SEVERN MANAGEMENT COMPANY, LLC has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan SEVERN MANAGEMENT COMPANY, LLC HEALTH PLAN
| Measure | Date | Value |
|---|
| 2022: SEVERN MANAGEMENT COMPANY, LLC HEALTH PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 124 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 134 |
| Number of retired or separated participants receiving benefits | 2022-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2022-01-01 | 0 |
| Total of all active and inactive participants | 2022-01-01 | 134 |
| 2021: SEVERN MANAGEMENT COMPANY, LLC HEALTH PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 109 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 124 |
| Number of retired or separated participants receiving benefits | 2021-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-01-01 | 0 |
| Total of all active and inactive participants | 2021-01-01 | 124 |
| 2020: SEVERN MANAGEMENT COMPANY, LLC HEALTH PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 119 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 109 |
| Total of all active and inactive participants | 2020-01-01 | 109 |
| 2019: SEVERN MANAGEMENT COMPANY, LLC HEALTH PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 130 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 119 |
| Total of all active and inactive participants | 2019-01-01 | 119 |
| Total participants | 2019-01-01 | 119 |
| 2018: SEVERN MANAGEMENT COMPANY, LLC HEALTH PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 133 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 130 |
| Total of all active and inactive participants | 2018-01-01 | 130 |
| 2017: SEVERN MANAGEMENT COMPANY, LLC HEALTH PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 103 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 133 |
| Total of all active and inactive participants | 2017-01-01 | 133 |
| Total participants | 2017-01-01 | 133 |
| 2016: SEVERN MANAGEMENT COMPANY, LLC HEALTH PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 112 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 103 |
| Total of all active and inactive participants | 2016-01-01 | 103 |
| Total participants | 2016-01-01 | 103 |
| 2015: SEVERN MANAGEMENT COMPANY, LLC HEALTH PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 100 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 112 |
| Total of all active and inactive participants | 2015-01-01 | 112 |
| Total participants | 2015-01-01 | 112 |
| 2014: SEVERN MANAGEMENT COMPANY, LLC HEALTH PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 105 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 100 |
| Total of all active and inactive participants | 2014-01-01 | 100 |
| Total participants | 2014-01-01 | 100 |
| 2013: SEVERN MANAGEMENT COMPANY, LLC HEALTH PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 123 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 105 |
| Total of all active and inactive participants | 2013-01-01 | 105 |
| Total participants | 2013-01-01 | 105 |
| 2012: SEVERN MANAGEMENT COMPANY, LLC HEALTH PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 115 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 123 |
| Total of all active and inactive participants | 2012-01-01 | 123 |
| Total participants | 2012-01-01 | 123 |
| 2011: SEVERN MANAGEMENT COMPANY, LLC HEALTH PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-01-01 | 110 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 115 |
| Total of all active and inactive participants | 2011-01-01 | 115 |
| Total participants | 2011-01-01 | 115 |
| 2010: SEVERN MANAGEMENT COMPANY, LLC HEALTH PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-01-01 | 113 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-01-01 | 110 |
| Total of all active and inactive participants | 2010-01-01 | 110 |
| Total participants | 2010-01-01 | 110 |
| 2009: SEVERN MANAGEMENT COMPANY, LLC HEALTH PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-01-01 | 117 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 113 |
| Total of all active and inactive participants | 2009-01-01 | 113 |
| Total participants | 2009-01-01 | 113 |
| Measure | Date | Value |
|---|
| 2022 : SEVERN MANAGEMENT COMPANY, LLC HEALTH PLAN 2022 401k financial data |
|---|
| Total income from all sources (including contributions) | 2022-12-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2022-12-31 | No |
| Was this plan covered by a fidelity bond | 2022-12-31 | No |
| If this is an individual account plan, was there a blackout period | 2022-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2022-12-31 | No |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2022-12-31 | No |
| Value of net assets at end of year (total assets less liabilities) | 2022-12-31 | $0 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2022-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2022-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2022-12-31 | No |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2022-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2022-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2022-12-31 | No |
| Did the plan have assets held for investment | 2022-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2022-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2022-12-31 | No |
| 2021 : SEVERN MANAGEMENT COMPANY, LLC HEALTH PLAN 2021 401k financial data |
|---|
| Total income from all sources (including contributions) | 2021-12-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2021-12-31 | No |
| Was this plan covered by a fidelity bond | 2021-12-31 | No |
| If this is an individual account plan, was there a blackout period | 2021-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2021-12-31 | No |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2021-12-31 | No |
| Value of net assets at end of year (total assets less liabilities) | 2021-12-31 | $0 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2021-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2021-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2021-12-31 | No |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2021-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2021-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2021-12-31 | No |
