end date | 2018-03-01 | | Total amount of commissions paid to insurance broker | USD $10,883 | | Total amount of fees paid to insurance company | USD $1,637 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $119,847 | | Amount paid for insurance broker fees | 1637 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 | | Commission paid to Insurance Broker | USD $10,883 | | Insurance broker name | GALLAGHER BENEFIT SERVICES |
|
| JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 ) |
| Policy contract number | 30502 |
| Policy instance | 6 |
| Insurance contract or identification number | 30502 | | Number of Individuals Covered | 11 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $1,746 | | Other welfare benefits provided | GROUP LONG-TERM CARE INSURANCE | | Welfare Benefit Premiums Paid to Carrier | USD $15,359 | | Commission paid to Insurance Broker | USD $1,746 | | Insurance broker organization code? | 3 | | Insurance broker name | GALLAGHER BENEFIT SERVICES |
|
| FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 ) |
| Policy contract number | 223166 |
| Policy instance | 8 |
| Insurance contract or identification number | 223166 | | Number of Individuals Covered | 331 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2018-01-01 | | Total amount of commissions paid to insurance broker | USD $3,921 | | Total amount of fees paid to insurance company | USD $1,214 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $97,366 | | Amount paid for insurance broker fees | 1214 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 | | Commission paid to Insurance Broker | USD $3,921 | | Insurance broker name | GALLAGHER BENEFIT SERVICES |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0140630 |
| Policy instance | 9 |
| Insurance contract or identification number | 0140630 | | Number of Individuals Covered | 141 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $174,579 |
|
| HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | X25001 |
| Policy instance | 10 |
| Insurance contract or identification number | X25001 | | Number of Individuals Covered | 938 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $3,662 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $36,625 | | Commission paid to Insurance Broker | USD $3,662 | | Insurance broker name | GALLAGHER BENEFIT SERVICES |
|
| FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 ) |
| Policy contract number | 213796 |
| Policy instance | 11 |
| Insurance contract or identification number | 213796 | | Number of Individuals Covered | 214 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2018-01-01 | | Total amount of commissions paid to insurance broker | USD $2,307 | | Total amount of fees paid to insurance company | USD $197 | | Other welfare benefits provided | DBL | | Welfare Benefit Premiums Paid to Carrier | USD $23,211 | | Amount paid for insurance broker fees | 197 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 | | Commission paid to Insurance Broker | USD $2,307 | | Insurance broker name | GALLAGHER BENEFIT SERVICES INC |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 07288R |
| Policy instance | 4 |
| Insurance contract or identification number | 07288R | | Number of Individuals Covered | 2 | | Insurance policy start date | 2014-10-01 | | Insurance policy end date | 2015-10-01 | | Are there contracts with allocated funds for individual policies? | Yes | | Other welfare benefits provided | STATUTORY DISABILITY |
|
| EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 ) |
| Policy contract number | 377193 |
| Policy instance | 3 |
| Insurance contract or identification number | 377193 | | Number of Individuals Covered | 312 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of fees paid to insurance company | USD $101,693 | | Amount paid for insurance broker fees | 101693 | | Insurance broker organization code? | 3 | | Insurance broker name | GALLAGHER BENEFIT SERVICES |
|
| AMERICAN FAMILY LIFE INSURANCE COMPANY OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | AP622 |
| Policy instance | 2 |
| Insurance contract or identification number | AP622 | | Number of Individuals Covered | 19 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $1,985 | | Total amount of fees paid to insurance company | USD $137 | | Other welfare benefits provided | CANCER PROTECTION PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $16,466 | | Commission paid to Insurance Broker | USD $41 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 5 | | Insurance broker name | 11260 CHESTER RD |
|
| AMERICAN FAMILY LIFE INSURANCE COMPANY OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | N9565 |
| Policy instance | 1 |
| Insurance contract or identification number | N9565 | | Number of Individuals Covered | 63 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $7,814 | | Total amount of fees paid to insurance company | USD $84 | | Other welfare benefits provided | CANCER PROTECTION PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $55,978 | | Commission paid to Insurance Broker | USD $112 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 15 | | Insurance broker name | 125 JERICHO TURNPIKE |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 818735 |
| Policy instance | 5 |
