WPP GROUP USA, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan WPP GROUP USA INC BENEFITS PLAN
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0136898 |
| Policy instance | 8 |
| Insurance contract or identification number | 0136898 | | Number of Individuals Covered | 18 | | 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 $45,303 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 ) |
| Policy contract number | 28735 |
| Policy instance | 7 |
| Insurance contract or identification number | 28735 | | Number of Individuals Covered | 37 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $8,729 | | Other welfare benefits provided | GROUP LONG-TERM CARE INSURANCE | | Welfare Benefit Premiums Paid to Carrier | USD $61,105 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,729 | | Insurance broker name | PROGRESSIVE PLAN ADMINISTRATORS |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 122383 |
| Policy instance | 17 |
| Insurance contract or identification number | 122383 | | Number of Individuals Covered | 153 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of fees paid to insurance company | USD $151 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $41,677 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 151 | | Additional information about fees paid to insurance broker | ADMIN FEES & NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | AON CONSULTING |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0104884 |
| Policy instance | 18 |
| Insurance contract or identification number | 0104884 | | Number of Individuals Covered | 3721 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of fees paid to insurance company | USD $3,099 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,132,363 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 3099 | | Additional information about fees paid to insurance broker | ADMIN FEES & NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | AON CONSULTING |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47029 ) |
| Policy contract number | 12270668 |
| Policy instance | 19 |
| Insurance contract or identification number | 12270668 | | Number of Individuals Covered | 15614 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HEALTH ALLIANCE PLAN 770 (National Association of Insurance Commissioners NAIC id number: 95844 ) |
| Policy contract number | 10002665 |
| Policy instance | 20 |
| Insurance contract or identification number | 10002665 | | Number of Individuals Covered | 398 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $4,562,378 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 ) |
| Policy contract number | 496514 |
| Policy instance | 21 |
| Insurance contract or identification number | 496514 | | Number of Individuals Covered | 14 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Other welfare benefits provided | GROUP LONG TERM CARE | | Welfare Benefit Premiums Paid to Carrier | USD $112,153 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 ) |
| Policy contract number | 28702 |
| Policy instance | 22 |
| Insurance contract or identification number | 28702 | | Number of Individuals Covered | 57 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $16,264 | | Other welfare benefits provided | GROUP LONG-TERM CARE | | Welfare Benefit Premiums Paid to Carrier | USD $86,329 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $16,264 | | Insurance broker organization code? | 3 | | Insurance broker name | PROGRESSIVE PLAN ADMINISTRATORS |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0118689 |
| Policy instance | 23 |
| Insurance contract or identification number | 0118689 | | Number of Individuals Covered | 26544 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of fees paid to insurance company | USD $11,498 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $3,881,846 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 11498 | | Additional information about fees paid to insurance broker | ADMIN FEES & NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | AON CONSULTING |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 ) |
| Policy contract number | 800272-B |
| Policy instance | 24 |
| Insurance contract or identification number | 800272-B | | Number of Individuals Covered | 3 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | MU1031 |
| Policy instance | 25 |
| Insurance contract or identification number | MU1031 | | Number of Individuals Covered | 668 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $5,246 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,937,480 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,246 | | Insurance broker organization code? | 3 | | Insurance broker name | AON CONSULTING |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0137919 |
| Policy instance | 26 |
| Insurance contract or identification number | 0137919 | | Number of Individuals Covered | 140 | | 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 $250,758 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0106459 |
| Policy instance | 16 |
| Insurance contract or identification number | 0106459 | | Number of Individuals Covered | 3214 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of fees paid to insurance company | USD $465 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $144,011 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 465 | | Additional information about fees paid to insurance broker | ADMIN FEES & NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | AON CONSULTING |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0105228 |
| Policy instance | 15 |
| Insurance contract or identification number | 0105228 | | Number of Individuals Covered | 198 | | 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 $3,790 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 ) |
| Policy contract number | 28709 |
| Policy instance | 14 |
| Insurance contract or identification number | 28709 | | Number of Individuals Covered | 14 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $2,131 | | Other welfare benefits provided | GROUP LONG-TERM CARE INSURANCE | | Welfare Benefit Premiums Paid to Carrier | USD $14,836 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,131 | | Insurance broker organization code? | 3 | | Insurance broker name | PROGRESSIVE PLAN ADMINISTRATORS |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0149279 |
| Policy instance | 50 |
| Insurance contract or identification number | 0149279 | | Number of Individuals Covered | 4 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Other welfare benefits provided | CII | | Welfare Benefit Premiums Paid to Carrier | USD $440 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 ) |
| Policy contract number | 458933 |
| Policy instance | 9 |
| Insurance contract or identification number | 458933 | | Number of Individuals Covered | 1785 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Other welfare benefits provided | STD | | Welfare Benefit Premiums Paid to Carrier | USD $104,089 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 3213432,3213436 |
| Policy instance | 1 |
| Insurance contract or identification number | 3213432,3213436 | | Number of Individuals Covered | 4506 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | PREPAID DENTAL | | Welfare Benefit Premiums Paid to Carrier | USD $812,916 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN PROPERTY AND CASUALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26298 ) |
| Policy contract number | 4490010 |
| Policy instance | 2 |
| Insurance contract or identification number | 4490010 | | Number of Individuals Covered | 2910 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of fees paid to insurance company | USD $24 | | Other welfare benefits provided | LEGAL | | Welfare Benefit Premiums Paid to Carrier | USD $614,652 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 24 | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES LLC |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 ) |
| Policy contract number | 800272-A |
| Policy instance | 3 |
| Insurance contract or identification number | 800272-A | | Number of Individuals Covered | 8 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 225108 |
| Policy instance | 4 |
| Insurance contract or identification number | 225108 | | Number of Individuals Covered | 30 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $158,247 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 26865 |
| Policy instance | 5 |
| Insurance contract or identification number | 26865 | | Number of Individuals Covered | 46 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $394,814 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 ) |
| Policy contract number | 800272-C |
| Policy instance | 10 |
| Insurance contract or identification number | 800272-C | | Number of Individuals Covered | 11 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Health Insurance Welfare Benefit | Yes | | Were dividends or retroactive rate refunds paid in cash? | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 ) |
| Policy contract number | 458934 |
| Policy instance | 11 |
| Insurance contract or identification number | 458934 | | Number of Individuals Covered | 627 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $34,812 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0101689 |
| Policy instance | 6 |
| Insurance contract or identification number | 0101689 | | Number of Individuals Covered | 17163 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of fees paid to insurance company | USD $13,200 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,456,215 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 13160 | | Additional information about fees paid to insurance broker | ADMIN FEES | | Insurance broker organization code? | 3 | | Insurance broker name | AON CONSULTING |
|
| JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 ) |
| Policy contract number | 28918 |
| Policy instance | 13 |
| Insurance contract or identification number | 28918 | | Number of Individuals Covered | 176 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $48,111 | | Other welfare benefits provided | GROUP LONG-TERM CARE INSURANCE | | Welfare Benefit Premiums Paid to Carrier | USD $333,721 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $48,111 | | Insurance broker organization code? | 3 | | Insurance broker name | PROGRESSIVE PLAN ADMINISTRATORS |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0190090 |
| Policy instance | 27 |
| Insurance contract or identification number | 0190090 | | Number of Individuals Covered | 207 | | 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 $49,000 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CORPORATE COUNSELING ASSOCIATES (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | N/A |
| Policy instance | 53 |
| Insurance contract or identification number | N/A | | Number of Individuals Covered | 18757 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Other welfare benefits provided | WORK/LIFE ASSISTANCE | | Welfare Benefit Premiums Paid to Carrier | USD $335,686 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 | | Insurance broker name | AHM FINANCIAL GROUP LLC |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 ) |
| Policy contract number | 10183440 |
| Policy instance | 42 |
| Insurance contract or identification number | 10183440 | | Number of Individuals Covered | 113 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $1,481 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $12,338 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,481 | | Insurance broker organization code? | 3 | | Insurance broker name | ASSUREDPARTNERS OF MO |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 ) |
| Policy contract number | 10183441 |
| Policy instance | 43 |
| Insurance contract or identification number | 10183441 | | Number of Individuals Covered | 113 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $2,509 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $16,727 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,509 | | Insurance broker organization code? | 3 | | Insurance broker name | ASSUREDPARTNERS OF MO LLC |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 ) |
| Policy contract number | 10183442 |
| Policy instance | 44 |
| Insurance contract or identification number | 10183442 | | Number of Individuals Covered | 113 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $2,815 | | Other welfare benefits provided | WEEKLY INCOME | | Welfare Benefit Premiums Paid to Carrier | USD $28,151 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,815 | | Insurance broker organization code? | 3 | | Insurance broker name | ASSUREDPARTNERS OF MO |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0136895 |
| Policy instance | 45 |
| Insurance contract or identification number | 0136895 | | Number of Individuals Covered | 331 | | 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 $627,778 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0121575 |
| Policy instance | 46 |
| Insurance contract or identification number | 0121575 | | Number of Individuals Covered | 8 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Other welfare benefits provided | CII | | Welfare Benefit Premiums Paid to Carrier | USD $2,220 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0142598 |
| Policy instance | 47 |
| Insurance contract or identification number | 0142598 | | Number of Individuals Covered | 60 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Other welfare benefits provided | CII | | Welfare Benefit Premiums Paid to Carrier | USD $13,233 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0142599 |
| Policy instance | 48 |
| Insurance contract or identification number | 0142599 | | Number of Individuals Covered | 5 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Other welfare benefits provided | CII | | Welfare Benefit Premiums Paid to Carrier | USD $405 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0149280 |
| Policy instance | 49 |
| Insurance contract or identification number | 0149280 | | Number of Individuals Covered | 3 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Other welfare benefits provided | CII | | Welfare Benefit Premiums Paid to Carrier | USD $1,148 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0151654 |
| Policy instance | 51 |
| Insurance contract or identification number | 0151654 | | Number of Individuals Covered | 732 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of fees paid to insurance company | USD $-5,713 | | Other welfare benefits provided | GVUL | | Welfare Benefit Premiums Paid to Carrier | USD $807,827 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | -5713 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | AON CONSULTING |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0160206 |
| Policy instance | 52 |
| Insurance contract or identification number | 0160206 | | Number of Individuals Covered | 569 | | Insurance policy start date | 2015-02-01 | | Insurance policy end date | 2016-01-31 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $227,540 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 ) |
| Policy contract number | 28838 |
| Policy instance | 12 |
| Insurance contract or identification number | 28838 | | Number of Individuals Covered | 96 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $24,966 | | Other welfare benefits provided | GROUP LONG-TERM CARE INSURANCE | | Welfare Benefit Premiums Paid to Carrier | USD $173,890 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $24,966 | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 342147 |
| Policy instance | 41 |
| Insurance contract or identification number | 342147 | | Number of Individuals Covered | 187 | | Insurance policy start date | 2014-12-01 | | Insurance policy end date | 2015-11-30 | | Total amount of commissions paid to insurance broker | USD $23,691 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $840,202 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $23,691 | | Insurance broker organization code? | 3 | | Insurance broker name | ASSUREDPARTNERS OF MISSOURI LLC |
|
| FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 ) |
| Policy contract number | 395790 |
| Policy instance | 40 |
| Insurance contract or identification number | 395790 | | Number of Individuals Covered | 70 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $560 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,108 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $560 | | Insurance broker organization code? | 3 | | Insurance broker name | AON CONSULTING |
