STA-HOME HEALTH & HOSPICE, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan STA-HOME GROUP MEDICAL & DENTAL PLAN
| Measure | Date | Value |
|---|
| 2018: STA-HOME GROUP MEDICAL & DENTAL PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 621 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 0 |
| Number of retired or separated participants receiving benefits | 2018-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-01-01 | 0 |
| Total of all active and inactive participants | 2018-01-01 | 0 |
| Number of employers contributing to the scheme | 2018-01-01 | 0 |
| 2017: STA-HOME GROUP MEDICAL & DENTAL PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 782 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 805 |
| Number of retired or separated participants receiving benefits | 2017-01-01 | 13 |
| Number of other retired or separated participants entitled to future benefits | 2017-01-01 | 0 |
| Total of all active and inactive participants | 2017-01-01 | 818 |
| 2016: STA-HOME GROUP MEDICAL & DENTAL PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 804 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 749 |
| Number of retired or separated participants receiving benefits | 2016-01-01 | 9 |
| Number of other retired or separated participants entitled to future benefits | 2016-01-01 | 24 |
| Total of all active and inactive participants | 2016-01-01 | 782 |
| 2015: STA-HOME GROUP MEDICAL & DENTAL PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 872 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 804 |
| Number of retired or separated participants receiving benefits | 2015-01-01 | 10 |
| Number of other retired or separated participants entitled to future benefits | 2015-01-01 | 38 |
| Total of all active and inactive participants | 2015-01-01 | 852 |
| 2014: STA-HOME GROUP MEDICAL & DENTAL PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 846 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 872 |
| Number of retired or separated participants receiving benefits | 2014-01-01 | 8 |
| Number of other retired or separated participants entitled to future benefits | 2014-01-01 | 48 |
| Total of all active and inactive participants | 2014-01-01 | 928 |
| 2013: STA-HOME GROUP MEDICAL & DENTAL PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 855 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 846 |
| Number of retired or separated participants receiving benefits | 2013-01-01 | 9 |
| Number of other retired or separated participants entitled to future benefits | 2013-01-01 | 20 |
| Total of all active and inactive participants | 2013-01-01 | 875 |
| 2012: STA-HOME GROUP MEDICAL & DENTAL PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 834 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 855 |
| Number of retired or separated participants receiving benefits | 2012-01-01 | 11 |
| Number of other retired or separated participants entitled to future benefits | 2012-01-01 | 12 |
| Total of all active and inactive participants | 2012-01-01 | 878 |
| 2011: STA-HOME GROUP MEDICAL & DENTAL PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-01-01 | 869 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 834 |
| Number of retired or separated participants receiving benefits | 2011-01-01 | 14 |
| Number of other retired or separated participants entitled to future benefits | 2011-01-01 | 11 |
| Total of all active and inactive participants | 2011-01-01 | 859 |
| 2018: STA-HOME GROUP MEDICAL & DENTAL PLAN 2018 form 5500 responses |
|---|
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | This submission is the final filing | Yes |
| 2018-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: STA-HOME GROUP MEDICAL & DENTAL 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 funding arrangement – General assets of the sponsor | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: STA-HOME GROUP MEDICAL & DENTAL 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 funding arrangement – General assets of the sponsor | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: STA-HOME GROUP MEDICAL & DENTAL 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 funding arrangement – General assets of the sponsor | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: STA-HOME GROUP MEDICAL & DENTAL 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 funding arrangement – General assets of the sponsor | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: STA-HOME GROUP MEDICAL & DENTAL 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 funding arrangement – General assets of the sponsor | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2012: STA-HOME GROUP MEDICAL & DENTAL 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 funding arrangement – General assets of the sponsor | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2011: STA-HOME GROUP MEDICAL & DENTAL 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 funding arrangement – General assets of the sponsor | Yes |
| 2011-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | R0610659 |
| Policy instance | 3 |
| Insurance contract or identification number | R0610659 | | Number of Individuals Covered | 405 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $27,088 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | ACCIDENT, CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $128,531 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $27,088 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Insurance broker name | REGIONS INSURANCE INC. |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TM05931498 |
| Policy instance | 2 |
| Insurance contract or identification number | TM05931498 | | Number of Individuals Covered | 1084 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $52,037 | | Total amount of fees paid to insurance company | USD $6,984 | | 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 $344,377 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $47,462 | | Amount paid for insurance broker fees | 12 | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | LOCKTON COMPANIES, LLC |
|
| NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 ) |
| Policy contract number | 35371 |
| Policy instance | 1 |
| Insurance contract or identification number | 35371 | | Number of Individuals Covered | 1173 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $11,360 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $60,953 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $11,360 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Insurance broker name | REGIONS INSURANCE INC. |
|
| TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 ) |
| Policy contract number | SDPSCHAJ |
| Policy instance | 5 |
