PREMERE REHAB, LLC has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan PREMERE REHAB, LLC EMPLOYEE HEALTH CARE BENEFITS PLAN
401k plan membership statisitcs for PREMERE REHAB, LLC EMPLOYEE HEALTH CARE BENEFITS PLAN
| Measure | Date | Value |
|---|
| 2022: PREMERE REHAB, LLC EMPLOYEE HEALTH CARE BENEFITS PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-07-01 | 834 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-07-01 | 555 |
| Number of retired or separated participants receiving benefits | 2022-07-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2022-07-01 | 0 |
| Total of all active and inactive participants | 2022-07-01 | 555 |
| Number of employers contributing to the scheme | 2022-07-01 | 0 |
| 2021: PREMERE REHAB, LLC EMPLOYEE HEALTH CARE BENEFITS PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-07-01 | 834 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-07-01 | 655 |
| Number of retired or separated participants receiving benefits | 2021-07-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-07-01 | 0 |
| Total of all active and inactive participants | 2021-07-01 | 655 |
| 2020: PREMERE REHAB, LLC EMPLOYEE HEALTH CARE BENEFITS PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-07-01 | 970 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-07-01 | 835 |
| Number of retired or separated participants receiving benefits | 2020-07-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2020-07-01 | 0 |
| Total of all active and inactive participants | 2020-07-01 | 835 |
| 2019: PREMERE REHAB, LLC EMPLOYEE HEALTH CARE BENEFITS PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-07-01 | 1,162 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-07-01 | 1,009 |
| Number of retired or separated participants receiving benefits | 2019-07-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-07-01 | 0 |
| Total of all active and inactive participants | 2019-07-01 | 1,009 |
| 2018: PREMERE REHAB, LLC EMPLOYEE HEALTH CARE BENEFITS PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-07-01 | 1,089 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-07-01 | 1,147 |
| Number of retired or separated participants receiving benefits | 2018-07-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-07-01 | 0 |
| Total of all active and inactive participants | 2018-07-01 | 1,147 |
| 2017: PREMERE REHAB, LLC EMPLOYEE HEALTH CARE BENEFITS PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-07-01 | 1,095 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-07-01 | 1,065 |
| Number of retired or separated participants receiving benefits | 2017-07-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-07-01 | 0 |
| Total of all active and inactive participants | 2017-07-01 | 1,065 |
| 2016: PREMERE REHAB, LLC EMPLOYEE HEALTH CARE BENEFITS PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-07-01 | 1,096 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-07-01 | 1,041 |
| Number of retired or separated participants receiving benefits | 2016-07-01 | 8 |
| Number of other retired or separated participants entitled to future benefits | 2016-07-01 | 48 |
| Total of all active and inactive participants | 2016-07-01 | 1,097 |
| 2015: PREMERE REHAB, LLC EMPLOYEE HEALTH CARE BENEFITS PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-07-01 | 1,005 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-07-01 | 794 |
| Number of retired or separated participants receiving benefits | 2015-07-01 | 18 |
| Number of other retired or separated participants entitled to future benefits | 2015-07-01 | 0 |
| Total of all active and inactive participants | 2015-07-01 | 812 |
| 2014: PREMERE REHAB, LLC EMPLOYEE HEALTH CARE BENEFITS PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-07-01 | 997 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-07-01 | 1,084 |
| Number of retired or separated participants receiving benefits | 2014-07-01 | 14 |
| Number of other retired or separated participants entitled to future benefits | 2014-07-01 | 50 |
| Total of all active and inactive participants | 2014-07-01 | 1,148 |
| 2013: PREMERE REHAB, LLC EMPLOYEE HEALTH CARE BENEFITS PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-07-01 | 553 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-07-01 | 744 |
| Total of all active and inactive participants | 2013-07-01 | 744 |
| 2012: PREMERE REHAB, LLC EMPLOYEE HEALTH CARE BENEFITS PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-07-01 | 553 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-07-01 | 952 |
| Total of all active and inactive participants | 2012-07-01 | 952 |
| 2011: PREMERE REHAB, LLC EMPLOYEE HEALTH CARE BENEFITS PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-07-01 | 493 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-07-01 | 553 |
| Total of all active and inactive participants | 2011-07-01 | 553 |
| 2009: PREMERE REHAB, LLC EMPLOYEE HEALTH CARE BENEFITS PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-07-01 | 350 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-07-01 | 383 |
| Total of all active and inactive participants | 2009-07-01 | 383 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 29977 |
| Policy instance | 4 |
| Insurance contract or identification number | 29977 | | Number of Individuals Covered | 555 | | Insurance policy start date | 2022-07-01 | | Insurance policy end date | 2023-06-30 | | Total amount of commissions paid to insurance broker | USD $47,111 | | Total amount of fees paid to insurance company | USD $6,596 | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $329,783 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $47,111 | | Amount paid for insurance broker fees | 6596 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30105083 |
| Policy instance | 3 |