|
| LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 ) |
| Policy contract number | 000010122759 |
| Policy instance | 28 |
| Insurance contract or identification number | 000010122759 | | Number of Individuals Covered | 49 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $3,193 | | Total amount of fees paid to insurance company | USD $4,738 | | Other welfare benefits provided | WEEKLY INCOME | | Welfare Benefit Premiums Paid to Carrier | USD $56,064 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,193 | | Amount paid for insurance broker fees | 4738 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | EMERSON REID & CO INC |
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| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0142603 |
| Policy instance | 29 |
| Insurance contract or identification number | 0142603 | | Number of Individuals Covered | 301 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $63,387 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 000000501086 |
| Policy instance | 30 |
| Insurance contract or identification number | 000000501086 | | Number of Individuals Covered | 125 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $30,302 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0149457 |
| Policy instance | 31 |
| Insurance contract or identification number | 0149457 | | Number of Individuals Covered | 176 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of fees paid to insurance company | USD $362 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $108,997 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 362 | | Additional information about fees paid to insurance broker | ADMIN FEES & NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | AON CONSULTING |
|
| FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 ) |
| Policy contract number | 496491 |
| Policy instance | 32 |
| Insurance contract or identification number | 496491 | | Number of Individuals Covered | 13 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $5,168 | | Total amount of fees paid to insurance company | USD $431 | | Other welfare benefits provided | LONG-TERM CARE | | Welfare Benefit Premiums Paid to Carrier | USD $34,205 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,168 | | Amount paid for insurance broker fees | 431 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES LLC |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0121574 |
| Policy instance | 33 |
| Insurance contract or identification number | 0121574 | | Number of Individuals Covered | 8 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Other welfare benefits provided | CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $5,595 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 0755007 |
| Policy instance | 34 |
| Insurance contract or identification number | 0755007 | | Number of Individuals Covered | 3249 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $-27 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $204,767 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $-27 | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES LLC |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0153513 |
| Policy instance | 35 |
| Insurance contract or identification number | 0153513 | | Number of Individuals Covered | 297 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of fees paid to insurance company | USD $242 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $74,224 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 242 | | Additional information about fees paid to insurance broker | ADMIN FEES & NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | AON CONSULTING |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0151222 |
| Policy instance | 36 |
| Insurance contract or identification number | 0151222 | | Number of Individuals Covered | 377 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of fees paid to insurance company | USD $93 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $21,334 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 93 | | Additional information about fees paid to insurance broker | ADMIN FEES & NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | AON CONSULTING |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 205447 |
| Policy instance | 39 |
| Insurance contract or identification number | 205447 | | Number of Individuals Covered | 16 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $857 | | Total amount of fees paid to insurance company | USD $104 | | Other welfare benefits provided | STD | | Welfare Benefit Premiums Paid to Carrier | USD $8,457 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $857 | | Amount paid for insurance broker fees | 104 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | EARLY CASSIDY & SCHILLING INC |
|
| WESCO INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 25011 ) |
| Policy contract number | 0235060 |
| Policy instance | 37 |
| Insurance contract or identification number | 0235060 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $230 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,149 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $230 | | Insurance broker organization code? | 3 | | Insurance broker name | AON CONSULTING |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0149278 |
| Policy instance | 38 |
| Insurance contract or identification number | 0149278 | | Number of Individuals Covered | 115 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Other welfare benefits provided | CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $21,507 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 ) |
| Policy contract number | 28709 |
| Policy instance | 14 |
| Insurance contract or identification number | 28709 | | Number of Individuals Covered | 14 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $2,868 | | Other welfare benefits provided | GROUP LONG-TERM CARE INSURANCE | | Welfare Benefit Premiums Paid to Carrier | USD $19,572 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,868 | | Insurance broker organization code? | 3 | | Insurance broker name | PROGRESSIVE PLAN ADMINISTRATORS |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0106459 |
| Policy instance | 16 |
| Insurance contract or identification number | 0106459 | | Number of Individuals Covered | 2842 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $7,257 | | Total amount of fees paid to insurance company | USD $897 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $148,641 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,257 | | Amount paid for insurance broker fees | 640 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION AND NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | AON CONSULTING |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 122383 |
| Policy instance | 17 |
| Insurance contract or identification number | 122383 | | Number of Individuals Covered | 154 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $7,102 | | Total amount of fees paid to insurance company | USD $110 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $44,248 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,102 | | Amount paid for insurance broker fees | 16 | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | AON CONSULTING |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47029 ) |
| Policy contract number | 12270668 |
| Policy instance | 19 |
| Insurance contract or identification number | 12270668 | | Number of Individuals Covered | 3868 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HEALTH ALLIANCE PLAN 770 (National Association of Insurance Commissioners NAIC id number: 95844 ) |
| Policy contract number | 10002665 |
| Policy instance | 20 |
| Insurance contract or identification number | 10002665 | | Number of Individuals Covered | 432 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $4,717,313 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 ) |
| Policy contract number | 496514 |
| Policy instance | 21 |
| Insurance contract or identification number | 496514 | | Number of Individuals Covered | 16 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of fees paid to insurance company | USD $990 | | Other welfare benefits provided | GROUP LONG TERM CARE | | Welfare Benefit Premiums Paid to Carrier | USD $119,716 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 933 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | AON CONSULTING |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0118689 |
| Policy instance | 23 |
| Insurance contract or identification number | 0118689 | | Number of Individuals Covered | 26376 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $130,018 | | Total amount of fees paid to insurance company | USD $6,947 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $4,058,078 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $130,018 | | Amount paid for insurance broker fees | 1045 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION & NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | AON CONSULTING |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 ) |
| Policy contract number | 800272-B |
| Policy instance | 24 |
| Insurance contract or identification number | 800272-B | | Number of Individuals Covered | 3 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0105228 |
| Policy instance | 15 |
| Insurance contract or identification number | 0105228 | | Number of Individuals Covered | 203 | | 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 $3,868 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 ) |
| Policy contract number | 28918 |
| Policy instance | 13 |
| Insurance contract or identification number | 28918 | | Number of Individuals Covered | 177 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $49,533 | | Other welfare benefits provided | GROUP LONG-TERM CARE INSURANCE | | Welfare Benefit Premiums Paid to Carrier | USD $335,938 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $49,533 | | Insurance broker organization code? | 3 | | Insurance broker name | PROGRESSIVE PLAN ADMINISTRATORS |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 ) |
| Policy contract number | 800272-A |
| Policy instance | 3 |
| Insurance contract or identification number | 800272-A | | Number of Individuals Covered | 10 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of fees paid to insurance company | USD $41 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 41 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | MERCER HEALTH & BENEFITS |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 225108 |
| Policy instance | 4 |
| Insurance contract or identification number | 225108 | | Number of Individuals Covered | 59 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $218,256 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 26865 |
| Policy instance | 5 |
| Insurance contract or identification number | 26865 | | Number of Individuals Covered | 76 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $468,784 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0101689 |
| Policy instance | 6 |
| Insurance contract or identification number | 0101689 | | Number of Individuals Covered | 16936 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $57,515 | | Total amount of fees paid to insurance company | USD $30,585 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,431,715 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $57,515 | | Amount paid for insurance broker fees | 23968 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION AND NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | HNI RISK SERVICES |
|
| JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 ) |
| Policy contract number | 28735 |
| Policy instance | 7 |
| Insurance contract or identification number | 28735 | | Number of Individuals Covered | 37 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $9,180 | | Other welfare benefits provided | GROUP LONG-TERM CARE INSURANCE | | Welfare Benefit Premiums Paid to Carrier | USD $62,633 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,180 | | Insurance broker organization code? | 3 | | Insurance broker name | PROGRESSIVE PLAN ADMINISTRATORS INC |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0136898 |
| Policy instance | 8 |
| Insurance contract or identification number | 0136898 | | Number of Individuals Covered | 23 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $1,249 | | Total amount of fees paid to insurance company | USD $29 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $42,268 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,249 | | Amount paid for insurance broker fees | 29 | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | USI SECURITIES INC. |
|
| FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 ) |
| Policy contract number | 458933 |
| Policy instance | 9 |
| Insurance contract or identification number | 458933 | | Number of Individuals Covered | 1800 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Other welfare benefits provided | STD | | Welfare Benefit Premiums Paid to Carrier | USD $112,356 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 ) |
| Policy contract number | 800272-C |
| Policy instance | 10 |
| Insurance contract or identification number | 800272-C | | Number of Individuals Covered | 12 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 ) |
| Policy contract number | 458934 |
| Policy instance | 11 |
| Insurance contract or identification number | 458934 | | Number of Individuals Covered | 656 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $42,386 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 ) |
| Policy contract number | 28838 |
| Policy instance | 12 |
| Insurance contract or identification number | 28838 | | Number of Individuals Covered | 103 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $24,089 | | Other welfare benefits provided | GROUP LONG-TERM CARE INSURANCE | | Welfare Benefit Premiums Paid to Carrier | USD $163,346 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $24,089 | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES |
|
| OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | MU1031 |
| Policy instance | 25 |
| Insurance contract or identification number | MU1031 | | Number of Individuals Covered | 990 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $60,487 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,614,210 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $38,839 | | Insurance broker organization code? | 3 | | Insurance broker name | AON CONSULTING INC |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0137919 |
| Policy instance | 26 |
| Insurance contract or identification number | 0137919 | | Number of Individuals Covered | 155 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $9,365 | | Total amount of fees paid to insurance company | USD $29 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $273,132 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,365 | | Amount paid for insurance broker fees | 29 | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES LLC |
|
| FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 ) |
| Policy contract number | 395790 |
| Policy instance | 40 |
| Insurance contract or identification number | 395790 | | Number of Individuals Covered | 70 | | Insurance policy start date | 2014-02-01 | | Insurance policy end date | 2015-01-31 | | Total amount of commissions paid to insurance broker | USD $4,981 | | Total amount of fees paid to insurance company | USD $297 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $31,209 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,884 | | Amount paid for insurance broker fees | 295 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | AON CONSULTING |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 342147 |
| Policy instance | 41 |
| Insurance contract or identification number | 342147 | | Number of Individuals Covered | 180 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-11-30 | | Total amount of commissions paid to insurance broker | USD $21,817 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $769,564 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $18,143 | | Insurance broker organization code? | 3 | | Insurance broker name | ASSUREDPARTNERS OF MISSOURI LLC |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 ) |
| Policy contract number | 10183440 |
| Policy instance | 42 |