| Did the plan have assets held for investment | 2021-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2021-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2021-12-31 | No |
| 2022: SEVERN MANAGEMENT COMPANY, LLC HEALTH PLAN 2022 form 5500 responses |
|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021: SEVERN MANAGEMENT COMPANY, LLC HEALTH PLAN 2021 form 5500 responses |
|---|
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: SEVERN MANAGEMENT COMPANY, LLC HEALTH PLAN 2020 form 5500 responses |
|---|
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: SEVERN MANAGEMENT COMPANY, LLC HEALTH PLAN 2019 form 5500 responses |
|---|
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: SEVERN MANAGEMENT COMPANY, LLC HEALTH PLAN 2018 form 5500 responses |
|---|
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: SEVERN MANAGEMENT COMPANY, LLC HEALTH PLAN 2017 form 5500 responses |
|---|
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: SEVERN MANAGEMENT COMPANY, LLC HEALTH PLAN 2016 form 5500 responses |
|---|
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: SEVERN MANAGEMENT COMPANY, LLC HEALTH PLAN 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: SEVERN MANAGEMENT COMPANY, LLC HEALTH PLAN 2014 form 5500 responses |
|---|
| 2014-01-01 | Type of plan entity | Single employer plan |
| 2014-01-01 | Plan funding arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: SEVERN MANAGEMENT COMPANY, LLC HEALTH PLAN 2013 form 5500 responses |
|---|
| 2013-01-01 | Type of plan entity | Single employer plan |
| 2013-01-01 | Plan funding arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: SEVERN MANAGEMENT COMPANY, LLC HEALTH PLAN 2012 form 5500 responses |
|---|
| 2012-01-01 | Type of plan entity | Single employer plan |
| 2012-01-01 | Plan funding arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: SEVERN MANAGEMENT COMPANY, LLC HEALTH PLAN 2011 form 5500 responses |
|---|
| 2011-01-01 | Type of plan entity | Single employer plan |
| 2011-01-01 | Plan funding arrangement – Insurance | Yes |
| 2011-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2010: SEVERN MANAGEMENT COMPANY, LLC HEALTH PLAN 2010 form 5500 responses |
|---|
| 2010-01-01 | Type of plan entity | Single employer plan |
| 2010-01-01 | Plan funding arrangement – Insurance | Yes |
| 2010-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: SEVERN MANAGEMENT COMPANY, LLC HEALTH PLAN 2009 form 5500 responses |
|---|
| 2009-01-01 | Type of plan entity | Single employer plan |
| 2009-01-01 | Plan funding arrangement – Insurance | Yes |
| 2009-01-01 | Plan benefit arrangement – Insurance | Yes |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 0921243 |
| Policy instance | 2 |
| Insurance contract or identification number | 0921243 | | Number of Individuals Covered | 137 | | Insurance policy start date | 2022-04-01 | | Insurance policy end date | 2023-03-31 | | Total amount of commissions paid to insurance broker | USD $22,317 | | Total amount of fees paid to insurance company | USD $59,606 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,299,527 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,555 | | Amount paid for insurance broker fees | 59606 | | Additional information about fees paid to insurance broker | N/A | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00569745 |
| Policy instance | 1 |
| Insurance contract or identification number | 00569745 | | Number of Individuals Covered | 134 | | Insurance policy start date | 2022-04-01 | | Insurance policy end date | 2023-03-31 | | Total amount of commissions paid to insurance broker | USD $21,803 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D, OPTIONAL AD&D, OPTIONAL LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $111,091 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $16,248 | | Insurance broker organization code? | 3 |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 0921243 |
| Policy instance | 2 |
| Insurance contract or identification number | 0921243 | | Number of Individuals Covered | 99 | | Insurance policy start date | 2021-04-01 | | Insurance policy end date | 2022-03-31 | | Total amount of commissions paid to insurance broker | USD $13,487 | | Total amount of fees paid to insurance company | USD $57,669 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,147,756 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 57669 | | Additional information about fees paid to insurance broker | SERVICE FEE AGREEMENT | | Insurance broker organization code? | 3 | | Commission paid to Insurance Broker | USD $13,487 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00569745 |
| Policy instance | 1 |
| Insurance contract or identification number | 00569745 | | Number of Individuals Covered | 124 | | Insurance policy start date | 2021-04-01 | | Insurance policy end date | 2022-03-31 | | Total amount of commissions paid to insurance broker | USD $26,111 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D, OPTIONAL AD&D, OPTIONAL LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $157,068 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $18,163 | | Insurance broker organization code? | 3 |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 0921243 |
| Policy instance | 2 |
| Insurance contract or identification number | 0921243 | | Number of Individuals Covered | 89 | | Insurance policy start date | 2020-04-01 | | Insurance policy end date | 2021-03-31 | | Total amount of commissions paid to insurance broker | USD $13,743 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $900,753 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,743 | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00569745 |
| Policy instance | 1 |