| Insurance contract or identification number | 30105083 | | Number of Individuals Covered | 333 | | Insurance policy start date | 2022-07-01 | | Insurance policy end date | 2023-06-30 | | Total amount of commissions paid to insurance broker | USD $2,003 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $64,983 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,003 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 5737009 |
| Policy instance | 2 |
| Insurance contract or identification number | 5737009 | | Number of Individuals Covered | 894 | | Insurance policy start date | 2022-07-01 | | Insurance policy end date | 2023-06-30 | | Total amount of commissions paid to insurance broker | USD $7,272 | | Total amount of fees paid to insurance company | USD $6,557 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $343,666 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,272 | | Amount paid for insurance broker fees | 6557 | | Additional information about fees paid to insurance broker | NON-MONETARY/SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| RELIANT BEHAVIORAL HEALTH (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 15021519 |
| Policy instance | 1 |
| Insurance contract or identification number | 15021519 | | Number of Individuals Covered | 1025 | | Insurance policy start date | 2022-07-01 | | Insurance policy end date | 2023-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | EMPLOYEE ASSISTANCE PROGRAM | | Welfare Benefit Premiums Paid to Carrier | USD $26,445 | | 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 | 029977 |
| Policy instance | 1 |
| Insurance contract or identification number | 029977 | | Number of Individuals Covered | 601 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Total amount of commissions paid to insurance broker | USD $3,614 | | Total amount of fees paid to insurance company | USD $1,085 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACC. DEATH/DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $42,129 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,614 | | Amount paid for insurance broker fees | 1085 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 608474 |
| Policy instance | 2 |
| Insurance contract or identification number | 608474 | | Number of Individuals Covered | 132 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Total amount of commissions paid to insurance broker | USD $55,639 | | Total amount of fees paid to insurance company | USD $7,419 | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $292,420 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $55,639 | | Amount paid for insurance broker fees | 7419 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 5737009 |
| Policy instance | 4 |
| Insurance contract or identification number | 5737009 | | Number of Individuals Covered | 1003 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Total amount of commissions paid to insurance broker | USD $7,485 | | Total amount of fees paid to insurance company | USD $6,553 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $423,106 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,485 | | Amount paid for insurance broker fees | 6553 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 079377 |
| Policy instance | 5 |
| Insurance contract or identification number | 079377 | | Number of Individuals Covered | 145 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Total amount of commissions paid to insurance broker | USD $19,204 | | Total amount of fees paid to insurance company | USD $2,561 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $109,519 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $19,204 | | Amount paid for insurance broker fees | 2561 | | Additional information about fees paid to insurance broker | ADDTL COMP | | Insurance broker organization code? | 3 |
|
| RELIANT BEHAVIORAL HEALTH (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 15021519 |
| Policy instance | 3 |
| Insurance contract or identification number | 15021519 | | Number of Individuals Covered | 3075 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Other welfare benefits provided | EMPLOYEE ASSISTANCE | | Welfare Benefit Premiums Paid to Carrier | USD $26,445 | | 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 | 608474 |
| Policy instance | 2 |
| Insurance contract or identification number | 608474 | | Number of Individuals Covered | 159 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | Total amount of commissions paid to insurance broker | USD $42,330 | | Total amount of fees paid to insurance company | USD $4,332 | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $331,412 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $42,330 | | Amount paid for insurance broker fees | 4332 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 029977 |
| Policy instance | 1 |
| Insurance contract or identification number | 029977 | | Number of Individuals Covered | 798 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | Total amount of commissions paid to insurance broker | USD $2,904 | | Total amount of fees paid to insurance company | USD $581 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACC. DEATH/DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $51,194 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,904 | | Amount paid for insurance broker fees | 581 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 230599 |
| Policy instance | 4 |
| Insurance contract or identification number | 230599 | | Number of Individuals Covered | 672 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | Total amount of commissions paid to insurance broker | USD $35,744 | | Total amount of fees paid to insurance company | USD $10,727 | | Welfare Benefit Premiums Paid to Carrier | USD $714,887 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $35,744 | | Amount paid for insurance broker fees | 10727 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 |
|
| RELIANT BEHAVIORAL HEALTH (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 15021519 |
| Policy instance | 3 |