| Insurance contract or identification number | 10183440 | | Number of Individuals Covered | 110 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $1,399 | | Total amount of fees paid to insurance company | USD $347 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $11,654 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,286 | | Amount paid for insurance broker fees | 347 | | Additional information about fees paid to insurance broker | BROKER BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | AHM FINANCIAL GROUP LLC |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 ) |
| Policy contract number | 10183441 |
| Policy instance | 43 |
| Insurance contract or identification number | 10183441 | | Number of Individuals Covered | 110 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $2,379 | | Total amount of fees paid to insurance company | USD $472 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $15,858 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,188 | | Amount paid for insurance broker fees | 472 | | Additional information about fees paid to insurance broker | BROKER BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | AHM FINANCIAL GROUP LLC |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 ) |
| Policy contract number | 10183442 |
| Policy instance | 44 |
| Insurance contract or identification number | 10183442 | | Number of Individuals Covered | 109 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $2,651 | | Total amount of fees paid to insurance company | USD $796 | | Other welfare benefits provided | WEEKLY INCOME | | Welfare Benefit Premiums Paid to Carrier | USD $26,510 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,435 | | Amount paid for insurance broker fees | 796 | | Additional information about fees paid to insurance broker | BROKER BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | AHM FINANCIAL GROUP LLC |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0136895 |
| Policy instance | 45 |
| Insurance contract or identification number | 0136895 | | Number of Individuals Covered | 350 | | 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 $634,980 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CORPORATE COUNSELING ASSOCIATES (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 00-Y&R |
| Policy instance | 46 |
| Insurance contract or identification number | 00-Y&R | | Number of Individuals Covered | 4644 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Other welfare benefits provided | EAP | | Welfare Benefit Premiums Paid to Carrier | USD $71,278 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CORPORATE COUNSELING ASSOCIATES (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 00-GROUP M |
| Policy instance | 47 |
| Insurance contract or identification number | 00-GROUP M | | Number of Individuals Covered | 3621 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Other welfare benefits provided | EAP | | Welfare Benefit Premiums Paid to Carrier | USD $65,178 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CORPORATE COUNSELING ASSOCIATES (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 00-WPP |
| Policy instance | 48 |
| Insurance contract or identification number | 00-WPP | | Number of Individuals Covered | 7618 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Other welfare benefits provided | EAP | | Welfare Benefit Premiums Paid to Carrier | USD $165,649 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 205447 |
| Policy instance | 39 |
| Insurance contract or identification number | 205447 | | Number of Individuals Covered | 18 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $874 | | Total amount of fees paid to insurance company | USD $50 | | Other welfare benefits provided | STD | | Welfare Benefit Premiums Paid to Carrier | USD $9,459 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $874 | | Amount paid for insurance broker fees | 50 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | EARLY CASSIDY & SCHILLING INC |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0149278 |
| Policy instance | 38 |
| Insurance contract or identification number | 0149278 | | Number of Individuals Covered | 270 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Other welfare benefits provided | CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $29,835 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0151222 |
| Policy instance | 36 |
| Insurance contract or identification number | 0151222 | | Number of Individuals Covered | 407 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $1,828 | | Total amount of fees paid to insurance company | USD $942 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $26,252 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,828 | | Amount paid for insurance broker fees | 873 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL AND NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | AON CONSULTING |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0190090 |
| Policy instance | 27 |
| Insurance contract or identification number | 0190090 | | Number of Individuals Covered | 238 | | 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 $24,007 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 ) |
| Policy contract number | 000010122759 |
| Policy instance | 28 |
| Insurance contract or identification number | 000010122759 | | Number of Individuals Covered | 244 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $3,117 | | Total amount of fees paid to insurance company | USD $3,917 | | Other welfare benefits provided | WEEKLY INCOME | | Welfare Benefit Premiums Paid to Carrier | USD $55,278 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $56 | | Amount paid for insurance broker fees | 3917 | | Additional information about fees paid to insurance broker | BROKER BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | AON CONSULTING |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0142603 |
| Policy instance | 29 |
| Insurance contract or identification number | 0142603 | | Number of Individuals Covered | 352 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $83,983 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 000000501086 |
| Policy instance | 30 |
| Insurance contract or identification number | 000000501086 | | Number of Individuals Covered | 113 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $29,562 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 ) |
| Policy contract number | 496491 |
| Policy instance | 32 |
| Insurance contract or identification number | 496491 | | Number of Individuals Covered | 13 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $5,514 | | Total amount of fees paid to insurance company | USD $460 | | Other welfare benefits provided | LONG-TERM CARE | | Welfare Benefit Premiums Paid to Carrier | USD $37,286 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,514 | | Amount paid for insurance broker fees | 460 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES LLC |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0149457 |
| Policy instance | 31 |
| Insurance contract or identification number | 0149457 | | Number of Individuals Covered | 171 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $2,613 | | Total amount of fees paid to insurance company | USD $498 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $109,000 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,613 | | Amount paid for insurance broker fees | 325 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL AND NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | AON CONSULTING |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0121574 |
| Policy instance | 33 |
| Insurance contract or identification number | 0121574 | | Number of Individuals Covered | 163 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Other welfare benefits provided | CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $24,997 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 0755007 |
| Policy instance | 34 |
| Insurance contract or identification number | 0755007 | | Number of Individuals Covered | 1738 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $4,181 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $193,379 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,181 | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES LLC |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0153513 |
| Policy instance | 35 |
| Insurance contract or identification number | 0153513 | | Number of Individuals Covered | 318 | | Insurance policy start date | 2014-06-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $340 | | Total amount of fees paid to insurance company | USD $151 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $44,014 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $340 | | Amount paid for insurance broker fees | 16 | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | AON CONSULTING |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0104884 |
| Policy instance | 18 |
| Insurance contract or identification number | 0104884 | | Number of Individuals Covered | 3512 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $32,686 | | Total amount of fees paid to insurance company | USD $7,649 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,165,402 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $32,686 | | Amount paid for insurance broker fees | 6145 | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION AND SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | AON CONSULTING |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 3213432,3213436 |
| Policy instance | 1 |
| Insurance contract or identification number | 3213432,3213436 | | Number of Individuals Covered | 4583 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $10,598 | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | PREPAID DENTAL | | Welfare Benefit Premiums Paid to Carrier | USD $982,048 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,415 | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES |
|
| HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 4490010 |
| Policy instance | 2 |
| Insurance contract or identification number | 4490010 | | Number of Individuals Covered | 2841 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $2,265 | | Total amount of fees paid to insurance company | USD $600 | | Other welfare benefits provided | LEGAL | | Welfare Benefit Premiums Paid to Carrier | USD $564,568 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,265 | | Amount paid for insurance broker fees | 600 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION AND NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES LLC |
|
| JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 ) |
| Policy contract number | 28702 |
| Policy instance | 22 |
| Insurance contract or identification number | 28702 | | Number of Individuals Covered | 69 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $13,095 | | Other welfare benefits provided | GROUP LONG-TERM CARE | | Welfare Benefit Premiums Paid to Carrier | USD $88,675 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,095 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | PROGRESSIVE PLAN ADMINISTRATORS |
|
| WESCO INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 25011 ) |
| Policy contract number | 0235060 |
| Policy instance | 37 |
| Insurance contract or identification number | 0235060 | | Number of Individuals Covered | 35 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,256 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 ) |
| Policy contract number | 458934 |
| Policy instance | 14 |
| Insurance contract or identification number | 458934 | | Number of Individuals Covered | 802 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $43,059 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 ) |
| Policy contract number | 28838 |
| Policy instance | 15 |
| Insurance contract or identification number | 28838 | | Number of Individuals Covered | 105 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $25,497 | | Other welfare benefits provided | GROUP LONG-TERM CARE INSURANCE | | Welfare Benefit Premiums Paid to Carrier | USD $169,980 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $25,497 | | Insurance broker organization code? | 3 | | Insurance broker name | PROGRESSIVE PLAN ADMINISTRATORS |
|
| JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 ) |
| Policy contract number | 28918 |
| Policy instance | 16 |
| Insurance contract or identification number | 28918 | | Number of Individuals Covered | 181 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $51,517 | | Other welfare benefits provided | GROUP LONG-TERM CARE INSURANCE | | Welfare Benefit Premiums Paid to Carrier | USD $343,440 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $51,517 | | Insurance broker organization code? | 3 | | Insurance broker name | PROGRESSIVE PLAN ADMINISTRATORS |
|
| JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 ) |
| Policy contract number | 28709 |
| Policy instance | 17 |
| Insurance contract or identification number | 28709 | | Number of Individuals Covered | 14 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $2,538 | | Other welfare benefits provided | GROUP LONG-TERM CARE INSURANCE | | Welfare Benefit Premiums Paid to Carrier | USD $16,921 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,538 | | Insurance broker organization code? | 3 | | Insurance broker name | PROGRESSIVE PLAN ADMINISTRATORS |
|
| FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 ) |
| Policy contract number | 458933 |
| Policy instance | 12 |
| Insurance contract or identification number | 458933 | | Number of Individuals Covered | 1743 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Other welfare benefits provided | STD | | Welfare Benefit Premiums Paid to Carrier | USD $114,645 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0105228 |
| Policy instance | 18 |
| Insurance contract or identification number | 0105228 | | Number of Individuals Covered | 198 | | 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 $3,823 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 142602 |
| Policy instance | 19 |
| Insurance contract or identification number | 142602 | | Number of Individuals Covered | 61 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $35,367 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0106459 |
| Policy instance | 20 |
| Insurance contract or identification number | 0106459 | | Number of Individuals Covered | 2669 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $12,470 | | Total amount of fees paid to insurance company | USD $1,888 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $127,351 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $12,470 | | Amount paid for insurance broker fees | 1888 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION AND NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES LLC |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 122383 |
| Policy instance | 21 |
| Insurance contract or identification number | 122383 | | Number of Individuals Covered | 158 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of fees paid to insurance company | USD $14 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $44,526 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 14 | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES LLC |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0104884 |
| Policy instance | 22 |
| Insurance contract or identification number | 0104884 | | Number of Individuals Covered | 2857 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $57,020 | | Total amount of fees paid to insurance company | USD $14 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $958,093 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $57,020 | | Amount paid for insurance broker fees | 14 | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | PROGRESSIVE PLAN ADMINISTRATORS |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 ) |
| Policy contract number | 800272-C |
| Policy instance | 13 |
| Insurance contract or identification number | 800272-C | | Number of Individuals Covered | 15 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0136898 |
| Policy instance | 11 |
| Insurance contract or identification number | 0136898 | | Number of Individuals Covered | 27 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $2,256 | | Total amount of fees paid to insurance company | USD $28 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $55,262 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,256 | | Amount paid for insurance broker fees | 28 | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | USI SECURITIES INC. |