| Insurance contract or identification number | SDPSCHAJ | | Number of Individuals Covered | 296 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $48,265 | | Health Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $287,270 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $48,265 | | Insurance broker name | OPTIBEN, LLC |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | 962188/963821 |
| Policy instance | 4 |
| Insurance contract or identification number | 962188/963821 | | Number of Individuals Covered | 503 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $35,526 | | Total amount of fees paid to insurance company | USD $3,827 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $219,706 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,506 | | Amount paid for insurance broker fees | 3827 | | Additional information about fees paid to insurance broker | SALES & SERVICE | | Insurance broker name | REGIONS INSURANCE INC |
|
| IRONSHORE INDEMNITY INC. (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | ERR000000033-02 |
| Policy instance | 3 |
| Insurance contract or identification number | ERR000000033-02 | | Number of Individuals Covered | 745 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $208,106 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker name | REGIONS INSURANCE INC |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | 960242/960241 |
| Policy instance | 2 |
| Insurance contract or identification number | 960242/960241 | | Number of Individuals Covered | 525 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $82,786 | | Total amount of fees paid to insurance company | USD $6,729 | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $404,340 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $23,991 | | Amount paid for insurance broker fees | 6729 | | Additional information about fees paid to insurance broker | SALES & SERVICE | | Insurance broker name | REGIONS INSURANCE INC |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | CA867/CA550/9S6 |
| Policy instance | 1 |
| Insurance contract or identification number | CA867/CA550/9S6 | | Number of Individuals Covered | 485 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $5,031 | | Total amount of fees paid to insurance company | USD $4,052 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $71,878 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,179 | | Amount paid for insurance broker fees | 4052 | | Insurance broker name | ACQUITY GROUP OF MS LLC |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | CA867/CA550 |
| Policy instance | 1 |
| Insurance contract or identification number | CA867/CA550 | | Number of Individuals Covered | 516 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $5,051 | | Total amount of fees paid to insurance company | USD $3,992 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $72,153 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,051 | | Amount paid for insurance broker fees | 3992 | | Insurance broker name | GALEY ASSOCIATES PA |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | 960242/960241 |
| Policy instance | 2 |
| Insurance contract or identification number | 960242/960241 | | Number of Individuals Covered | 585 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $95,329 | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $381,314 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $95,329 | | Additional information about fees paid to insurance broker | SALES & SERVICE | | Insurance broker name | OPTIBEN LLC |
|
| IRONSHORE INDEMNITY INC. (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | ERR00000003301 |
| Policy instance | 3 |
| Insurance contract or identification number | ERR00000003301 | | Number of Individuals Covered | 787 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $193,236 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker name | REGIONS INSURANCE INC |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | 962188/963821 |
| Policy instance | 4 |
| Insurance contract or identification number | 962188/963821 | | Number of Individuals Covered | 525 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $35,777 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $223,827 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $35,777 | | Additional information about fees paid to insurance broker | SALES & SERVICE | | Insurance broker name | OPTIBEN LLC |
|
| TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 ) |
| Policy contract number | SDPSCHAJ |
| Policy instance | 5 |
| Insurance contract or identification number | SDPSCHAJ | | Number of Individuals Covered | 343 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $120,494 | | Health Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $439,148 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $31 | | Insurance broker name | OPTIBEN, LLC |
|
| TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 ) |
| Policy contract number | SDPSCHAJ |
| Policy instance | 5 |
| Insurance contract or identification number | SDPSCHAJ | | Number of Individuals Covered | 401 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $248,321 | | Health Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $335,570 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,810 | | Insurance broker name | OPTIBEN, LLC |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | CA867/CA550 |
| Policy instance | 1 |
| Insurance contract or identification number | CA867/CA550 | | Number of Individuals Covered | 494 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $4,127 | | Total amount of fees paid to insurance company | USD $3,673 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $58,954 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,127 | | Amount paid for insurance broker fees | 3673 | | Insurance broker name | GALEY ASSOCIATES PA |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | 960242/960241 |
| Policy instance | 2 |
| Insurance contract or identification number | 960242/960241 | | Number of Individuals Covered | 539 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $88,383 | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $353,532 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $88,383 | | Additional information about fees paid to insurance broker | SALES & SERVICE | | Insurance broker name | OPTIBEN LLC |
|
| QBE A&H (National Association of Insurance Commissioners NAIC id number: 10219 ) |
| Policy contract number | AJS00408-12 |
| Policy instance | 3 |
| Insurance contract or identification number | AJS00408-12 | | Number of Individuals Covered | 770 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $289,469 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker name | REGIONS INSURANCE INC |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | 962188/963821 |
