401k Plan data: PORZIO BROMBERG & NEWMAN PC ACCIDENTAL DEATH & DISMEMBERMENT plan

PORZIO BROMBERG & NEWMAN PC ACCIDENTAL DEATH & DISMEMBERMENT 401k Plan overview

Plan Name	PORZIO BROMBERG & NEWMAN PC ACCIDENTAL DEATH & DISMEMBERMENT
Plan identification number	503

PORZIO BROMBERG & NEWMAN PC ACCIDENTAL DEATH & DISMEMBERMENT Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Temporary disability (accident and sickness) Long-term disability cover Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

PORZIO, BROMBERG & NEWMAN, P.C. has sponsored the creation of one or more 401k plans.

Company Name: PORZIO, BROMBERG & NEWMAN, P.C.

Employer identification number (EIN): 222005150

NAIC Classification: 541110
NAIC Description: Offices of Lawyers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PORZIO BROMBERG & NEWMAN PC ACCIDENTAL DEATH & DISMEMBERMENT

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2022-04-01 VITO A. GAGLIARDI JR. 2024-01-16
503 2021-04-01 VITO A. GAGLIARDI JR. 2023-01-12
503 2020-04-01 VITO A. GAGLIARDI JR. 2021-12-22
503 2019-04-01 VITO A. GAGLIARDI JR. 2021-01-14
503 2018-04-01 VITO A. GAGLIARDI JR. 2019-12-05
503 2017-04-01
503 2016-04-01
503 2015-04-01
503 2014-04-01
503 2013-04-01
503 2012-04-01 D JEFFREY CAMPBELL
503 2011-04-01 D JEFFREY CAMPBELL
503 2010-04-01 D JEFFREY CAMPBELL
503 2009-04-01 D JEFFREY CAMPBELL
503 2009-04-01 D JEFFREY CAMPBELL

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
503	2022-04-01	VITO A. GAGLIARDI JR.	2024-01-16
503	2021-04-01	VITO A. GAGLIARDI JR.	2023-01-12
503	2020-04-01	VITO A. GAGLIARDI JR.	2021-12-22
503	2019-04-01	VITO A. GAGLIARDI JR.	2021-01-14
503	2018-04-01	VITO A. GAGLIARDI JR.	2019-12-05
503	2017-04-01
503	2016-04-01
503	2015-04-01
503	2014-04-01
503	2013-04-01
503	2012-04-01	D JEFFREY CAMPBELL
503	2011-04-01	D JEFFREY CAMPBELL
503	2010-04-01	D JEFFREY CAMPBELL
503	2009-04-01	D JEFFREY CAMPBELL
503	2009-04-01	D JEFFREY CAMPBELL

Plan Statistics for PORZIO BROMBERG & NEWMAN PC ACCIDENTAL DEATH & DISMEMBERMENT

401k plan membership statisitcs for PORZIO BROMBERG & NEWMAN PC ACCIDENTAL DEATH & DISMEMBERMENT