|
| JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 ) |
| Policy contract number | 28735 |
| Policy instance | 10 |
| Insurance contract or identification number | 28735 | | Number of Individuals Covered | 37 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $9,149 | | Other welfare benefits provided | GROUP LONG-TERM CARE INSURANCE | | Welfare Benefit Premiums Paid to Carrier | USD $60,992 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,149 | | Insurance broker organization code? | 3 | | Insurance broker name | PROGRESSIVE PLAN ADMINISTRATORS INC |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 ) |
| Policy contract number | 800272-B |
| Policy instance | 31 |
| Insurance contract or identification number | 800272-B | | Number of Individuals Covered | 3 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Health Insurance Welfare Benefit | Yes | | Were dividends or retroactive rate refunds paid in cash? | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 3213432,3213436 |
| Policy instance | 1 |
| Insurance contract or identification number | 3213432,3213436 | | Number of Individuals Covered | 5170 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $21,796 | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | PREPAID DENTAL | | Welfare Benefit Premiums Paid to Carrier | USD $1,096,935 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $17,990 | | Insurance broker organization code? | 3 | | Insurance broker name | HAYS GROUP INC |
|
| OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | YR1000 |
| Policy instance | 2 |
| Insurance contract or identification number | YR1000 | | Number of Individuals Covered | 199 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $17,594 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,700,073 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $17,594 | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES LLC |
|
| METROPOLITAN PROPERTY AND CASUALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26298 ) |
| Policy contract number | 4490010 |
| Policy instance | 3 |
| Insurance contract or identification number | 4490010 | | Number of Individuals Covered | 2865 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $6,530 | | Total amount of fees paid to insurance company | USD $699 | | Other welfare benefits provided | LEGAL | | Welfare Benefit Premiums Paid to Carrier | USD $547,222 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,530 | | Amount paid for insurance broker fees | 699 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION AND NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES LLC |
|
| MAGELLAN HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: N/A ) |
| Policy contract number | WPGP0-002 |
| Policy instance | 4 |
| Insurance contract or identification number | WPGP0-002 | | Number of Individuals Covered | 4659 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $98,375 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 ) |
| Policy contract number | 800272-A |
| Policy instance | 5 |
| Insurance contract or identification number | 800272-A | | Number of Individuals Covered | 10 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 225108 |
| Policy instance | 6 |
| Insurance contract or identification number | 225108 | | Number of Individuals Covered | 63 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $216,822 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 26865 |
| Policy instance | 7 |
| Insurance contract or identification number | 26865 | | Number of Individuals Covered | 85 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $510,836 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0101689 |
| Policy instance | 8 |
| Insurance contract or identification number | 0101689 | | Number of Individuals Covered | 18769 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $88,921 | | Total amount of fees paid to insurance company | USD $58,472 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,243,264 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $88,921 | | Amount paid for insurance broker fees | 58472 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION AND NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES LLC |
|
| OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | JW00201 |
| Policy instance | 9 |
| Insurance contract or identification number | JW00201 | | Number of Individuals Covered | 166 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $11,886 | | Total amount of fees paid to insurance company | USD $2,000 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,167,117 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,886 | | Amount paid for insurance broker fees | 2000 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES LLC |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 236565 |
| Policy instance | 23 |
| Insurance contract or identification number | 236565 | | Number of Individuals Covered | 1940 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-05-31 | | Total amount of commissions paid to insurance broker | USD $5,497 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $109,934 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,497 | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47029 ) |
| Policy contract number | 12270668 |
| Policy instance | 24 |
| Insurance contract or identification number | 12270668 | | Number of Individuals Covered | 14743 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $113,651 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $113,651 | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SVC |
|
| FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 ) |
| Policy contract number | 496514 |
| Policy instance | 26 |
| Insurance contract or identification number | 496514 | | Number of Individuals Covered | 20 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of fees paid to insurance company | USD $1,647 | | Other welfare benefits provided | GROUP LONG TERM CARE | | Welfare Benefit Premiums Paid to Carrier | USD $123,823 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 1647 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES LLC |
|
| FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 ) |
| Policy contract number | 496491 |
| Policy instance | 40 |
| Insurance contract or identification number | 496491 | | Number of Individuals Covered | 16 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $6,151 | | Total amount of fees paid to insurance company | USD $513 | | Other welfare benefits provided | LONG-TERM CARE | | Welfare Benefit Premiums Paid to Carrier | USD $37,441 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,151 | | Amount paid for insurance broker fees | 513 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES LLC |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0121574 |
| Policy instance | 41 |
| Insurance contract or identification number | 0121574 | | Number of Individuals Covered | 112 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Other welfare benefits provided | CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $26,325 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0136893 |
| Policy instance | 42 |
| Insurance contract or identification number | 0136893 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $946 | | Total amount of fees paid to insurance company | USD $28 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $93,600 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $946 | | Amount paid for insurance broker fees | 28 | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | USI SECURITIES INC |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 0755007 |
| Policy instance | 43 |
| Insurance contract or identification number | 0755007 | | Number of Individuals Covered | 1911 | | Insurance policy start date | 2013-06-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $5,626 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $112,514 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,626 | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES LLC |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0156462 |
| Policy instance | 44 |
| Insurance contract or identification number | 0156462 | | Number of Individuals Covered | 73 | | Insurance policy start date | 2013-12-01 | | Insurance policy end date | 2013-12-31 | | Total amount of fees paid to insurance company | USD $14 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,633 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 14 | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES LLC |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0153513 |
| Policy instance | 45 |
| Insurance contract or identification number | 0153513 | | Number of Individuals Covered | 204 | | Insurance policy start date | 2013-06-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $1,083 | | Total amount of fees paid to insurance company | USD $664 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $33,049 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,083 | | Amount paid for insurance broker fees | 664 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION & NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES LLC |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0151222 |
| Policy instance | 46 |
| Insurance contract or identification number | 0151222 | | Number of Individuals Covered | 486 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of fees paid to insurance company | USD $14 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $27,210 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 14 | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES LLC |
|
| NATIONAL BENEFIT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61409 ) |
| Policy contract number | 0235060 |
| Policy instance | 47 |
| Insurance contract or identification number | 0235060 | | Number of Individuals Covered | 28 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $216 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,078 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $216 | | Insurance broker organization code? | 3 | | Insurance broker name | EMERSON REID LLC |
|
| SECURITY MUTUAL LIFE INSURANCE COMPANY OF NY (National Association of Insurance Commissioners NAIC id number: 68772 ) |
| Policy contract number | GNY0040441 |
| Policy instance | 48 |
| Insurance contract or identification number | GNY0040441 | | Number of Individuals Covered | 1818 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $8,557 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $58,984 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,557 | | Insurance broker organization code? | 3 | | Insurance broker name | EMERSON REID LLC |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 ) |
| Policy contract number | 800799 |
| Policy instance | 49 |
| Insurance contract or identification number | 800799 | | Number of Individuals Covered | 15 | | Insurance policy start date | 2013-08-16 | | Insurance policy end date | 2013-12-31 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $16,916 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0149457 |
| Policy instance | 39 |
| Insurance contract or identification number | 0149457 | | Number of Individuals Covered | 164 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $9,977 | | Total amount of fees paid to insurance company | USD $1,974 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $104,778 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,816 | | Amount paid for insurance broker fees | 1974 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION & NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | ROBERT REERS |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 1329 |
| Policy instance | 38 |
| Insurance contract or identification number | 1329 | | Number of Individuals Covered | 10 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $32,413 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 000000501086 |
| Policy instance | 37 |
| Insurance contract or identification number | 000000501086 | | Number of Individuals Covered | 129 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $2,058 | | Total amount of fees paid to insurance company | USD $278 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $26,907 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,058 | | Amount paid for insurance broker fees | 278 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | MERCER HEALTH & BENEFITS |
|
| HEALTH ALLIANCE PLAN 770 (National Association of Insurance Commissioners NAIC id number: 95844 ) |
| Policy contract number | 10002665 |
| Policy instance | 25 |
| Insurance contract or identification number | 10002665 | | Number of Individuals Covered | 468 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $4,655,228 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 ) |
| Policy contract number | 28702 |
| Policy instance | 27 |
| Insurance contract or identification number | 28702 | | Number of Individuals Covered | 61 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $13,866 | | Other welfare benefits provided | GROUP LONG-TERM CARE | | Welfare Benefit Premiums Paid to Carrier | USD $92,437 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,866 | | Insurance broker organization code? | 3 | | Insurance broker name | PROGRESSIVE PLAN ADMINISTRATORS INC |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0118689 |
| Policy instance | 28 |
| Insurance contract or identification number | 0118689 | | Number of Individuals Covered | 40272 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $225,034 | | Total amount of fees paid to insurance company | USD $3,185 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $4,461,197 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $225,034 | | Amount paid for insurance broker fees | 3185 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION AND NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES LLC |
|
| MAGELLAN HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: N/A ) |
| Policy contract number | WPGP0-003 |
| Policy instance | 29 |
| Insurance contract or identification number | WPGP0-003 | | Number of Individuals Covered | 3675 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $56,726 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELAWARE AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62634 ) |
| Policy contract number | 10825 |
| Policy instance | 30 |
| Insurance contract or identification number | 10825 | | Number of Individuals Covered | 14 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $2,597 | | Other welfare benefits provided | GTL, ADD | | Welfare Benefit Premiums Paid to Carrier | USD $21,612 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,597 | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES LLC |
|
| OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | MU1031 |
| Policy instance | 32 |
| Insurance contract or identification number | MU1031 | | Number of Individuals Covered | 1019 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $62,668 | | Total amount of fees paid to insurance company | USD $10,640 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,291,028 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $62,668 | | Amount paid for insurance broker fees | 10640 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0137919 |
| Policy instance | 33 |
| Insurance contract or identification number | 0137919 | | Number of Individuals Covered | 155 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $14,965 | | Total amount of fees paid to insurance company | USD $28 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $381,799 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $14,965 | | Amount paid for insurance broker fees | 28 | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | USI SECURITIES INC |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0190090 |
| Policy instance | 34 |
| Insurance contract or identification number | 0190090 | | Number of Individuals Covered | 312 | | 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 $18,000 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 ) |
| Policy contract number | 000010122759 |
| Policy instance | 35 |