| Insurance contract or identification number | 15021519 | | Number of Individuals Covered | 1025 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | Other welfare benefits provided | EMPLOYEE ASSISTANCE | | Welfare Benefit Premiums Paid to Carrier | USD $26,445 | | 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 | 5737009 |
| Policy instance | 5 |
| Insurance contract or identification number | 5737009 | | Number of Individuals Covered | 1371 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | Total amount of commissions paid to insurance broker | USD $8,342 | | Total amount of fees paid to insurance company | USD $1,632 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $505,720 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,342 | | Amount paid for insurance broker fees | 1632 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 079377 |
| Policy instance | 6 |
| Insurance contract or identification number | 079377 | | Number of Individuals Covered | 178 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | Total amount of commissions paid to insurance broker | USD $13,000 | | Total amount of fees paid to insurance company | USD $1,291 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $114,428 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,000 | | Amount paid for insurance broker fees | 1291 | | Additional information about fees paid to insurance broker | ADDTL COMP | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | R0496497 |
| Policy instance | 7 |
| Insurance contract or identification number | R0496497 | | Number of Individuals Covered | 427 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | Total amount of commissions paid to insurance broker | USD $16,156 | | Total amount of fees paid to insurance company | USD $853 | | Other welfare benefits provided | GROUP ACCIDENT | | Welfare Benefit Premiums Paid to Carrier | USD $127,739 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,210 | | Amount paid for insurance broker fees | 486 | | Additional information about fees paid to insurance broker | ADDTL COMP | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 079377 |
| Policy instance | 6 |
| Insurance contract or identification number | 079377 | | Number of Individuals Covered | 205 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $18,986 | | Total amount of fees paid to insurance company | USD $1,088 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $126,571 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $18,986 | | Amount paid for insurance broker fees | 1088 | | Additional information about fees paid to insurance broker | ADDTL COMP | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 5737009 |
| Policy instance | 5 |
| Insurance contract or identification number | 5737009 | | Number of Individuals Covered | 1579 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $9,003 | | Total amount of fees paid to insurance company | USD $1,254 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $590,078 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,003 | | Amount paid for insurance broker fees | 1254 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| RELIANT BEHAVIORAL HEALTH (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 15021519 |
| Policy instance | 3 |
| Insurance contract or identification number | 15021519 | | Number of Individuals Covered | 1025 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Other welfare benefits provided | EMPLOYEE ASSISTANCE | | Welfare Benefit Premiums Paid to Carrier | USD $26,445 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 230599 |
| Policy instance | 4 |
| Insurance contract or identification number | 230599 | | Number of Individuals Covered | 759 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $35,889 | | Total amount of fees paid to insurance company | USD $4,494 | | Welfare Benefit Premiums Paid to Carrier | USD $717,772 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $35,889 | | Amount paid for insurance broker fees | 4494 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 608474 |
| Policy instance | 2 |
| Insurance contract or identification number | 608474 | | Number of Individuals Covered | 193 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $87,075 | | Total amount of fees paid to insurance company | USD $4,325 | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $422,686 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $87,075 | | Amount paid for insurance broker fees | 4325 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 029977 |
| Policy instance | 1 |
| Insurance contract or identification number | 029977 | | Number of Individuals Covered | 941 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $3,564 | | Total amount of fees paid to insurance company | USD $556 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACC. DEATH/DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $61,403 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,564 | | Amount paid for insurance broker fees | 556 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | R0496497 |
| Policy instance | 7 |
| Insurance contract or identification number | R0496497 | | Number of Individuals Covered | 479 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $22,535 | | Total amount of fees paid to insurance company | USD $1,232 | | Other welfare benefits provided | GROUP ACCIDENT | | Welfare Benefit Premiums Paid to Carrier | USD $130,535 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,664 | | Amount paid for insurance broker fees | 725 | | Additional information about fees paid to insurance broker | ADDTL COMP | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | R0496497 |
| Policy instance | 7 |