Measure Date Value
2022: PORZIO BROMBERG & NEWMAN PC ACCIDENTAL DEATH & DISMEMBERMENT 2022 401k membership
Total participants, beginning-of-year 2022-04-01 208
Total number of active participants reported on line 7a of the Form 5500 2022-04-01 169
Total of all active and inactive participants 2022-04-01 169
2021: PORZIO BROMBERG & NEWMAN PC ACCIDENTAL DEATH & DISMEMBERMENT 2021 401k membership
Total participants, beginning-of-year 2021-04-01 212
Total number of active participants reported on line 7a of the Form 5500 2021-04-01 208
Total of all active and inactive participants 2021-04-01 208
2020: PORZIO BROMBERG & NEWMAN PC ACCIDENTAL DEATH & DISMEMBERMENT 2020 401k membership
Total participants, beginning-of-year 2020-04-01 204
Total number of active participants reported on line 7a of the Form 5500 2020-04-01 212
Total of all active and inactive participants 2020-04-01 212
2019: PORZIO BROMBERG & NEWMAN PC ACCIDENTAL DEATH & DISMEMBERMENT 2019 401k membership
Total participants, beginning-of-year 2019-04-01 200
Total number of active participants reported on line 7a of the Form 5500 2019-04-01 204
Total of all active and inactive participants 2019-04-01 204
2018: PORZIO BROMBERG & NEWMAN PC ACCIDENTAL DEATH & DISMEMBERMENT 2018 401k membership
Total participants, beginning-of-year 2018-04-01 198
Total number of active participants reported on line 7a of the Form 5500 2018-04-01 200
Total of all active and inactive participants 2018-04-01 200
2017: PORZIO BROMBERG & NEWMAN PC ACCIDENTAL DEATH & DISMEMBERMENT 2017 401k membership
Total participants, beginning-of-year 2017-04-01 197
Total number of active participants reported on line 7a of the Form 5500 2017-04-01 198
Total of all active and inactive participants 2017-04-01 198
2016: PORZIO BROMBERG & NEWMAN PC ACCIDENTAL DEATH & DISMEMBERMENT 2016 401k membership
Total participants, beginning-of-year 2016-04-01 230
Total number of active participants reported on line 7a of the Form 5500 2016-04-01 138
Total of all active and inactive participants 2016-04-01 138
2015: PORZIO BROMBERG & NEWMAN PC ACCIDENTAL DEATH & DISMEMBERMENT 2015 401k membership
Total participants, beginning-of-year 2015-04-01 230
Total number of active participants reported on line 7a of the Form 5500 2015-04-01 230
Total of all active and inactive participants 2015-04-01 230
2014: PORZIO BROMBERG & NEWMAN PC ACCIDENTAL DEATH & DISMEMBERMENT 2014 401k membership
Total participants, beginning-of-year 2014-04-01 210
Total number of active participants reported on line 7a of the Form 5500 2014-04-01 230
Total of all active and inactive participants 2014-04-01 230
2013: PORZIO BROMBERG & NEWMAN PC ACCIDENTAL DEATH & DISMEMBERMENT 2013 401k membership
Total participants, beginning-of-year 2013-04-01 217
Total number of active participants reported on line 7a of the Form 5500 2013-04-01 210
Total of all active and inactive participants 2013-04-01 210
2012: PORZIO BROMBERG & NEWMAN PC ACCIDENTAL DEATH & DISMEMBERMENT 2012 401k membership
Total participants, beginning-of-year 2012-04-01 201
Total number of active participants reported on line 7a of the Form 5500 2012-04-01 217
Total of all active and inactive participants 2012-04-01 217
2011: PORZIO BROMBERG & NEWMAN PC ACCIDENTAL DEATH & DISMEMBERMENT 2011 401k membership
Total participants, beginning-of-year 2011-04-01 208
Total number of active participants reported on line 7a of the Form 5500 2011-04-01 201
Total of all active and inactive participants 2011-04-01 201
2010: PORZIO BROMBERG & NEWMAN PC ACCIDENTAL DEATH & DISMEMBERMENT 2010 401k membership
Total participants, beginning-of-year 2010-04-01 205
Total number of active participants reported on line 7a of the Form 5500 2010-04-01 208
Total of all active and inactive participants 2010-04-01 208
2009: PORZIO BROMBERG & NEWMAN PC ACCIDENTAL DEATH & DISMEMBERMENT 2009 401k membership
Total participants, beginning-of-year 2009-04-01 175
Total number of active participants reported on line 7a of the Form 5500 2009-04-01 205
Total of all active and inactive participants 2009-04-01 205