| Insurance contract or identification number | 00569745 | | Number of Individuals Covered | 109 | | Insurance policy start date | 2020-04-01 | | Insurance policy end date | 2021-03-31 | | Total amount of commissions paid to insurance broker | USD $19,688 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D, OPTIONAL AD&D, OPTIONAL LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $114,865 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,142 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 3337022 |
| Policy instance | 1 |
| Insurance contract or identification number | 3337022 | | Number of Individuals Covered | 85 | | Insurance policy start date | 2019-04-01 | | Insurance policy end date | 2020-03-31 | | Total amount of commissions paid to insurance broker | USD $3,149 | | Total amount of fees paid to insurance company | USD $69,076 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,015,085 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,149 | | Amount paid for insurance broker fees | 48096 | | Additional information about fees paid to insurance broker | BENEFIT ADVISOR PAYMENTS | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 879578 TO 79 |
| Policy instance | 2 |
| Insurance contract or identification number | 879578 TO 79 | | Number of Individuals Covered | 119 | | Insurance policy start date | 2018-12-01 | | Insurance policy end date | 2019-12-01 | | Total amount of commissions paid to insurance broker | USD $10,167 | | Total amount of fees paid to insurance company | USD $3,389 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $73,958 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,167 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 879578 TO 79 |
| Policy instance | 2 |
| Insurance contract or identification number | 879578 TO 79 | | Number of Individuals Covered | 130 | | Insurance policy start date | 2017-12-01 | | Insurance policy end date | 2018-12-01 | | Total amount of commissions paid to insurance broker | USD $7,892 | | Total amount of fees paid to insurance company | USD $2,630 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $52,616 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,892 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 3337022 |
| Policy instance | 1 |
| Insurance contract or identification number | 3337022 | | Number of Individuals Covered | 100 | | Insurance policy start date | 2018-04-01 | | Insurance policy end date | 2019-03-31 | | Total amount of commissions paid to insurance broker | USD $3,266 | | Total amount of fees paid to insurance company | USD $68,746 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,012,335 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,266 | | Amount paid for insurance broker fees | 47812 | | Additional information about fees paid to insurance broker | BENEFIT ADVISOR PAYMENTS | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 879578 |
| Policy instance | 2 |
| Insurance contract or identification number | 879578 | | Number of Individuals Covered | 133 | | Insurance policy start date | 2016-12-01 | | Insurance policy end date | 2017-12-01 | | Total amount of commissions paid to insurance broker | USD $6,490 | | Total amount of fees paid to insurance company | USD $2,163 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $43,265 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,490 | | Amount paid for insurance broker fees | 0 | | Insurance broker name | KELLY & ASSOCIATES INS GROUP |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 3337022 |
| Policy instance | 1 |
| Insurance contract or identification number | 3337022 | | Number of Individuals Covered | 103 | | Insurance policy start date | 2017-04-01 | | Insurance policy end date | 2018-03-31 | | Total amount of commissions paid to insurance broker | USD $3,110 | | Total amount of fees paid to insurance company | USD $68,213 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,003,310 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,110 | | Amount paid for insurance broker fees | 47510 | | Additional information about fees paid to insurance broker | BENEFIT ADVISOR PAYMENTS | | Insurance broker organization code? | 3 | | Insurance broker name | KELLY & ASSOCIATES INS GROUP |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 3337022 |
| Policy instance | 2 |
| Insurance contract or identification number | 3337022 | | Number of Individuals Covered | 111 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $3,328 | | Total amount of fees paid to insurance company | USD $67,237 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,011,828 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,328 | | Amount paid for insurance broker fees | 46310 | | Additional information about fees paid to insurance broker | BENEFIT ADVISOR PAYMENTS | | Insurance broker organization code? | 3 | | Insurance broker name | KELLY & ASSOCIATES INS GROUP |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010071129-31 |
| Policy instance | 1 |
| Insurance contract or identification number | 000010071129-31 | | Number of Individuals Covered | 112 | | Insurance policy start date | 2014-12-01 | | Insurance policy end date | 2015-11-30 | | Total amount of commissions paid to insurance broker | USD $6,007 | | Total amount of fees paid to insurance company | USD $3,705 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $51,162 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,007 | | Amount paid for insurance broker fees | 3705 | | Additional information about fees paid to insurance broker | TPA FEE, OVERRIDES, BROKER BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | KELLY & ASSOCIATES INS GROUP INC. |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 3337022 |
| Policy instance | 2 |
| Insurance contract or identification number | 3337022 | | Number of Individuals Covered | 90 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $2,678 | | Total amount of fees paid to insurance company | USD $56,782 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $808,387 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 18663 | | Additional information about fees paid to insurance broker | GENERAL AGENT PAYMENTS | | Insurance broker organization code? | 3 | | Commission paid to Insurance Broker | USD $2,678 | | Insurance broker name | KELLY BENEFITS, INC. |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010071129-31 |