| Insurance contract or identification number | R0496497 | | Number of Individuals Covered | 497 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2019-06-30 | | Total amount of commissions paid to insurance broker | USD $38,398 | | Total amount of fees paid to insurance company | USD $2,537 | | Other welfare benefits provided | GROUP ACCIDENT | | Welfare Benefit Premiums Paid to Carrier | USD $153,467 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $14,785 | | Amount paid for insurance broker fees | 1597 | | Additional information about fees paid to insurance broker | ADDTL COMP | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 029977 |
| Policy instance | 1 |
| Insurance contract or identification number | 029977 | | Number of Individuals Covered | 1138 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2019-06-30 | | Total amount of commissions paid to insurance broker | USD $3,575 | | Total amount of fees paid to insurance company | USD $129 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACC. DEATH/DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $67,552 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,575 | | Amount paid for insurance broker fees | 129 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 079377 |
| Policy instance | 6 |
| Insurance contract or identification number | 079377 | | Number of Individuals Covered | 269 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2019-06-30 | | Total amount of commissions paid to insurance broker | USD $18,582 | | Total amount of fees paid to insurance company | USD $260 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $123,879 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $18,582 | | Amount paid for insurance broker fees | 260 | | Additional information about fees paid to insurance broker | ADDTL COMP | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 5737009 |
| Policy instance | 5 |
| Insurance contract or identification number | 5737009 | | Number of Individuals Covered | 1720 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2019-06-30 | | Total amount of commissions paid to insurance broker | USD $9,942 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $613,827 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,388 | | Insurance broker organization code? | 3 |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 230599 |
| Policy instance | 4 |
| Insurance contract or identification number | 230599 | | Number of Individuals Covered | 829 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2019-06-30 | | Total amount of commissions paid to insurance broker | USD $35,735 | | Welfare Benefit Premiums Paid to Carrier | USD $599,428 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $17,740 | | Insurance broker organization code? | 3 |
|
| RELIANT BEHAVIORAL HEALTH (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 15021519 |
| Policy instance | 3 |
| Insurance contract or identification number | 15021519 | | Number of Individuals Covered | 1025 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2019-06-30 | | Other welfare benefits provided | EMPLOYEE ASSISTANCE | | Welfare Benefit Premiums Paid to Carrier | USD $26,445 | | 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 | 608474 |
| Policy instance | 2 |
| Insurance contract or identification number | 608474 | | Number of Individuals Covered | 222 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2019-06-30 | | Total amount of commissions paid to insurance broker | USD $28,582 | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $377,655 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $28,582 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | R0496497 |
| Policy instance | 7 |
| Insurance contract or identification number | R0496497 | | Number of Individuals Covered | 380 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $26,493 | | Total amount of fees paid to insurance company | USD $1,504 | | Other welfare benefits provided | GROUP ACCIDENT | | Welfare Benefit Premiums Paid to Carrier | USD $80,135 | | 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 | 079377 |
| Policy instance | 6 |
| Insurance contract or identification number | 079377 | | Number of Individuals Covered | 414 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $20,115 | | Total amount of fees paid to insurance company | USD $1,676 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $124,322 | | 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 | KM05737009 |
| Policy instance | 5 |
| Insurance contract or identification number | KM05737009 | | Number of Individuals Covered | 1727 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $9,474 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $641,506 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 230599 |
| Policy instance | 4 |
| Insurance contract or identification number | 230599 | | Number of Individuals Covered | 822 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $35,612 | | Welfare Benefit Premiums Paid to Carrier | USD $550,373 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIANT BEHAVIORAL HEALTH (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 15021519 |
| Policy instance | 3 |
| Insurance contract or identification number | 15021519 | | Number of Individuals Covered | 1025 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Other welfare benefits provided | EMPLOYEE ASSISTANCE | | Welfare Benefit Premiums Paid to Carrier | USD $26,445 | | 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 | 608474 |
| Policy instance | 2 |
| Insurance contract or identification number | 608474 | | Number of Individuals Covered | 377 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $67,258 | | Total amount of fees paid to insurance company | USD $5,605 | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $414,328 | | 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 | 029977 |
| Policy instance | 1 |
| Insurance contract or identification number | 029977 | | Number of Individuals Covered | 1055 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $3,642 | | Total amount of fees paid to insurance company | USD $773 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACC. DEATH/DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $61,436 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 230599 |