Measure	Date	Value
2022: PORZIO BROMBERG & NEWMAN PC ACCIDENTAL DEATH & DISMEMBERMENT 2022 401k membership
Total participants, beginning-of-year	2022-04-01	208
Total number of active participants reported on line 7a of the Form 5500	2022-04-01	169
Total of all active and inactive participants	2022-04-01	169
2021: PORZIO BROMBERG & NEWMAN PC ACCIDENTAL DEATH & DISMEMBERMENT 2021 401k membership
Total participants, beginning-of-year	2021-04-01	212
Total number of active participants reported on line 7a of the Form 5500	2021-04-01	208
Total of all active and inactive participants	2021-04-01	208
2020: PORZIO BROMBERG & NEWMAN PC ACCIDENTAL DEATH & DISMEMBERMENT 2020 401k membership
Total participants, beginning-of-year	2020-04-01	204
Total number of active participants reported on line 7a of the Form 5500	2020-04-01	212
Total of all active and inactive participants	2020-04-01	212
2019: PORZIO BROMBERG & NEWMAN PC ACCIDENTAL DEATH & DISMEMBERMENT 2019 401k membership
Total participants, beginning-of-year	2019-04-01	200
Total number of active participants reported on line 7a of the Form 5500	2019-04-01	204
Total of all active and inactive participants	2019-04-01	204
2018: PORZIO BROMBERG & NEWMAN PC ACCIDENTAL DEATH & DISMEMBERMENT 2018 401k membership
Total participants, beginning-of-year	2018-04-01	198
Total number of active participants reported on line 7a of the Form 5500	2018-04-01	200
Total of all active and inactive participants	2018-04-01	200
2017: PORZIO BROMBERG & NEWMAN PC ACCIDENTAL DEATH & DISMEMBERMENT 2017 401k membership
Total participants, beginning-of-year	2017-04-01	197
Total number of active participants reported on line 7a of the Form 5500	2017-04-01	198
Total of all active and inactive participants	2017-04-01	198
2016: PORZIO BROMBERG & NEWMAN PC ACCIDENTAL DEATH & DISMEMBERMENT 2016 401k membership
Total participants, beginning-of-year	2016-04-01	230
Total number of active participants reported on line 7a of the Form 5500	2016-04-01	138
Total of all active and inactive participants	2016-04-01	138
2015: PORZIO BROMBERG & NEWMAN PC ACCIDENTAL DEATH & DISMEMBERMENT 2015 401k membership
Total participants, beginning-of-year	2015-04-01	230
Total number of active participants reported on line 7a of the Form 5500	2015-04-01	230
Total of all active and inactive participants	2015-04-01	230
2014: PORZIO BROMBERG & NEWMAN PC ACCIDENTAL DEATH & DISMEMBERMENT 2014 401k membership
Total participants, beginning-of-year	2014-04-01	210
Total number of active participants reported on line 7a of the Form 5500	2014-04-01	230
Total of all active and inactive participants	2014-04-01	230
2013: PORZIO BROMBERG & NEWMAN PC ACCIDENTAL DEATH & DISMEMBERMENT 2013 401k membership
Total participants, beginning-of-year	2013-04-01	217
Total number of active participants reported on line 7a of the Form 5500	2013-04-01	210
Total of all active and inactive participants	2013-04-01	210
2012: PORZIO BROMBERG & NEWMAN PC ACCIDENTAL DEATH & DISMEMBERMENT 2012 401k membership
Total participants, beginning-of-year	2012-04-01	201
Total number of active participants reported on line 7a of the Form 5500	2012-04-01	217
Total of all active and inactive participants	2012-04-01	217
2011: PORZIO BROMBERG & NEWMAN PC ACCIDENTAL DEATH & DISMEMBERMENT 2011 401k membership
Total participants, beginning-of-year	2011-04-01	208
Total number of active participants reported on line 7a of the Form 5500	2011-04-01	201
Total of all active and inactive participants	2011-04-01	201
2010: PORZIO BROMBERG & NEWMAN PC ACCIDENTAL DEATH & DISMEMBERMENT 2010 401k membership
Total participants, beginning-of-year	2010-04-01	205
Total number of active participants reported on line 7a of the Form 5500	2010-04-01	208
Total of all active and inactive participants	2010-04-01	208
2009: PORZIO BROMBERG & NEWMAN PC ACCIDENTAL DEATH & DISMEMBERMENT 2009 401k membership
Total participants, beginning-of-year	2009-04-01	175
Total number of active participants reported on line 7a of the Form 5500	2009-04-01	205
Total of all active and inactive participants	2009-04-01	205

Form 5500 Responses for PORZIO BROMBERG & NEWMAN PC ACCIDENTAL DEATH & DISMEMBERMENT