| Insurance contract or identification number | 818735 | | Number of Individuals Covered | 887 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $17,915 | | Total amount of fees paid to insurance company | USD $6,165 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $351,120 | | Commission paid to Insurance Broker | USD $17,915 | | Amount paid for insurance broker fees | 6165 | | Additional information about fees paid to insurance broker | 2013/2014 PPP ENGAGEMENT CREDIT | | Insurance broker organization code? | 3 | | Insurance broker name | GALLAGHER BENEFIT SERVICES |
|
| JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 ) |
| Policy contract number | 30502 |
| Policy instance | 6 |
| Insurance contract or identification number | 30502 | | Number of Individuals Covered | 8 | | Insurance policy start date | 2005-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $1,641 | | Other welfare benefits provided | GROUP LONG-TERM CARE INSURANCE | | Welfare Benefit Premiums Paid to Carrier | USD $14,180 | | Commission paid to Insurance Broker | USD $1,641 | | Insurance broker organization code? | 3 | | Insurance broker name | GALLAGHER BENEFIT SERVICES |
|
| FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 ) |
| Policy contract number | 223165 |
| Policy instance | 7 |
| Insurance contract or identification number | 223165 | | Number of Individuals Covered | 339 | | Insurance policy start date | 2015-03-01 | | Insurance policy end date | 2016-03-01 | | Total amount of commissions paid to insurance broker | USD $10,605 | | Total amount of fees paid to insurance company | USD $1,233 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $93,627 | | Commission paid to Insurance Broker | USD $10,605 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 1233 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker name | GALLAGHER BENEFIT SERVICES |
|
| FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 ) |
| Policy contract number | 223166 |
| Policy instance | 8 |
| Insurance contract or identification number | 223166 | | Number of Individuals Covered | 349 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2016-01-01 | | Total amount of commissions paid to insurance broker | USD $3,818 | | Total amount of fees paid to insurance company | USD $1,115 | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $89,232 | | Commission paid to Insurance Broker | USD $3,818 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 1115 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker name | GALLAGHER BENEFIT SERVICES |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0140630 |
| Policy instance | 9 |
| Insurance contract or identification number | 0140630 | | Number of Individuals Covered | 169 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $167,766 |
|
| HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | X25001 |
| Policy instance | 10 |
| Insurance contract or identification number | X25001 | | Number of Individuals Covered | 976 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $4,817 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $48,166 | | Commission paid to Insurance Broker | USD $4,817 | | Insurance broker name | GALLAGHER BENEFIT SERVICES |
|
| WAGE WORKS (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 2052963 |
| Policy instance | 11 |
| Insurance contract or identification number | 2052963 | | Number of Individuals Covered | 153 | | Insurance policy start date | 2015-03-01 | | Insurance policy end date | 2016-02-29 | | Other welfare benefits provided | FLEXIBLE SPENDING ACCOUNT | | Welfare Benefit Premiums Paid to Carrier | USD $5,548 |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 07288R |
| Policy instance | 4 |
| Insurance contract or identification number | 07288R | | Number of Individuals Covered | 2 | | Insurance policy start date | 2013-10-01 | | Insurance policy end date | 2014-10-01 | | Are there contracts with allocated funds for individual policies? | Yes | | Other welfare benefits provided | STATUTORY DISABILITY |
|
| AMERICAN FAMILY LIFE INSURANCE COMPANY OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | AP622 |
| Policy instance | 2 |
| Insurance contract or identification number | AP622 | | Number of Individuals Covered | 20 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-30 | | Total amount of commissions paid to insurance broker | USD $3,058 | | Total amount of fees paid to insurance company | USD $139 | | Other welfare benefits provided | CANCER PROTECTION PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $14,509 | | Commission paid to Insurance Broker | USD $35 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 81 | | Insurance broker name | MICHAEL E MCCARTHY |
|
| AMERICAN FAMILY LIFE INSURANCE COMPANY OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | N9565 |
| Policy instance | 1 |
| Insurance contract or identification number | N9565 | | Number of Individuals Covered | 83 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $8,199 | | Total amount of fees paid to insurance company | USD $173 | | Other welfare benefits provided | CANCER PROTECTION PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $54,731 | | Commission paid to Insurance Broker | USD $116 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 29 | | Insurance broker name | WILLIAM H WHICHER |