| Policy instance | 4 |
| Insurance contract or identification number | 230599 | | Number of Individuals Covered | 814 | | Insurance policy start date | 2015-07-01 | | Insurance policy end date | 2016-06-30 | | Total amount of commissions paid to insurance broker | USD $55,465 | | Welfare Benefit Premiums Paid to Carrier | USD $551,538 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $27,577 | | Insurance broker organization code? | 3 | | Insurance broker name | HEALTHCARE MANAGEMENT ADMINISTRATOR |
|
| RELIANT BEHAVIORAL HEALTH (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 15021519 |
| Policy instance | 3 |
| Insurance contract or identification number | 15021519 | | Number of Individuals Covered | 1025 | | Insurance policy start date | 2015-07-01 | | Insurance policy end date | 2016-06-30 | | Other welfare benefits provided | EMPLOYEE ASSISTANCE | | Welfare Benefit Premiums Paid to Carrier | USD $25,400 | | 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 | 608474 |
| Policy instance | 2 |
| Insurance contract or identification number | 608474 | | Number of Individuals Covered | 373 | | Insurance policy start date | 2015-07-01 | | Insurance policy end date | 2016-06-30 | | Total amount of commissions paid to insurance broker | USD $65,191 | | Total amount of fees paid to insurance company | USD $7,647 | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $382,329 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $65,191 | | Amount paid for insurance broker fees | 7647 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | DAVIDSON BENEFITS PLANNING LLC |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 029977 |
| Policy instance | 1 |
| Insurance contract or identification number | 029977 | | Number of Individuals Covered | 972 | | Insurance policy start date | 2015-07-01 | | Insurance policy end date | 2016-06-30 | | Total amount of commissions paid to insurance broker | USD $3,697 | | Total amount of fees paid to insurance company | USD $646 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACC. DEATH/DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $65,778 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,697 | | Amount paid for insurance broker fees | 646 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | DAVIDSON BENEFITS PLANNING LLC |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | KM05737009 |
| Policy instance | 5 |
| Insurance contract or identification number | KM05737009 | | Number of Individuals Covered | 1755 | | Insurance policy start date | 2015-07-01 | | Insurance policy end date | 2016-06-30 | | Total amount of commissions paid to insurance broker | USD $9,119 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $614,011 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,119 | | Insurance broker organization code? | 3 | | Insurance broker name | DAVIDSON BENEFITS PLANNING LLC |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 230599 |
| Policy instance | 4 |
| Insurance contract or identification number | 230599 | | Number of Individuals Covered | 807 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Total amount of commissions paid to insurance broker | USD $35,567 | | Welfare Benefit Premiums Paid to Carrier | USD $474,221 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $23,711 | | Insurance broker organization code? | 3 | | Insurance broker name | UNITED BENEFIT ADVISORS NW LLC |
|
| RELIANT BEHAVIORAL HEALTH (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 15021519 |
| Policy instance | 3 |
| Insurance contract or identification number | 15021519 | | Number of Individuals Covered | 1025 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Other welfare benefits provided | EMPLOYEE ASSISTANCE | | Welfare Benefit Premiums Paid to Carrier | USD $24,354 | | 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 | 079377 |
| Policy instance | 2 |
| Insurance contract or identification number | 079377 | | Number of Individuals Covered | 278 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Total amount of commissions paid to insurance broker | USD $19,455 | | Total amount of fees paid to insurance company | USD $973 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACC. DEATH/DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $129,702 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $19,455 | | Amount paid for insurance broker fees | 973 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | DAVIDSON BENEFITS PLANNING LLC |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 029977 |
| Policy instance | 1 |
| Insurance contract or identification number | 029977 | | Number of Individuals Covered | 989 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Total amount of commissions paid to insurance broker | USD $3,384 | | Total amount of fees paid to insurance company | USD $393 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACC. DEATH/DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $52,333 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,384 | | Amount paid for insurance broker fees | 393 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | DAVIDSON BENEFITS PLANNING LLC |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 604599 |
| Policy instance | 6 |
| Insurance contract or identification number | 604599 | | Number of Individuals Covered | 325 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Total amount of commissions paid to insurance broker | USD $27,079 | | Total amount of fees paid to insurance company | USD $2,031 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $270,787 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $27,079 | | Amount paid for insurance broker fees | 2031 | | Additional information about fees paid to insurance broker | ADDTL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | DAVIDSON BENEFITS PLANNING LLC |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | KM05737009 |