| Insurance contract or identification number | 000010122759 | | Number of Individuals Covered | 254 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $3,294 | | Total amount of fees paid to insurance company | USD $3,613 | | Other welfare benefits provided | WEEKLY INCOME | | Welfare Benefit Premiums Paid to Carrier | USD $63,430 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,294 | | Amount paid for insurance broker fees | 442 | | Additional information about fees paid to insurance broker | BROKER BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | EMERSON REID & CO INC |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0142603 |
| Policy instance | 36 |
| Insurance contract or identification number | 0142603 | | Number of Individuals Covered | 406 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $109,631 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0149278 |
| Policy instance | 50 |
| Insurance contract or identification number | 0149278 | | Number of Individuals Covered | 168 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Other welfare benefits provided | CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $27,101 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 26865 |
| Policy instance | 40 |
| Insurance contract or identification number | 26865 | | Number of Individuals Covered | 113 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $549,493 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0121574 |
| Policy instance | 2 |
| Insurance contract or identification number | 0121574 | | Number of Individuals Covered | 123 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Other welfare benefits provided | CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $8,498 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELAWARE AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62634 ) |
| Policy contract number | 10825 |
| Policy instance | 14 |
| Insurance contract or identification number | 10825 | | Number of Individuals Covered | 19 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $2,302 | | Other welfare benefits provided | GTL, ADD | | Welfare Benefit Premiums Paid to Carrier | USD $23,168 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,302 | | Insurance broker organization code? | 3 | | Insurance broker name | PROGRESSIVE PLAN ADMINISTRATORS INC |
|
| MAGELLAN HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: N/A ) |
| Policy contract number | WPGP0-003 |
| Policy instance | 15 |
| Insurance contract or identification number | WPGP0-003 | | Number of Individuals Covered | 3243 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $66,485 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0014529 |
| Policy instance | 16 |
| Insurance contract or identification number | 0014529 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of fees paid to insurance company | USD $34 | | Life Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 34 | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | USI INS SERVICES LLC |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0118689 |
| Policy instance | 17 |
| Insurance contract or identification number | 0118689 | | Number of Individuals Covered | 25235 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $378,001 | | Total amount of fees paid to insurance company | USD $3,051 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $4,418,123 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $378,001 | | Amount paid for insurance broker fees | 3051 | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES LLC |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0136895 |
| Policy instance | 18 |
| Insurance contract or identification number | 0136895 | | Number of Individuals Covered | 327 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $548,303 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 ) |
| Policy contract number | 496514 |
| Policy instance | 20 |
| Insurance contract or identification number | 496514 | | Number of Individuals Covered | 26 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of fees paid to insurance company | USD $1,432 | | Other welfare benefits provided | GROUP LONG TERM CARE | | Welfare Benefit Premiums Paid to Carrier | USD $128,727 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 1432 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES LLC |
|
| HEALTH ALLIANCE PLAN (National Association of Insurance Commissioners NAIC id number: 95844 ) |
| Policy contract number | 770 |
| Policy instance | 21 |
| Insurance contract or identification number | 770 | | Number of Individuals Covered | 484 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $4,402,250 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47029 ) |
| Policy contract number | 12270668 |
| Policy instance | 22 |
| Insurance contract or identification number | 12270668 | | Number of Individuals Covered | 13142 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $97,482 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $97,482 | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES LLC |
|
| UNITEDHEALTHCARE INSURANCE COMPANY OF NY (National Association of Insurance Commissioners NAIC id number: 32395 ) |
| Policy contract number | 236565 |
| Policy instance | 23 |
| Insurance contract or identification number | 236565 | | Number of Individuals Covered | 1936 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $10,533 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $210,670 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,533 | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES LLC |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 ) |
| Policy contract number | 800272-B |
| Policy instance | 13 |
| Insurance contract or identification number | 800272-B | | Number of Individuals Covered | 4 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Health Insurance Welfare Benefit | Yes | | Were dividends or retroactive rate refunds paid in cash? | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | MU1031 |
| Policy instance | 12 |
| Insurance contract or identification number | MU1031 | | Number of Individuals Covered | 1061 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $63,531 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,392,594 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $63,531 | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SVC - NY |
|
| FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 ) |
| Policy contract number | 496491 |
| Policy instance | 3 |
| Insurance contract or identification number | 496491 | | Number of Individuals Covered | 22 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $5,817 | | Total amount of fees paid to insurance company | USD $485 | | Other welfare benefits provided | LONG-TERM CARE | | Welfare Benefit Premiums Paid to Carrier | USD $43,380 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,817 | | Amount paid for insurance broker fees | 485 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES LLC |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0149457 |
| Policy instance | 4 |
| Insurance contract or identification number | 0149457 | | Number of Individuals Covered | 164 | | Insurance policy start date | 2012-05-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $2,555 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $69,190 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,555 | | Insurance broker organization code? | 3 | | Insurance broker name | ROBERT REERS |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 1329 |
| Policy instance | 5 |
| Insurance contract or identification number | 1329 | | Number of Individuals Covered | 8 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $31,320 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 000000501086 |
| Policy instance | 6 |
| Insurance contract or identification number | 000000501086 | | Number of Individuals Covered | 115 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $1,768 | | Total amount of fees paid to insurance company | USD $242 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $21,167 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,768 | | Amount paid for insurance broker fees | 242 | | Additional information about fees paid to insurance broker | ADDDITIONAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | MERCER HEALTH & BENEFITS |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0142603 |
| Policy instance | 7 |
| Insurance contract or identification number | 0142603 | | Number of Individuals Covered | 256 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $142,259 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0144904 |
| Policy instance | 8 |
| Insurance contract or identification number | 0144904 | | Number of Individuals Covered | 483 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $79,385 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 ) |
| Policy contract number | 000010122759 |
| Policy instance | 9 |
| Insurance contract or identification number | 000010122759 | | Number of Individuals Covered | 281 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $2,438 | | Total amount of fees paid to insurance company | USD $2,182 | | Other welfare benefits provided | WEEKLY INCOME | | Welfare Benefit Premiums Paid to Carrier | USD $43,632 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $246 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 614 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker name | GROUP HEALTH SOLUTIONS INC. |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0190090 |
| Policy instance | 10 |
| Insurance contract or identification number | 0190090 | | Number of Individuals Covered | 317 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $42,000 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0137919 |
| Policy instance | 11 |
| Insurance contract or identification number | 0137919 | | Number of Individuals Covered | 296 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $13,954 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $333,400 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,954 | | Insurance broker organization code? | 3 | | Insurance broker name | USI SECURITIES INC |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0104884 |
| Policy instance | 24 |
| Insurance contract or identification number | 0104884 | | Number of Individuals Covered | 2978 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $53,849 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $897,164 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $53,849 | | Insurance broker organization code? | 3 | | Insurance broker name | PROGRESSIVE PLAN ADMINISTRATORS |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0137092 |
| Policy instance | 25 |
| Insurance contract or identification number | 0137092 | | Number of Individuals Covered | 40 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $2,131 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $54,148 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,131 | | Insurance broker organization code? | 3 | | Insurance broker name | USI SECURITIES INC |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 122383 |
| Policy instance | 26 |
| Insurance contract or identification number | 122383 | | Number of Individuals Covered | 162 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of fees paid to insurance company | USD $34 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $47,267 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 34 | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | | Insurance broker name | USI INSURANCE SERVICES LLC |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0101689 |
| Policy instance | 39 |
| Insurance contract or identification number | 0101689 | | Number of Individuals Covered | 16056 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $93,376 | | Total amount of fees paid to insurance company | USD $19,604 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,134,783 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $93,376 | | Amount paid for insurance broker fees | 19604 | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES LLC |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 225108 |
| Policy instance | 41 |
| Insurance contract or identification number | 225108 | | Number of Individuals Covered | 68 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $222,959 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 ) |
| Policy contract number | 800272-A |
| Policy instance | 42 |
| Insurance contract or identification number | 800272-A | | Number of Individuals Covered | 11 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Health Insurance Welfare Benefit | Yes | | Were dividends or retroactive rate refunds paid in cash? | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 ) |
| Policy contract number | 28702 |
| Policy instance | 19 |
| Insurance contract or identification number | 28702 | | Number of Individuals Covered | 74 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $13,473 | | Other welfare benefits provided | GROUP LONG-TERM CARE | | Welfare Benefit Premiums Paid to Carrier | USD $89,818 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,473 | | Insurance broker organization code? | 3 | | Insurance broker name | PROGRESSIVE PLAN ADMINISTRATORS |
|
| MAGELLAN HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: N/A ) |
| Policy contract number | WPGP0-002 |
| Policy instance | 43 |
| Insurance contract or identification number | WPGP0-002 | | Number of Individuals Covered | 4923 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $100,781 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN PROPERTY AND CASUALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26298 ) |
| Policy contract number | 4490010 |
| Policy instance | 44 |
| Insurance contract or identification number | 4490010 | | Number of Individuals Covered | 2760 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $6,119 | | Total amount of fees paid to insurance company | USD $256 | | Other welfare benefits provided | LEGAL | | Welfare Benefit Premiums Paid to Carrier | USD $563,121 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,119 | | Amount paid for insurance broker fees | 256 | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES LLC |
|
| OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | YR1000 |
| Policy instance | 45 |
| Insurance contract or identification number | YR1000 | | Number of Individuals Covered | 276 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $22,767 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,366,247 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $22,767 | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES LLC |
|
| CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 ) |
| Policy contract number | 3213432,3213436 |
| Policy instance | 46 |
| Insurance contract or identification number | 3213432,3213436 | | Number of Individuals Covered | 7436 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $42,419 | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | PREPAID DENTAL | | Welfare Benefit Premiums Paid to Carrier | USD $1,820,254 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,814 | | Insurance broker organization code? | 3 | | Insurance broker name | PROGRESSIVE PLAN ADMINISTRATORS INC |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0136893 |
| Policy instance | 1 |
| Insurance contract or identification number | 0136893 | | Number of Individuals Covered | 24 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $5,610 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $124,939 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,610 | | Insurance broker organization code? | 3 | | Insurance broker name | USI SECURITIES INC |
|
| OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | JW00201 |
| Policy instance | 38 |
| Insurance contract or identification number | JW00201 | | Number of Individuals Covered | 215 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $15,481 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,494,144 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $15,481 | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES LLC |
|
| JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 ) |
| Policy contract number | 28735 |
| Policy instance | 37 |
| Insurance contract or identification number | 28735 | | Number of Individuals Covered | 41 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $9,558 | | Other welfare benefits provided | GROUP LONG-TERM CARE INSURANCE | | Welfare Benefit Premiums Paid to Carrier | USD $63,715 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,558 | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCES SERVICES LLC |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0136898 |