|
| HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | X25001 |
| Policy instance | 10 |
| Insurance contract or identification number | X25001 | | Number of Individuals Covered | 1193 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $4,772 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $47,717 | | Commission paid to Insurance Broker | USD $4,772 | | Insurance broker name | GALLAGHER BENEFIT SERVICES |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 818735 |
| Policy instance | 5 |
| Insurance contract or identification number | 818735 | | Number of Individuals Covered | 1056 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $17,102 | | Total amount of fees paid to insurance company | USD $6,823 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $383,922 | | Commission paid to Insurance Broker | USD $17,102 | | Amount paid for insurance broker fees | 6823 | | Additional information about fees paid to insurance broker | 2013/2014 MM P3 BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | GALLAGHER BENEFIT SERVICES |
|
| JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 ) |
| Policy contract number | 30502 |
| Policy instance | 6 |
| Insurance contract or identification number | 30502 | | Number of Individuals Covered | 8 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $1,578 | | Other welfare benefits provided | GROUP LONG-TERM CARE INSURANCE | | Welfare Benefit Premiums Paid to Carrier | USD $13,155 | | Commission paid to Insurance Broker | USD $1,578 | | Insurance broker organization code? | 3 | | Insurance broker name | GALLAGHER BENEFIT SERVICES |
|
| FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 ) |
| Policy contract number | 223165 |
| Policy instance | 7 |
| Insurance contract or identification number | 223165 | | Number of Individuals Covered | 411 | | Insurance policy start date | 2014-03-01 | | Insurance policy end date | 2015-03-01 | | Total amount of commissions paid to insurance broker | USD $8,487 | | Total amount of fees paid to insurance company | USD $1,017 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $98,451 | | Commission paid to Insurance Broker | USD $8,487 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 1017 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker name | GALLAGHER BENEFIT SERVICES |
|
| EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 ) |
| Policy contract number | 377193 |
| Policy instance | 3 |
| Insurance contract or identification number | 377193 | | Number of Individuals Covered | 355 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $105,296 | | Total amount of fees paid to insurance company | USD $2,208 | | Commission paid to Insurance Broker | USD $105,296 | | Amount paid for insurance broker fees | 2208 | | Insurance broker organization code? | 3 | | Insurance broker name | GALLAGHER BENEFIT SERVICES |
|
| WAGE WORKS (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 2052963 |
| Policy instance | 11 |
| Insurance contract or identification number | 2052963 | | Number of Individuals Covered | 114 | | Insurance policy start date | 2014-03-01 | | Insurance policy end date | 2015-02-28 | | Other welfare benefits provided | FLEXIBLE SPENDING ACCOUNT | | Welfare Benefit Premiums Paid to Carrier | USD $4,594 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0140630 |
| Policy instance | 9 |
| Insurance contract or identification number | 0140630 | | Number of Individuals Covered | 180 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $149,904 |
|
| FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 ) |
| Policy contract number | 223166 |
| Policy instance | 8 |
| Insurance contract or identification number | 223166 | | Number of Individuals Covered | 422 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2015-01-01 | | Total amount of commissions paid to insurance broker | USD $3,913 | | Total amount of fees paid to insurance company | USD $1,204 | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $96,292 | | Commission paid to Insurance Broker | USD $3,913 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 1204 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker name | GALLAGHER BENEFIT SERVICES |
|
| JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 ) |
| Policy contract number | 30502 |
| Policy instance | 6 |
| Insurance contract or identification number | 30502 | | Number of Individuals Covered | 8 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $1,623 | | Other welfare benefits provided | GROUP LONG-TERM CARE INSURANCE | | Welfare Benefit Premiums Paid to Carrier | USD $14,619 | | Commission paid to Insurance Broker | USD $1,623 | | Insurance broker organization code? | 3 | | Insurance broker name | GALLAGHER BENEFIT SERVICES |
|
| AMERICAN FAMILY LIFE INSURANCE COMPANY OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | AP622 |
| Policy instance | 2 |
| Insurance contract or identification number | AP622 | | Number of Individuals Covered | 21 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $3,421 | | Other welfare benefits provided | CANCER PROTECTION PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $16,517 | | Commission paid to Insurance Broker | USD $44 | | Insurance broker organization code? | 3 | | Insurance broker name | JOHN COLLINS |