| Policy instance | 5 |
| Insurance contract or identification number | KM05737009 | | Number of Individuals Covered | 1798 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Total amount of commissions paid to insurance broker | USD $9,000 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $594,792 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,000 | | Insurance broker organization code? | 3 | | Insurance broker name | DAVIDSON BENEFITS PLANNING LLC |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 029977 |
| Policy instance | 1 |
| Insurance contract or identification number | 029977 | | Number of Individuals Covered | 925 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Total amount of commissions paid to insurance broker | USD $3,460 | | Total amount of fees paid to insurance company | USD $382 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACC. DEATH/DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $50,974 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,460 | | Amount paid for insurance broker fees | 382 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | DAVIDSON BENEFITS PLANNING LLC |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 079377 |
| Policy instance | 2 |
| Insurance contract or identification number | 079377 | | Number of Individuals Covered | 320 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Total amount of commissions paid to insurance broker | USD $19,781 | | Total amount of fees paid to insurance company | USD $989 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACC. DEATH/DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $132,358 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $19,781 | | Amount paid for insurance broker fees | 989 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | DAVIDSON BENEFITS PLANNING LLC |
|
| RELIANT BEHAVIORAL HEALTH (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 15021519 |
| Policy instance | 3 |
| Insurance contract or identification number | 15021519 | | Number of Individuals Covered | 1025 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Other welfare benefits provided | EMPLOYEE ASSISTANCE | | Welfare Benefit Premiums Paid to Carrier | USD $20,196 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 230599 |
| Policy instance | 4 |
| Insurance contract or identification number | 230599 | | Number of Individuals Covered | 767 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Total amount of commissions paid to insurance broker | USD $31,370 | | Welfare Benefit Premiums Paid to Carrier | USD $426,866 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $20,698 | | Insurance broker organization code? | 3 | | Insurance broker name | UNITED BENEFIT ADVISORS NW LLC |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | R0496497 |
| Policy instance | 6 |
| Insurance contract or identification number | R0496497 | | Number of Individuals Covered | 134 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Total amount of commissions paid to insurance broker | USD $19,227 | | Total amount of fees paid to insurance company | USD $1,461 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | GROUP ACCIDENT | | Welfare Benefit Premiums Paid to Carrier | USD $28,676 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $14,419 | | Amount paid for insurance broker fees | 1461 | | Additional information about fees paid to insurance broker | ADDTL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | TRUSTNODE |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | KM05737009 |
| Policy instance | 5 |
| Insurance contract or identification number | KM05737009 | | Number of Individuals Covered | 1825 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Total amount of commissions paid to insurance broker | USD $9,075 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $555,328 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,075 | | Insurance broker organization code? | 3 | | Insurance broker name | DAVIDSON BENEFITS PLANNING LLC |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 604599 |
| Policy instance | 7 |
| Insurance contract or identification number | 604599 | | Number of Individuals Covered | 334 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Total amount of commissions paid to insurance broker | USD $28,766 | | Total amount of fees paid to insurance company | USD $5,753 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $287,659 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $28,766 | | Amount paid for insurance broker fees | 5753 | | Additional information about fees paid to insurance broker | ADDTL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | DAVIDSON BENEFITS PLANNING LLC |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | KM05737009 |
| Policy instance | 5 |
| Insurance contract or identification number | KM05737009 | | Number of Individuals Covered | 1738 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Total amount of commissions paid to insurance broker | USD $8,297 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $484,660 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,297 | | Insurance broker organization code? | 3 | | Insurance broker name | DAVIDSON BENEFITS PLANNING LLC |
|
| TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 ) |
| Policy contract number | PF00329103 |
| Policy instance | 4 |
| Insurance contract or identification number | PF00329103 | | Number of Individuals Covered | 727 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Welfare Benefit Premiums Paid to Carrier | USD $539,861 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIANT BEHAVIORAL HEALTH (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 15021519 |
| Policy instance | 3 |