| Policy instance | 4 |
| Insurance contract or identification number | 962188/963821 | | Number of Individuals Covered | 512 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $34,595 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $215,541 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $34,595 | | Additional information about fees paid to insurance broker | SALES & SERVICE | | Insurance broker name | OPTIBEN LLC |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | 960242/960241 |
| Policy instance | 2 |
| Insurance contract or identification number | 960242/960241 | | Number of Individuals Covered | 536 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $87,092 | | Total amount of fees paid to insurance company | USD $6,021 | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $348,367 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,893 | | Amount paid for insurance broker fees | 6021 | | Additional information about fees paid to insurance broker | SALES AND SERVICE | | Insurance broker name | OPTIBEN LLC |
|
| QBE A&H (National Association of Insurance Commissioners NAIC id number: 10219 ) |
| Policy contract number | AJS00408-11 |
| Policy instance | 3 |
| Insurance contract or identification number | AJS00408-11 | | Number of Individuals Covered | 783 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $42,155 | | Welfare Benefit Premiums Paid to Carrier | USD $380,866 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $42,155 | | Insurance broker name | ROSS & YERGER INSURANCE |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | 962188/963821 |
| Policy instance | 4 |
| Insurance contract or identification number | 962188/963821 | | Number of Individuals Covered | 494 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $33,173 | | Total amount of fees paid to insurance company | USD $3,628 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $204,462 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,742 | | Amount paid for insurance broker fees | 3628 | | Additional information about fees paid to insurance broker | SALES & SERVICE | | Insurance broker name | OPTIBEN LLC |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | CA867/CA550 |
| Policy instance | 1 |
| Insurance contract or identification number | CA867/CA550 | | Number of Individuals Covered | 459 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $27,954 | | Total amount of fees paid to insurance company | USD $16,427 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $399,340 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $27,954 | | Amount paid for insurance broker fees | 16427 | | Insurance broker name | GALEY ASSOCIATES PA |
|
| QBE A&H (National Association of Insurance Commissioners NAIC id number: 10219 ) |
| Policy contract number | AJS00408-10 |
| Policy instance | 3 |
| Insurance contract or identification number | AJS00408-10 | | Number of Individuals Covered | 759 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $66,043 | | Welfare Benefit Premiums Paid to Carrier | USD $419,068 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | CA867CA550 |
| Policy instance | 1 |
| Insurance contract or identification number | CA867CA550 | | Number of Individuals Covered | 742 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $43,992 | | Total amount of fees paid to insurance company | USD $15,868 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $628,454 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | 960242960241 |
| Policy instance | 2 |
| Insurance contract or identification number | 960242960241 | | Number of Individuals Covered | 522 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $79,123 | | Total amount of fees paid to insurance company | USD $4,936 | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $316,492 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | 962188963821 |
| Policy instance | 4 |
| Insurance contract or identification number | 962188963821 | | Number of Individuals Covered | 510 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $31,359 | | Total amount of fees paid to insurance company | USD $3,062 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $192,340 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | 960242960241 |
| Policy instance | 2 |
| Insurance contract or identification number | 960242960241 | | Number of Individuals Covered | 545 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $82,265 | | Total amount of fees paid to insurance company | USD $7,645 | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $329,061 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $82,265 | | Amount paid for insurance broker fees | 7645 | | Additional information about fees paid to insurance broker | SALES AND SERVICE | | Insurance broker organization code? | 3 | | Insurance broker name | OPTIBEN LLC |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | 962188963821 |
| Policy instance | 4 |
| Insurance contract or identification number | 962188963821 | | Number of Individuals Covered | 522 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $33,392 | | Total amount of fees paid to insurance company | USD $4,762 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $204,146 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $33,392 | | Amount paid for insurance broker fees | 4762 | | Additional information about fees paid to insurance broker | SALES SERVICE | | Insurance broker organization code? | 3 | | Insurance broker name | OPTIBEN LLC |
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| QBE A&H (National Association of Insurance Commissioners NAIC id number: 10219 ) |
| Policy contract number | AJS00408-09 |
| Policy instance | 3 |
| Insurance contract or identification number | AJS00408-09 | | Number of Individuals Covered | 793 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $66,825 | | Welfare Benefit Premiums Paid to Carrier | USD $424,214 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $66,825 | | Insurance broker organization code? | 3 | | Insurance broker name | ROSS & YERGER INSURANCE |
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| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | CA867CA550 |
| Policy instance | 1 |
| Insurance contract or identification number | CA867CA550 | | Number of Individuals Covered | 752 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $41,384 | | Total amount of fees paid to insurance company | USD $15,016 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $591,205 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $41,384 | | Amount paid for insurance broker fees | 15016 | | Insurance broker organization code? | 3 | | Insurance broker name | GALEY ASSOCIATES PA |
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