| Policy instance | 36 |
| Insurance contract or identification number | 0136898 | | Number of Individuals Covered | 35 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $2,085 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $50,594 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,085 | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0106459 |
| Policy instance | 27 |
| Insurance contract or identification number | 0106459 | | Number of Individuals Covered | 2346 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $12,191 | | Total amount of fees paid to insurance company | USD $681 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $122,919 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $12,191 | | Amount paid for insurance broker fees | 681 | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES LLC |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 142602 |
| Policy instance | 28 |
| Insurance contract or identification number | 142602 | | Number of Individuals Covered | 57 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $30,395 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0105228 |
| Policy instance | 29 |
| Insurance contract or identification number | 0105228 | | Number of Individuals Covered | 203 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,972 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 ) |
| Policy contract number | 28709 |
| Policy instance | 30 |
| Insurance contract or identification number | 28709 | | Number of Individuals Covered | 15 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $2,313 | | Other welfare benefits provided | GROUP LONG-TERM CARE INSURANCE | | Welfare Benefit Premiums Paid to Carrier | USD $15,418 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,313 | | Insurance broker organization code? | 3 | | Insurance broker name | PROGRESSIVE PLAN ADMINISTRATORS, IN |
|
| JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 ) |
| Policy contract number | 28918 |
| Policy instance | 31 |
| Insurance contract or identification number | 28918 | | Number of Individuals Covered | 209 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $50,183 | | Other welfare benefits provided | GROUP LONG-TERM CARE INSURANCE | | Welfare Benefit Premiums Paid to Carrier | USD $334,546 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $50,183 | | Insurance broker organization code? | 3 | | Insurance broker name | PROGRESSIVE PLAN ADMINISTRATORS INC |
|
| JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 ) |
| Policy contract number | 28838 |
| Policy instance | 32 |
| Insurance contract or identification number | 28838 | | Number of Individuals Covered | 127 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $27,415 | | Other welfare benefits provided | GROUP LONG-TERM CARE INSURANCE | | Welfare Benefit Premiums Paid to Carrier | USD $182,762 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $27,415 | | Insurance broker organization code? | 3 | | Insurance broker name | PROGRESSIVE PLAN ADMINISTRATORS |
|
| FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 ) |
| Policy contract number | 458934 |
| Policy instance | 33 |
| Insurance contract or identification number | 458934 | | Number of Individuals Covered | 816 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $55,812 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 ) |
| Policy contract number | 800272-C |
| Policy instance | 34 |
| Insurance contract or identification number | 800272-C | | Number of Individuals Covered | 15 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Health Insurance Welfare Benefit | Yes | | Were dividends or retroactive rate refunds paid in cash? | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 ) |
| Policy contract number | 458933 |
| Policy instance | 35 |
| Insurance contract or identification number | 458933 | | Number of Individuals Covered | 2138 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Other welfare benefits provided | STD | | Welfare Benefit Premiums Paid to Carrier | USD $124,335 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0014529 |
| Policy instance | 13 |
| Insurance contract or identification number | 0014529 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of fees paid to insurance company | USD $19 | | Life Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 ) |
| Policy contract number | 800799 |
| Policy instance | 14 |
| Insurance contract or identification number | 800799 | | Number of Individuals Covered | 28 | | Insurance policy start date | 2010-08-16 | | Insurance policy end date | 2011-08-15 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $139,492 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0118689 |
| Policy instance | 15 |
| Insurance contract or identification number | 0118689 | | Number of Individuals Covered | 24896 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $59,023 | | Total amount of fees paid to insurance company | USD $910 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $4,285,424 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0136895 |
| Policy instance | 16 |
| Insurance contract or identification number | 0136895 | | Number of Individuals Covered | 309 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $484,094 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 ) |
| Policy contract number | 28702 |
| Policy instance | 17 |
| Insurance contract or identification number | 28702 | | Number of Individuals Covered | 77 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $13,198 | | Other welfare benefits provided | GROUP LONG-TERM CARE | | Welfare Benefit Premiums Paid to Carrier | USD $87,981 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 ) |
| Policy contract number | 496514 |
| Policy instance | 18 |
| Insurance contract or identification number | 496514 | | Number of Individuals Covered | 34 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of fees paid to insurance company | USD $1,633 | | Other welfare benefits provided | GROUP LONG TERM CARE | | Welfare Benefit Premiums Paid to Carrier | USD $129,995 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HEALTH ALLIANCE PLAN (National Association of Insurance Commissioners NAIC id number: 95844 ) |
| Policy contract number | 770 |
| Policy instance | 19 |
| Insurance contract or identification number | 770 | | Number of Individuals Covered | 509 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $4,003,187 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47029 ) |
| Policy contract number | 12270668 |
| Policy instance | 20 |
| Insurance contract or identification number | 12270668 | | Number of Individuals Covered | 13845 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $75,718 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY OF NY (National Association of Insurance Commissioners NAIC id number: 32395 ) |
| Policy contract number | 236565 |
| Policy instance | 21 |
| Insurance contract or identification number | 236565 | | Number of Individuals Covered | 1807 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $9,787 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $195,747 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 ) |
| Policy contract number | PA9293 |
| Policy instance | 22 |
| Insurance contract or identification number | PA9293 | | Number of Individuals Covered | 1326 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $23,450 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MAGELLAN HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: N/A ) |
| Policy contract number | WPGP0-003 |
| Policy instance | 12 |
| Insurance contract or identification number | WPGP0-003 | | Number of Individuals Covered | 3095 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $61,122 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELAWARE AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62634 ) |
| Policy contract number | 10825 |
| Policy instance | 11 |
| Insurance contract or identification number | 10825 | | Number of Individuals Covered | 25 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of fees paid to insurance company | USD $2,244 | | Other welfare benefits provided | GTL, ADD | | Welfare Benefit Premiums Paid to Carrier | USD $22,438 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0142598 |
| Policy instance | 2 |
| Insurance contract or identification number | 0142598 | | Number of Individuals Covered | 137 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Other welfare benefits provided | CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $25,018 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 000000501086 |
| Policy instance | 3 |
| Insurance contract or identification number | 000000501086 | | Number of Individuals Covered | 109 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $2,092 | | Total amount of fees paid to insurance company | USD $286 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $22,878 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0142603 |
| Policy instance | 4 |
| Insurance contract or identification number | 0142603 | | Number of Individuals Covered | 719 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $172,556 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0144904 |
| Policy instance | 5 |
| Insurance contract or identification number | 0144904 | | Number of Individuals Covered | 596 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $83,009 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 ) |
| Policy contract number | 000010122759 |
| Policy instance | 6 |
| Insurance contract or identification number | 000010122759 | | Number of Individuals Covered | 291 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $2,980 | | Total amount of fees paid to insurance company | USD $2,497 | | Other welfare benefits provided | WEEKLY INCOME | | Welfare Benefit Premiums Paid to Carrier | USD $49,934 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0190090 |
| Policy instance | 7 |
| Insurance contract or identification number | 0190090 | | Number of Individuals Covered | 326 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $50,000 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0137919 |
| Policy instance | 8 |
| Insurance contract or identification number | 0137919 | | Number of Individuals Covered | 169 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $13,280 | | Total amount of fees paid to insurance company | USD $35 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $244,869 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | MU1031 |
| Policy instance | 9 |
| Insurance contract or identification number | MU1031 | | Number of Individuals Covered | 1137 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $57,855 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,798,750 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 ) |
| Policy contract number | 800272-B |
| Policy instance | 10 |
| Insurance contract or identification number | 800272-B | | Number of Individuals Covered | 4 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00411354 |
| Policy instance | 1 |
| Insurance contract or identification number | 00411354 | | Number of Individuals Covered | 134 | | Insurance policy start date | 2011-08-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $4,320 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | A D & D | | Welfare Benefit Premiums Paid to Carrier | USD $53,579 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0104884 |
| Policy instance | 23 |
| Insurance contract or identification number | 0104884 | | Number of Individuals Covered | 3058 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $48,521 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $886,139 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 ) |
| Policy contract number | 28735 |
| Policy instance | 36 |
| Insurance contract or identification number | 28735 | | Number of Individuals Covered | 43 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $9,761 | | Other welfare benefits provided | GROUP LONG-TERM CARE INSURANCE | | Welfare Benefit Premiums Paid to Carrier | USD $65,071 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | JW00201 |
| Policy instance | 37 |
| Insurance contract or identification number | JW00201 | | Number of Individuals Covered | 270 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $23,997 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,344,218 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0101689 |
| Policy instance | 38 |
| Insurance contract or identification number | 0101689 | | Number of Individuals Covered | 15931 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $79,591 | | Total amount of fees paid to insurance company | USD $69,247 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,575,847 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 26865 |
| Policy instance | 39 |
| Insurance contract or identification number | 26865 | | Number of Individuals Covered | 64 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $424,740 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 225108 |
| Policy instance | 40 |
| Insurance contract or identification number | 225108 | | Number of Individuals Covered | 30 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $208,679 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 ) |
| Policy contract number | 800272-A |
| Policy instance | 41 |
| Insurance contract or identification number | 800272-A | | Number of Individuals Covered | 13 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | OM00101 |
| Policy instance | 42 |
| Insurance contract or identification number | OM00101 | | Number of Individuals Covered | 275 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $34,267 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,726,875 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MAGELLAN HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: N/A ) |
| Policy contract number | WPGP0-002 |
| Policy instance | 43 |
| Insurance contract or identification number | WPGP0-002 | | Number of Individuals Covered | 4762 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $98,802 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN PROPERTY AND CASUALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26298 ) |
| Policy contract number | 4490010 |
| Policy instance | 44 |
| Insurance contract or identification number | 4490010 | | Number of Individuals Covered | 2695 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $5,560 | | Total amount of fees paid to insurance company | USD $1,108 | | Other welfare benefits provided | LEGAL | | Welfare Benefit Premiums Paid to Carrier | USD $508,607 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0136898 |
| Policy instance | 35 |
| Insurance contract or identification number | 0136898 | | Number of Individuals Covered | 42 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $2,995 | | Total amount of fees paid to insurance company | USD $35 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $62,117 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 ) |
| Policy contract number | 458933 |
| Policy instance | 34 |
| Insurance contract or identification number | 458933 | | Number of Individuals Covered | 2154 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Other welfare benefits provided | STD | | Welfare Benefit Premiums Paid to Carrier | USD $129,286 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0137092 |
| Policy instance | 24 |
| Insurance contract or identification number | 0137092 | | Number of Individuals Covered | 44 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $3,061 | | Total amount of fees paid to insurance company | USD $35 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $54,828 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 122383 |
| Policy instance | 25 |
| Insurance contract or identification number | 122383 | | Number of Individuals Covered | 167 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $757 | | Total amount of fees paid to insurance company | USD $38 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $46,424 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0106459 |
| Policy instance | 26 |