|
| EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 ) |
| Policy contract number | 377193 |
| Policy instance | 3 |
| Insurance contract or identification number | 377193 | | Number of Individuals Covered | 368 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $110,744 | | Total amount of fees paid to insurance company | USD $2,214 | | Commission paid to Insurance Broker | USD $110,744 | | Amount paid for insurance broker fees | 2214 | | Insurance broker organization code? | 3 | | Insurance broker name | GALLAGHER BENEFIT SERVICES |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 07288R |
| Policy instance | 4 |
| Insurance contract or identification number | 07288R | | Number of Individuals Covered | 2 | | Insurance policy start date | 2012-10-01 | | Insurance policy end date | 2013-10-01 | | Are there contracts with allocated funds for individual policies? | Yes | | Other welfare benefits provided | STATUTORY DISABILITY |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 818735 |
| Policy instance | 5 |
| Insurance contract or identification number | 818735 | | Number of Individuals Covered | 798 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $13,019 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $240,078 | | Commission paid to Insurance Broker | USD $13,019 | | Insurance broker organization code? | 3 | | Insurance broker name | GALLAGHER BENEFIT SERVICES |
|
| AMERICAN FAMILY LIFE INSURANCE COMPANY OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | N9565 |
| Policy instance | 1 |
| Insurance contract or identification number | N9565 | | Number of Individuals Covered | 87 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $11,234 | | Total amount of fees paid to insurance company | USD $343 | | Other welfare benefits provided | CANCER PROTECTION PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $68,012 | | Commission paid to Insurance Broker | USD $290 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 54 | | Insurance broker name | MASSIMO & ASSOCIATES INC |
|
| FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 ) |
| Policy contract number | 223165 |
| Policy instance | 7 |
| Insurance contract or identification number | 223165 | | Number of Individuals Covered | 435 | | Insurance policy start date | 2013-03-01 | | Insurance policy end date | 2014-03-01 | | Total amount of commissions paid to insurance broker | USD $12,372 | | Total amount of fees paid to insurance company | USD $1,624 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $96,256 | | Commission paid to Insurance Broker | USD $12,372 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 1624 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker name | GALLAGHER BENEFIT SERVICES |
|
| FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 ) |
| Policy contract number | 223166 |
| Policy instance | 8 |
| Insurance contract or identification number | 223166 | | Number of Individuals Covered | 431 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2014-01-01 | | Total amount of commissions paid to insurance broker | USD $4,041 | | Total amount of fees paid to insurance company | USD $1,374 | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $101,697 | | Commission paid to Insurance Broker | USD $4,041 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 1374 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker name | GALLAGHER BENEFIT SERVICES |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0140630 |
| Policy instance | 9 |
| Insurance contract or identification number | 0140630 | | Number of Individuals Covered | 178 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $147,014 |
|
| HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | X25001 |
| Policy instance | 10 |
| Insurance contract or identification number | X25001 | | Number of Individuals Covered | 432 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $3,369 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $33,689 | | Commission paid to Insurance Broker | USD $3,369 | | Insurance broker name | GALLAGHER BENEFIT SERVICES |
|
| WAGE WORKS (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 2052963 |
| Policy instance | 11 |
| Insurance contract or identification number | 2052963 | | Number of Individuals Covered | 114 | | Insurance policy start date | 2013-03-01 | | Insurance policy end date | 2014-02-28 | | Other welfare benefits provided | FLEXIBLE SPENDING ACCOUNT | | Welfare Benefit Premiums Paid to Carrier | USD $4,158 |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 07288R |
| Policy instance | 5 |
| Insurance contract or identification number | 07288R | | Number of Individuals Covered | 2 | | Insurance policy start date | 2011-10-01 | | Insurance policy end date | 2012-10-01 | | Are there contracts with allocated funds for individual policies? | Yes | | Other welfare benefits provided | STATUTORY DISABILITY |
|
| EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 ) |
| Policy contract number | 377193 |
| Policy instance | 4 |
| Insurance contract or identification number | 377193 | | Number of Individuals Covered | 373 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $111,329 | | Commission paid to Insurance Broker | USD $111,329 | | Insurance broker organization code? | 3 | | Insurance broker name | GALLAGHER BENEFIT SERVICES |