| Insurance contract or identification number | 15021519 | | Number of Individuals Covered | 945 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Other welfare benefits provided | EMPLOYEE ASSISTANCE | | Welfare Benefit Premiums Paid to Carrier | USD $14,735 | | 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 | 079377 |
| Policy instance | 2 |
| Insurance contract or identification number | 079377 | | Number of Individuals Covered | 137 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Total amount of commissions paid to insurance broker | USD $9,368 | | Total amount of fees paid to insurance company | USD $468 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACC. DEATH/DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $62,456 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,368 | | Amount paid for insurance broker fees | 468 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | DAVIDSON BENEFITS PLANNING LLC |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 029977 |
| Policy instance | 1 |
| Insurance contract or identification number | 029977 | | Number of Individuals Covered | 952 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Total amount of commissions paid to insurance broker | USD $3,305 | | Total amount of fees paid to insurance company | USD $353 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACC. DEATH/DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $47,100 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,305 | | Amount paid for insurance broker fees | 353 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | DAVIDSON BENEFITS PLANNING LLC |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 029977 |
| Policy instance | 1 |
| Insurance contract or identification number | 029977 | | Number of Individuals Covered | 662 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Total amount of commissions paid to insurance broker | USD $9,348 | | Total amount of fees paid to insurance company | USD $824 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACC DEATHDISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $109,846 | | 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 | 079377 |
| Policy instance | 2 |
| Insurance contract or identification number | 079377 | | Number of Individuals Covered | 138 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Total amount of commissions paid to insurance broker | USD $9,479 | | Total amount of fees paid to insurance company | USD $474 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACC DEATHDISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $63,195 | | 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 | KM05737009 |
| Policy instance | 5 |
| Insurance contract or identification number | KM05737009 | | Number of Individuals Covered | 1330 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Total amount of commissions paid to insurance broker | USD $7,853 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $467,828 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 ) |
| Policy contract number | PF00329102 |
| Policy instance | 4 |
| Insurance contract or identification number | PF00329102 | | Number of Individuals Covered | 553 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Welfare Benefit Premiums Paid to Carrier | USD $430,652 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIANT BEHAVIORAL HEALTH (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 15021519 |
| Policy instance | 3 |
| Insurance contract or identification number | 15021519 | | Number of Individuals Covered | 383 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Other welfare benefits provided | EMPLOYEE ASSISTANCE | | Welfare Benefit Premiums Paid to Carrier | USD $6,825 | | 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 | 079377 |
| Policy instance | 2 |
| Insurance contract or identification number | 079377 | | Number of Individuals Covered | 126 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-06-30 | | Total amount of commissions paid to insurance broker | USD $8,707 | | Total amount of fees paid to insurance company | USD $468 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACC DEATHDISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $53,758 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| EASE (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | INFINITYREHAB |
| Policy instance | 3 |
| Insurance contract or identification number | INFINITYREHAB | | Number of Individuals Covered | 383 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-06-30 | | Other welfare benefits provided | EMPLOYEE ASSISTANCE | | Welfare Benefit Premiums Paid to Carrier | USD $9,100 | | 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 | KM05737009 |
| Policy instance | 5 |
| Insurance contract or identification number | KM05737009 | | Number of Individuals Covered | 1244 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-06-30 | | Total amount of commissions paid to insurance broker | USD $6,996 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $319,856 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 ) |
| Policy contract number | PF00329101 |
| Policy instance | 4 |
| Insurance contract or identification number | PF00329101 | | Number of Individuals Covered | 493 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-06-30 | | Welfare Benefit Premiums Paid to Carrier | USD $322,908 | | 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 | 029977 |
| Policy instance | 1 |
| Insurance contract or identification number | 029977 | | Number of Individuals Covered | 565 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-06-30 | | Total amount of commissions paid to insurance broker | USD $11,540 | | Total amount of fees paid to insurance company | USD $1,974 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACC DEATHDISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $227,206 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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