| Insurance contract or identification number | 0106459 | | Number of Individuals Covered | 2269 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $13,843 | | Total amount of fees paid to insurance company | USD $19 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $112,291 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0105228 |
| Policy instance | 28 |
| Insurance contract or identification number | 0105228 | | Number of Individuals Covered | 211 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,260 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 ) |
| Policy contract number | 28709 |
| Policy instance | 29 |
| Insurance contract or identification number | 28709 | | Number of Individuals Covered | 14 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $2,476 | | Other welfare benefits provided | GROUP LONG-TERM CARE INSURANCE | | Welfare Benefit Premiums Paid to Carrier | USD $16,503 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 ) |
| Policy contract number | 28918 |
| Policy instance | 30 |
| Insurance contract or identification number | 28918 | | Number of Individuals Covered | 218 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $53,292 | | Other welfare benefits provided | GROUP LONG-TERM CARE INSURANCE | | Welfare Benefit Premiums Paid to Carrier | USD $355,276 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 ) |
| Policy contract number | 28838 |
| Policy instance | 31 |
| Insurance contract or identification number | 28838 | | Number of Individuals Covered | 139 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $29,613 | | Other welfare benefits provided | GROUP LONG-TERM CARE INSURANCE | | Welfare Benefit Premiums Paid to Carrier | USD $197,419 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 ) |
| Policy contract number | 458934 |
| Policy instance | 32 |
| Insurance contract or identification number | 458934 | | Number of Individuals Covered | 955 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $66,127 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 ) |
| Policy contract number | 800272-C |
| Policy instance | 33 |
| Insurance contract or identification number | 800272-C | | Number of Individuals Covered | 17 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | YR1000 |
| Policy instance | 45 |
| Insurance contract or identification number | YR1000 | | Number of Individuals Covered | 365 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $27,151 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,640,758 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 ) |
| Policy contract number | 3213432,3213436 |
| Policy instance | 46 |
| Insurance contract or identification number | 3213432,3213436 | | Number of Individuals Covered | 7647 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $43,118 | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | PREPAID DENTAL | | Welfare Benefit Premiums Paid to Carrier | USD $1,907,594 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 142602 |
| Policy instance | 27 |
| Insurance contract or identification number | 142602 | | Number of Individuals Covered | 60 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $25,425 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 ) |
| Policy contract number | 28702 |
| Policy instance | 23 |
| Insurance contract or identification number | 28702 | | Number of Individuals Covered | 74 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $15,293 | | Other welfare benefits provided | GROUP LONG-TERM CARE | | Welfare Benefit Premiums Paid to Carrier | USD $101,953 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $15,293 | | Insurance broker organization code? | 3 | | Insurance broker name | PROGRESSIVE PLAN ADMINISTRATORS |
|
| HEALTH ALLIANCE PLAN 770 (National Association of Insurance Commissioners NAIC id number: 95844 ) |
| Policy contract number | 00278116 |
| Policy instance | 22 |
| Insurance contract or identification number | 00278116 | | Number of Individuals Covered | 92 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $656,672 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 ) |
| Policy contract number | 000010070715 00 |
| Policy instance | 21 |
| Insurance contract or identification number | 000010070715 00 | | Insurance policy start date | 2008-07-01 | | Insurance policy end date | 2009-06-30 | | Other welfare benefits provided | WEEKLY INCOME | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 | | Additional information about fees paid to insurance broker | BROKER BONUS | | Insurance broker name | LOCKTON COMPANIES LLC |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 142602 |
| Policy instance | 38 |
| Insurance contract or identification number | 142602 | | Number of Individuals Covered | 53 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $22,795 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0136895 |
| Policy instance | 20 |
| Insurance contract or identification number | 0136895 | | Number of Individuals Covered | 304 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $500,513 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0118689 |
| Policy instance | 19 |
| Insurance contract or identification number | 0118689 | | Number of Individuals Covered | 5007 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $13,179 | | Total amount of fees paid to insurance company | USD $20 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $1,084,622 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,179 | | Amount paid for insurance broker fees | 20 | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES LLC |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0137092 |
| Policy instance | 35 |
| Insurance contract or identification number | 0137092 | | Number of Individuals Covered | 54 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $4,273 | | Total amount of fees paid to insurance company | USD $12 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $76,514 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Commission paid to Insurance Broker | USD $4,273 | | Amount paid for insurance broker fees | 12 | | Insurance broker name | USI SECURITIES INC. |
|
| FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 ) |
| Policy contract number | 496514 |
| Policy instance | 24 |
| Insurance contract or identification number | 496514 | | Number of Individuals Covered | 37 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of fees paid to insurance company | USD $1,609 | | Other welfare benefits provided | GROUP LONG TERM CARE | | Welfare Benefit Premiums Paid to Carrier | USD $132,211 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 1609 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES LLC |
|
| HEALTH ALLIANCE PLAN (National Association of Insurance Commissioners NAIC id number: 95844 ) |
| Policy contract number | 770 |
| Policy instance | 25 |
| Insurance contract or identification number | 770 | | Number of Individuals Covered | 441 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $3,302,236 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 ) |
| Policy contract number | 410820T |
| Policy instance | 26 |
| Insurance contract or identification number | 410820T | | Number of Individuals Covered | 616 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $10,005 | | Total amount of fees paid to insurance company | USD $4,177 | | Other welfare benefits provided | WD-SUPP | | Welfare Benefit Premiums Paid to Carrier | USD $130,180 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,005 | | Amount paid for insurance broker fees | 4177 | | Additional information about fees paid to insurance broker | BONUS PAID | | Insurance broker organization code? | 3 | | Insurance broker name | EMERSON REID & CO INC |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 090870 |
| Policy instance | 27 |
| Insurance contract or identification number | 090870 | | Insurance policy start date | 2009-01-01 | | Insurance policy end date | 2009-12-31 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 | | Insurance broker name | SGP BENEFITS OF TEXAS |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 1329 |
| Policy instance | 28 |
| Insurance contract or identification number | 1329 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $24,282 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47029 ) |
| Policy contract number | 12270668 |
| Policy instance | 29 |
| Insurance contract or identification number | 12270668 | | Number of Individuals Covered | 11765 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $70,098 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $70,098 | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES LLC |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47029 ) |
| Policy contract number | 12270667 |
| Policy instance | 30 |
| Insurance contract or identification number | 12270667 | | Insurance policy start date | 2009-01-01 | | Insurance policy end date | 2009-12-31 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES LLC |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0106337 |
| Policy instance | 31 |
| Insurance contract or identification number | 0106337 | | Insurance policy start date | 2009-01-01 | | Insurance policy end date | 2009-12-31 | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | HAYS GROUP INC |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 ) |
| Policy contract number | 800799 |
| Policy instance | 18 |
| Insurance contract or identification number | 800799 | | Number of Individuals Covered | 54 | | Insurance policy start date | 2009-08-16 | | Insurance policy end date | 2010-08-16 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $120,836 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0014529 |
| Policy instance | 17 |
| Insurance contract or identification number | 0014529 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of fees paid to insurance company | USD $20 | | Life Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 20 | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | USI INS SERVICES LLC |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 601000 |
| Policy instance | 1 |
| Insurance contract or identification number | 601000 | | Number of Individuals Covered | 28 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $195,453 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 000000501086 |
| Policy instance | 2 |
| Insurance contract or identification number | 000000501086 | | Number of Individuals Covered | 119 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $2,000 | | Total amount of fees paid to insurance company | USD $268 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $21,401 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,000 | | Amount paid for insurance broker fees | 268 | | Additional information about fees paid to insurance broker | ADDDITIONAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | MERCER HEALTH & BENEFITS |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0142603 |
| Policy instance | 3 |
| Insurance contract or identification number | 0142603 | | Number of Individuals Covered | 1191 | | Insurance policy start date | 2010-08-01 | | Insurance policy end date | 2010-12-31 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $79,413 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0144904 |
| Policy instance | 4 |
| Insurance contract or identification number | 0144904 | | Number of Individuals Covered | 563 | | Insurance policy start date | 2010-04-01 | | Insurance policy end date | 2010-12-31 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $57,017 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 ) |
| Policy contract number | 000010122759 |
| Policy instance | 5 |
| Insurance contract or identification number | 000010122759 | | Number of Individuals Covered | 296 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $3,475 | | Total amount of fees paid to insurance company | USD $2,524 | | Other welfare benefits provided | WEEKLY INCOME | | Welfare Benefit Premiums Paid to Carrier | USD $50,486 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 2524 | | Additional information about fees paid to insurance broker | FEES PAID | | Insurance broker organization code? | 3 | | Commission paid to Insurance Broker | USD $3,475 | | Insurance broker name | GROUP HEALTH SOLUTIONS INC. |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0190090 |
| Policy instance | 6 |
| Insurance contract or identification number | 0190090 | | Number of Individuals Covered | 334 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $142,257 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0137919 |
| Policy instance | 7 |
| Insurance contract or identification number | 0137919 | | Number of Individuals Covered | 169 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $23,854 | | Total amount of fees paid to insurance company | USD $12 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $358,731 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $23,854 | | Amount paid for insurance broker fees | 12 | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | USI SECURITIES INC |
|
| JOHN HANCOCK LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65099 ) |
| Policy contract number | 28749 |
| Policy instance | 8 |
| Insurance contract or identification number | 28749 | | Insurance policy start date | 2009-01-01 | | Insurance policy end date | 2009-12-31 | | Other welfare benefits provided | LONG TERM CARE INSURANCE | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | AON CONSULTING INC |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0117631 |
| Policy instance | 9 |
| Insurance contract or identification number | 0117631 | | Insurance policy start date | 2009-01-01 | | Insurance policy end date | 2009-12-31 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | PROGRESSIVE PLAN ADMINISTRATORS INC |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0104667 |
| Policy instance | 10 |
| Insurance contract or identification number | 0104667 | | Insurance policy start date | 2009-01-01 | | Insurance policy end date | 2009-12-31 | | Temporary Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | PROGRESSIVE PLAN ADMINISTRATORS, IN |
|
| OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | MU1031 |
| Policy instance | 11 |
| Insurance contract or identification number | MU1031 | | Number of Individuals Covered | 1169 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $55,510 | | Total amount of fees paid to insurance company | USD $151 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,528,193 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $55,510 | | Amount paid for insurance broker fees | 151 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | PROGRESSIVE PLAN ADMINISTRATORS |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 ) |
| Policy contract number | 800272-475014-1 |
| Policy instance | 12 |
| Insurance contract or identification number | 800272-475014-1 | | Number of Individuals Covered | 20 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Health Insurance Welfare Benefit | Yes | | Were dividends or retroactive rate refunds paid as a credit? | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | H63055 |
| Policy instance | 13 |
| Insurance contract or identification number | H63055 | | Insurance policy start date | 2009-01-01 | | Insurance policy end date | 2009-12-31 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 | | Insurance broker name | PROGRESSIVE PLAN ADMINISTRATORS |
|
| DELAWARE AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62634 ) |
| Policy contract number | 10825 |
| Policy instance | 14 |
| Insurance contract or identification number | 10825 | | Number of Individuals Covered | 18 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $1,613 | | Other welfare benefits provided | GTL, ADD | | Welfare Benefit Premiums Paid to Carrier | USD $16,134 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,613 | | Insurance broker organization code? | 3 | | Insurance broker name | PROGRESSIVE PLAN ADMINISTRATORS |
|
| CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 ) |
| Policy contract number | H52182, 944343 |
| Policy instance | 15 |
| Insurance contract or identification number | H52182, 944343 | | Insurance policy start date | 2009-01-01 | | Insurance policy end date | 2009-12-31 | | Other welfare benefits provided | MEDICAL | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MAGELLAN HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: N/A ) |
| Policy contract number | WPGP0-003 |
| Policy instance | 16 |