2022: PORZIO BROMBERG & NEWMAN PC ACCIDENTAL DEATH & DISMEMBERMENT 2022 form 5500 responses
2022-04-01	Type of plan entity	Single employer plan
2022-04-01	Plan funding arrangement – Insurance	Yes
2022-04-01	Plan benefit arrangement – Insurance	Yes
2021: PORZIO BROMBERG & NEWMAN PC ACCIDENTAL DEATH & DISMEMBERMENT 2021 form 5500 responses
2021-04-01	Type of plan entity	Single employer plan
2021-04-01	Plan funding arrangement – Insurance	Yes
2021-04-01	Plan benefit arrangement – Insurance	Yes
2020: PORZIO BROMBERG & NEWMAN PC ACCIDENTAL DEATH & DISMEMBERMENT 2020 form 5500 responses
2020-04-01	Type of plan entity	Single employer plan
2020-04-01	Plan funding arrangement – Insurance	Yes
2020-04-01	Plan benefit arrangement – Insurance	Yes
2019: PORZIO BROMBERG & NEWMAN PC ACCIDENTAL DEATH & DISMEMBERMENT 2019 form 5500 responses
2019-04-01	Type of plan entity	Single employer plan
2019-04-01	Plan funding arrangement – Insurance	Yes
2019-04-01	Plan benefit arrangement – Insurance	Yes
2018: PORZIO BROMBERG & NEWMAN PC ACCIDENTAL DEATH & DISMEMBERMENT 2018 form 5500 responses
2018-04-01	Type of plan entity	Single employer plan
2018-04-01	Plan funding arrangement – Insurance	Yes
2018-04-01	Plan benefit arrangement – Insurance	Yes
2017: PORZIO BROMBERG & NEWMAN PC ACCIDENTAL DEATH & DISMEMBERMENT 2017 form 5500 responses
2017-04-01	Type of plan entity	Single employer plan
2017-04-01	Plan funding arrangement – Insurance	Yes
2017-04-01	Plan benefit arrangement – Insurance	Yes
2016: PORZIO BROMBERG & NEWMAN PC ACCIDENTAL DEATH & DISMEMBERMENT 2016 form 5500 responses
2016-04-01	Type of plan entity	Single employer plan
2016-04-01	Plan funding arrangement – Insurance	Yes
2016-04-01	Plan benefit arrangement – Insurance	Yes
2015: PORZIO BROMBERG & NEWMAN PC ACCIDENTAL DEATH & DISMEMBERMENT 2015 form 5500 responses
2015-04-01	Type of plan entity	Single employer plan
2015-04-01	Plan funding arrangement – Insurance	Yes
2015-04-01	Plan benefit arrangement – Insurance	Yes
2014: PORZIO BROMBERG & NEWMAN PC ACCIDENTAL DEATH & DISMEMBERMENT 2014 form 5500 responses
2014-04-01	Type of plan entity	Single employer plan
2014-04-01	Plan funding arrangement – Insurance	Yes
2014-04-01	Plan benefit arrangement – Insurance	Yes
2013: PORZIO BROMBERG & NEWMAN PC ACCIDENTAL DEATH & DISMEMBERMENT 2013 form 5500 responses
2013-04-01	Type of plan entity	Single employer plan
2013-04-01	Plan funding arrangement – Insurance	Yes
2013-04-01	Plan benefit arrangement – Insurance	Yes
2012: PORZIO BROMBERG & NEWMAN PC ACCIDENTAL DEATH & DISMEMBERMENT 2012 form 5500 responses
2012-04-01	Type of plan entity	Single employer plan
2012-04-01	Plan funding arrangement – Insurance	Yes
2012-04-01	Plan benefit arrangement – Insurance	Yes
2011: PORZIO BROMBERG & NEWMAN PC ACCIDENTAL DEATH & DISMEMBERMENT 2011 form 5500 responses
2011-04-01	Type of plan entity	Single employer plan
2011-04-01	Plan funding arrangement – Insurance	Yes
2011-04-01	Plan benefit arrangement – Insurance	Yes
2010: PORZIO BROMBERG & NEWMAN PC ACCIDENTAL DEATH & DISMEMBERMENT 2010 form 5500 responses
2010-04-01	Type of plan entity	Single employer plan
2010-04-01	Plan funding arrangement – Insurance	Yes
2010-04-01	Plan benefit arrangement – Insurance	Yes
2009: PORZIO BROMBERG & NEWMAN PC ACCIDENTAL DEATH & DISMEMBERMENT 2009 form 5500 responses
2009-04-01	Type of plan entity	Single employer plan
2009-04-01	This submission is the final filing	No
2009-04-01	Plan funding arrangement – Insurance	Yes
2009-04-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

VDT601675

Policy instance

Insurance contract or identification number	VDT601675
Number of Individuals Covered	19
Insurance policy start date	2022-01-01
Insurance policy end date	2023-01-01
Total amount of commissions paid to insurance broker	USD $956
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $6,237
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $956
Insurance broker organization code?	3

GREAT NORTHERN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20303 )

Policy contract number

64094954

Policy instance

Insurance contract or identification number	64094954
Number of Individuals Covered	186
Insurance policy start date	2022-04-01
Insurance policy end date	2023-04-01
Total amount of commissions paid to insurance broker	USD $231
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $1,539
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $231
Insurance broker organization code?	3

MARKEL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 38970 )

Policy contract number

4102AH02034-16

Policy instance

Insurance contract or identification number	4102AH02034-16
Number of Individuals Covered	113
Insurance policy start date	2022-04-01
Insurance policy end date	2023-04-01
Total amount of commissions paid to insurance broker	USD $105
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $350
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $105
Insurance broker organization code?	4

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

00535562

Policy instance

Insurance contract or identification number	00535562
Number of Individuals Covered	36
Insurance policy start date	2022-04-01
Insurance policy end date	2023-04-01
Total amount of commissions paid to insurance broker	USD $2,558
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	LONG TERM CARE
Welfare Benefit Premiums Paid to Carrier	USD $22,187
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,558
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