| Policy instance | 1 |
| Insurance contract or identification number | 000010071129-31 | | Number of Individuals Covered | 100 | | Insurance policy start date | 2013-12-01 | | Insurance policy end date | 2014-11-30 | | Total amount of commissions paid to insurance broker | USD $5,942 | | Total amount of fees paid to insurance company | USD $3,876 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $50,292 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,942 | | Amount paid for insurance broker fees | 3876 | | Additional information about fees paid to insurance broker | TPA FEE, OVERRIDES, BROKER BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | KELLY & ASSOCIATES INS GROUP INC. |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010071129-31 |
| Policy instance | 1 |
| Insurance contract or identification number | 000010071129-31 | | Number of Individuals Covered | 105 | | Insurance policy start date | 2012-12-01 | | Insurance policy end date | 2013-11-30 | | Total amount of commissions paid to insurance broker | USD $5,463 | | Total amount of fees paid to insurance company | USD $3,679 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $45,074 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,463 | | Amount paid for insurance broker fees | 3679 | | Additional information about fees paid to insurance broker | TPA FEE, OVERRIDES, BROKER BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | KELLY & ASSOCIATES INS GROUP INC. |
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| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 3337022 |
| Policy instance | 2 |
| Insurance contract or identification number | 3337022 | | Number of Individuals Covered | 93 | | Insurance policy start date | 2013-04-01 | | Insurance policy end date | 2014-03-31 | | Total amount of commissions paid to insurance broker | USD $2,660 | | Total amount of fees paid to insurance company | USD $53,507 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $789,257 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 16308 | | Additional information about fees paid to insurance broker | GENERAL AGENT PAYMENTS | | Insurance broker organization code? | 3 | | Commission paid to Insurance Broker | USD $2,660 | | Insurance broker name | KELLY BENEFITS, INC. |
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| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 518995 |
| Policy instance | 2 |
| Insurance contract or identification number | 518995 | | Number of Individuals Covered | 123 | | Insurance policy start date | 2012-04-01 | | Insurance policy end date | 2013-03-31 | | Total amount of commissions paid to insurance broker | USD $38,051 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $724,583 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $38,051 | | Insurance broker organization code? | 3 | | Insurance broker name | KELLY BENEFITS, INC. |
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| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010071129-31 |
| Policy instance | 1 |
| Insurance contract or identification number | 000010071129-31 | | Number of Individuals Covered | 95 | | Insurance policy start date | 2011-12-01 | | Insurance policy end date | 2012-11-30 | | Total amount of commissions paid to insurance broker | USD $4,941 | | Total amount of fees paid to insurance company | USD $3,850 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $39,597 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,941 | | Amount paid for insurance broker fees | 3850 | | Additional information about fees paid to insurance broker | TPA FEE, OVERRIDES, BROKER BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | KELLY & ASSOCIATES INS GROUP INC. |
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| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010071129-31 |
| Policy instance | 1 |
| Insurance contract or identification number | 000010071129-31 | | Number of Individuals Covered | 99 | | Insurance policy start date | 2010-12-01 | | Insurance policy end date | 2011-11-30 | | Total amount of commissions paid to insurance broker | USD $5,008 | | Total amount of fees paid to insurance company | USD $3,440 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $39,330 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 518995 |
| Policy instance | 2 |
| Insurance contract or identification number | 518995 | | Number of Individuals Covered | 115 | | Insurance policy start date | 2011-04-01 | | Insurance policy end date | 2012-03-31 | | Total amount of commissions paid to insurance broker | USD $35,494 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $684,500 | | 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: 65676 ) |
| Policy contract number | 000010071129-31 |
| Policy instance | 1 |
| Insurance contract or identification number | 000010071129-31 | | Number of Individuals Covered | 93 | | Insurance policy start date | 2009-12-01 | | Insurance policy end date | 2010-11-30 | | Total amount of commissions paid to insurance broker | USD $4,788 | | Total amount of fees paid to insurance company | USD $3,165 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $36,522 | | Commission paid to Insurance Broker | USD $4,788 | | Amount paid for insurance broker fees | 3165 | | Additional information about fees paid to insurance broker | TPA FEE | | Insurance broker organization code? | 3 | | Insurance broker name | KELLY & ASSOCIATES INS GROUP INC. |
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| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 518995 |
| Policy instance | 2 |
| Insurance contract or identification number | 518995 | | Number of Individuals Covered | 110 | | Insurance policy start date | 2010-04-01 | | Insurance policy end date | 2011-03-31 | | Total amount of commissions paid to insurance broker | USD $31,078 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $594,914 | | Commission paid to Insurance Broker | USD $31,078 | | Insurance broker organization code? | 3 | | Insurance broker name | KELLY BENEFITS, INC. |
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