| Insurance contract or identification number | WPGP0-003 | | Number of Individuals Covered | 2911 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $57,093 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY OF NY (National Association of Insurance Commissioners NAIC id number: 32395 ) |
| Policy contract number | 236565 |
| Policy instance | 32 |
| Insurance contract or identification number | 236565 | | Number of Individuals Covered | 1648 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $8,219 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $164,390 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,219 | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SVC - NY |
|
| DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 ) |
| Policy contract number | PA9293 |
| Policy instance | 33 |
| Insurance contract or identification number | PA9293 | | Number of Individuals Covered | 1501 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $22,914 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $22,914 | | Insurance broker organization code? | 3 | | Insurance broker name | USI NEW YORK |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 ) |
| Policy contract number | 800272-475017-1 |
| Policy instance | 60 |
| Insurance contract or identification number | 800272-475017-1 | | Number of Individuals Covered | 17 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Health Insurance Welfare Benefit | Yes | | Were dividends or retroactive rate refunds paid as a credit? | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 225108 |
| Policy instance | 59 |
| Insurance contract or identification number | 225108 | | Number of Individuals Covered | 34 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $170,677 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 26865 |
| Policy instance | 58 |
| Insurance contract or identification number | 26865 | | Number of Individuals Covered | 59 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $435,985 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| NATIONAL UNION FIRE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60607 ) |
| Policy contract number | GTP 8037345 |
| Policy instance | 57 |
| Insurance contract or identification number | GTP 8037345 | | Insurance policy start date | 2008-08-01 | | Insurance policy end date | 2009-08-01 | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 | | Insurance broker name | MERCER HEALTH & BENEFITS |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0101689 |
| Policy instance | 56 |
| Insurance contract or identification number | 0101689 | | Number of Individuals Covered | 50563 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $72,570 | | Total amount of fees paid to insurance company | USD $56,653 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,835,911 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $72,570 | | Amount paid for insurance broker fees | 56653 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | PROGRESSIVE PLAN ADMINISTRATOR |
|
| OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | JW00201 |
| Policy instance | 55 |
| Insurance contract or identification number | JW00201 | | Number of Individuals Covered | 519 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $30,084 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,980,219 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $30,084 | | Insurance broker organization code? | 3 | | Insurance broker name | USI NORTHEAST, INC |
|
| FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | 000064084084 |
| Policy instance | 54 |
| Insurance contract or identification number | 000064084084 | | Insurance policy start date | 2008-07-01 | | Insurance policy end date | 2009-07-01 | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 | | Insurance broker name | AON RISK SERVICES CENTRAL INC |
|
| JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 ) |
| Policy contract number | 28735 |
| Policy instance | 53 |
| Insurance contract or identification number | 28735 | | Number of Individuals Covered | 42 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $8,833 | | Other welfare benefits provided | GROUP LONG-TERM CARE INSURANCE | | Welfare Benefit Premiums Paid to Carrier | USD $58,881 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,833 | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES LLC |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0136898 |
| Policy instance | 52 |
| Insurance contract or identification number | 0136898 | | Number of Individuals Covered | 48 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $5,289 | | Total amount of fees paid to insurance company | USD $12 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $94,188 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,289 | | Amount paid for insurance broker fees | 12 | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | USI SECURITIES INC |
|
| CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 ) |
| Policy contract number | YOK980004 |
| Policy instance | 51 |
| Insurance contract or identification number | YOK980004 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $7,561 | | Total amount of fees paid to insurance company | USD $566 | | Other welfare benefits provided | ACCIDENTAL DEATH | | Welfare Benefit Premiums Paid to Carrier | USD $143,702 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,561 | | Amount paid for insurance broker fees | 566 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0136893 |
| Policy instance | 50 |
| Insurance contract or identification number | 0136893 | | Number of Individuals Covered | 40 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $3,127 | | Total amount of fees paid to insurance company | USD $12 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $158,190 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,127 | | Amount paid for insurance broker fees | 12 | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | USI SECURITIES INC. |
|
| FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 ) |
| Policy contract number | 458933 |
| Policy instance | 49 |
| Insurance contract or identification number | 458933 | | Number of Individuals Covered | 2013 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Other welfare benefits provided | STD | | Welfare Benefit Premiums Paid to Carrier | USD $99,308 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 ) |
| Policy contract number | 620580 |
| Policy instance | 48 |
| Insurance contract or identification number | 620580 | | Insurance policy start date | 2009-01-01 | | Insurance policy end date | 2009-12-31 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | DEATH | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 | | Insurance broker name | PROGRESSIVE PLAN ADMINISTRATORS |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 ) |
| Policy contract number | 620579 |
| Policy instance | 47 |
| Insurance contract or identification number | 620579 | | Insurance policy start date | 2009-01-01 | | Insurance policy end date | 2009-12-31 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | DEATH | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 | | Insurance broker name | PROGRESSIVE PLAN ADMINISTRATORS |
|
| BLUE SHIELD OF CALIFORNIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61557 ) |
| Policy contract number | H52182, 944343 |
| Policy instance | 46 |
| Insurance contract or identification number | H52182, 944343 | | Insurance policy start date | 2009-01-01 | | Insurance policy end date | 2009-12-31 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SVCS OF NORTHERN CA |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 601199 |
| Policy instance | 61 |
| Insurance contract or identification number | 601199 | | Insurance policy start date | 2009-01-01 | | Insurance policy end date | 2009-12-31 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 | | Insurance broker name | PROGRESSIVE PLAN ADMINISTRATORS INC |
|
| OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 95479 ) |
| Policy contract number | OM00101 |
| Policy instance | 62 |
| Insurance contract or identification number | OM00101 | | Number of Individuals Covered | 306 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $31,444 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,579,215 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $31,444 | | Insurance broker organization code? | 3 | | Insurance broker name | PROGRESSIVE PLAN ADMINISTRATORS |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0104884 |
| Policy instance | 34 |
| Insurance contract or identification number | 0104884 | | Number of Individuals Covered | 2855 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $48,795 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $834,980 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $48,795 | | Insurance broker organization code? | 3 | | Insurance broker name | PROGRESSIVE PLAN ADMINISTRATORS INC |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 122383 |
| Policy instance | 36 |
| Insurance contract or identification number | 122383 | | Number of Individuals Covered | 168 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $2,496 | | Total amount of fees paid to insurance company | USD $20 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $46,874 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,496 | | Amount paid for insurance broker fees | 20 | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES LLC |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0106459 |
| Policy instance | 37 |
| Insurance contract or identification number | 0106459 | | Number of Individuals Covered | 2135 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $10,438 | | Total amount of fees paid to insurance company | USD $2,519 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $130,989 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 490 | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Commission paid to Insurance Broker | USD $10,438 | | Insurance broker name | PROGRESSIVE PLAN ADMINISTRATORS |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0105228 |
| Policy instance | 39 |
| Insurance contract or identification number | 0105228 | | Number of Individuals Covered | 232 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,269 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 ) |
| Policy contract number | 28709 |
| Policy instance | 40 |
| Insurance contract or identification number | 28709 | | Number of Individuals Covered | 16 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $2,934 | | Other welfare benefits provided | GROUP LONG-TERM CARE INSURANCE | | Welfare Benefit Premiums Paid to Carrier | USD $19,561 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,934 | | Insurance broker organization code? | 3 | | Insurance broker name | PROGRESSIVE PLAN ADMINISTRATORS INC |
|
| JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 ) |
| Policy contract number | 28918 |
| Policy instance | 41 |
| Insurance contract or identification number | 28918 | | Number of Individuals Covered | 214 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $49,937 | | Other welfare benefits provided | GROUP LONG-TERM CARE INSURANCE | | Welfare Benefit Premiums Paid to Carrier | USD $332,907 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $49,937 | | Insurance broker organization code? | 3 | | Insurance broker name | PROGRESSIVE PLAN ADMINISTRATORS INC |
|
| JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 ) |
| Policy contract number | 28838 |
| Policy instance | 42 |
| Insurance contract or identification number | 28838 | | Number of Individuals Covered | 144 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $30,280 | | Other welfare benefits provided | GROUP LONG-TERM CARE INSURANCE | | Welfare Benefit Premiums Paid to Carrier | USD $201,862 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $30,280 | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES LLC |
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| FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 ) |
| Policy contract number | 458934 |
| Policy instance | 43 |
| Insurance contract or identification number | 458934 | | Number of Individuals Covered | 1088 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $57,961 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 ) |
| Policy contract number | FLY980001 |
| Policy instance | 44 |
| Insurance contract or identification number | FLY980001 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $166,295 | | Total amount of fees paid to insurance company | USD $53,242 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,444,002 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $166,295 | | Amount paid for insurance broker fees | 53242 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SVC |
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| CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 ) |
| Policy contract number | 3213432,3213436 |
| Policy instance | 68 |
| Insurance contract or identification number | 3213432,3213436 | | Number of Individuals Covered | 7797 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $44,646 | | Total amount of fees paid to insurance company | USD $18,638 | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | PREPAID DENTAL | | Welfare Benefit Premiums Paid to Carrier | USD $1,861,085 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 18638 | | Insurance broker organization code? | 3 | | Commission paid to Insurance Broker | USD $20,928 | | Insurance broker name | PROGRESSIVE PLAN ADMINISTRATORS INC |
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| OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | GA03001 |
| Policy instance | 67 |
| Insurance contract or identification number | GA03001 | | Insurance policy start date | 2009-01-01 | | Insurance policy end date | 2009-12-31 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 | | Insurance broker name | 2 TRION GROUP INC |
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| OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | YR1000 |
| Policy instance | 66 |
| Insurance contract or identification number | YR1000 | | Number of Individuals Covered | 536 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $32,031 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,166,769 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $32,031 | | Insurance broker organization code? | 3 | | Insurance broker name | USI NORTHEAST, INC |
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| HEALTH ALLIANCE PLAN (National Association of Insurance Commissioners NAIC id number: 95844 ) |
| Policy contract number | 1-21006AA |
| Policy instance | 65 |
| Insurance contract or identification number | 1-21006AA | | Number of Individuals Covered | 10 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $56,078 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| METROPOLITAN PROPERTY AND CASUALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26298 ) |
| Policy contract number | 4490010 |
| Policy instance | 64 |
| Insurance contract or identification number | 4490010 | | Number of Individuals Covered | 2651 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $4,089 | | Total amount of fees paid to insurance company | USD $746 | | Other welfare benefits provided | LEGAL | | Welfare Benefit Premiums Paid to Carrier | USD $472,295 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,089 | | Amount paid for insurance broker fees | 746 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION PROGRAM | | Insurance broker organization code? | 3 | | Insurance broker name | USI NEW YORK PROGRESSIVE PLAN ADMI |
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| MAGELLAN HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: N/A ) |
| Policy contract number | WPGP0-002 |
| Policy instance | 63 |
| Insurance contract or identification number | WPGP0-002 | | Number of Individuals Covered | 44657 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $94,110 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 ) |
| Policy contract number | YOK980002 |
| Policy instance | 45 |
| Insurance contract or identification number | YOK980002 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $14,092 | | Total amount of fees paid to insurance company | USD $4,522 | | Other welfare benefits provided | ACCIDENTAL DEATH | | Welfare Benefit Premiums Paid to Carrier | USD $281,999 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $14,092 | | Amount paid for insurance broker fees | 4522 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES |
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