|
| CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 ) |
| Policy contract number | NYK030044 |
| Policy instance | 3 |
| Insurance contract or identification number | NYK030044 | | Number of Individuals Covered | 433 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $2,608 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $19,955 | | Commission paid to Insurance Broker | USD $2,608 | | Insurance broker organization code? | 3 | | Insurance broker name | DBL CENTER LTD |
|
| AMERICAN FAMILY LIFE INSURANCE COMPANY OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | AP622 |
| Policy instance | 2 |
| Insurance contract or identification number | AP622 | | Number of Individuals Covered | 20 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $2,480 | | Other welfare benefits provided | CANCER PROTECTION PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $11,746 | | Commission paid to Insurance Broker | USD $325 | | Insurance broker organization code? | 3 | | Insurance broker name | LINDA N SHEPHERD |
|
| CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 ) |
| Policy contract number | NYD074449 |
| Policy instance | 6 |
| Insurance contract or identification number | NYD074449 | | Number of Individuals Covered | 433 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $2,799 | | Other welfare benefits provided | STATUTORY DISABILITY | | Welfare Benefit Premiums Paid to Carrier | USD $22,389 | | Commission paid to Insurance Broker | USD $2,799 | | Insurance broker organization code? | 3 | | Insurance broker name | DBL CENTER LTD |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 818735 |
| Policy instance | 7 |
| Insurance contract or identification number | 818735 | | Number of Individuals Covered | 351 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $11,291 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $245,612 | | Commission paid to Insurance Broker | USD $11,291 | | Insurance broker organization code? | 3 | | Insurance broker name | GALLAGHER BENEFIT SERVICES |
|
| JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 ) |
| Policy contract number | 30502 |
| Policy instance | 8 |
| Insurance contract or identification number | 30502 | | Number of Individuals Covered | 8 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $1,853 | | Other welfare benefits provided | GROUP LONG-TERM CARE INSURANCE | | Welfare Benefit Premiums Paid to Carrier | USD $15,439 | | Commission paid to Insurance Broker | USD $1,853 | | Insurance broker organization code? | 3 | | Insurance broker name | GALLAGHER BENEFIT SERVICES |
|
| AMERICAN FAMILY LIFE INSURANCE COMPANY OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | N9565 |
| Policy instance | 1 |
| Insurance contract or identification number | N9565 | | Number of Individuals Covered | 90 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $13,858 | | Total amount of fees paid to insurance company | USD $129 | | Other welfare benefits provided | CANCER PROTECTION PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $67,091 | | Commission paid to Insurance Broker | USD $2,132 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 16 | | Insurance broker name | BARBARA NIVEYRO |
|
| FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 ) |
| Policy contract number | 223166 |
| Policy instance | 10 |
| Insurance contract or identification number | 223166 | | Number of Individuals Covered | 433 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2013-01-01 | | Total amount of commissions paid to insurance broker | USD $3,846 | | Total amount of fees paid to insurance company | USD $1,120 | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $97,814 | | Commission paid to Insurance Broker | USD $3,846 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 1120 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker name | GALLAGHER BENEFIT SERVICES |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0140630 |
| Policy instance | 11 |
| Insurance contract or identification number | 0140630 | | Number of Individuals Covered | 181 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $2,215 | | Total amount of fees paid to insurance company | USD $455 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $139,646 | | Commission paid to Insurance Broker | USD $2,188 | | Amount paid for insurance broker fees | 44 | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | STEVEN PUCKETT |
|
| FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 ) |
| Policy contract number | 223165 |
| Policy instance | 9 |
| Insurance contract or identification number | 223165 | | Number of Individuals Covered | 433 | | Insurance policy start date | 2012-03-01 | | Insurance policy end date | 2013-03-01 | | Total amount of commissions paid to insurance broker | USD $6,871 | | Total amount of fees paid to insurance company | USD $749 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $66,982 | | Commission paid to Insurance Broker | USD $6,871 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 749 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker name | GALLAGHER BENEFIT SERVICES |
|