00412744

Policy instance

Insurance contract or identification number	00412744
Number of Individuals Covered	0
Insurance policy start date	2022-04-01
Insurance policy end date	2023-04-01
Total amount of commissions paid to insurance broker	USD $6,591
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $166,978
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,591
Insurance broker organization code?	3

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00522328

Policy instance

Insurance contract or identification number	00522328
Number of Individuals Covered	169
Insurance policy start date	2022-04-01
Insurance policy end date	2023-03-31
Total amount of commissions paid to insurance broker	USD $1,260
Total amount of fees paid to insurance company	USD $409
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $13,767
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,260
Amount paid for insurance broker fees	409
Additional information about fees paid to insurance broker	ADMINISTRATIVE FEES
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

VDT601674

Policy instance

Insurance contract or identification number	VDT601674
Number of Individuals Covered	15
Insurance policy start date	2022-01-01
Insurance policy end date	2023-01-01
Total amount of commissions paid to insurance broker	USD $396
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,838
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $396
Insurance broker organization code?	3

GREAT NORTHERN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20303 )

Policy contract number

64094954

Policy instance

Insurance contract or identification number	64094954
Number of Individuals Covered	204
Insurance policy start date	2021-04-01
Insurance policy end date	2022-04-01
Total amount of commissions paid to insurance broker	USD $231
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $1,539
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $231
Insurance broker organization code?	3

MARKEL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 38970 )

Policy contract number

4102AH020348-15

Policy instance

Insurance contract or identification number	4102AH020348-15
Number of Individuals Covered	403
Insurance policy start date	2021-04-01
Insurance policy end date	2022-03-31
Total amount of commissions paid to insurance broker	USD $105
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $350
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $105
Insurance broker organization code?	4

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

00535562

Policy instance

Insurance contract or identification number	00535562
Number of Individuals Covered	37
Insurance policy start date	2021-04-01
Insurance policy end date	2022-04-01
Total amount of commissions paid to insurance broker	USD $7,902
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	LONG TERM CARE
Welfare Benefit Premiums Paid to Carrier	USD $52,513
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,902
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

00412744

Policy instance

Insurance contract or identification number	00412744
Number of Individuals Covered	125
Insurance policy start date	2021-04-01
Insurance policy end date	2022-04-01
Total amount of commissions paid to insurance broker	USD $5,018
Total amount of fees paid to insurance company	USD $1,257
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $100,554
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,018
Amount paid for insurance broker fees	1257
Insurance broker organization code?	3

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00522328

Policy instance

Insurance contract or identification number	00522328
Number of Individuals Covered	208
Insurance policy start date	2021-04-01
Insurance policy end date	2022-03-31
Total amount of commissions paid to insurance broker	USD $1,390
Total amount of fees paid to insurance company	USD $3,963
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $14,434
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,390
Amount paid for insurance broker fees	3963
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

VDT601674

Policy instance

Insurance contract or identification number	VDT601674
Number of Individuals Covered	14
Insurance policy start date	2021-01-01
Insurance policy end date	2022-01-01
Total amount of commissions paid to insurance broker	USD $549
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,144
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $549
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

VDT601675

Policy instance

Insurance contract or identification number	VDT601675
Number of Individuals Covered	18
Insurance policy start date	2021-01-01
Insurance policy end date	2022-01-01
Total amount of commissions paid to insurance broker	USD $1,316
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $8,398
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,316
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

VDT601675

Policy instance

Insurance contract or identification number	VDT601675
Number of Individuals Covered	19
Insurance policy start date	2020-01-01
Insurance policy end date	2021-01-01
Total amount of commissions paid to insurance broker	USD $1,513
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $9,688
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,513
Insurance broker organization code?	3

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00522328

Policy instance

Insurance contract or identification number	00522328
Number of Individuals Covered	212
Insurance policy start date	2020-04-01
Insurance policy end date	2021-03-31
Total amount of commissions paid to insurance broker	USD $9,177
Total amount of fees paid to insurance company	USD $3,796
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $128,951
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,177
Amount paid for insurance broker fees	3796
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION PAID
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

00412744

Policy instance

Insurance contract or identification number	00412744
Number of Individuals Covered	116
Insurance policy start date	2020-04-01
Insurance policy end date	2021-04-01
Total amount of commissions paid to insurance broker	USD $5,091
Total amount of fees paid to insurance company	USD $1,204
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $96,339
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,091
Amount paid for insurance broker fees	1204
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION PAID
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

00535562

Policy instance

Insurance contract or identification number	00535562
Number of Individuals Covered	39
Insurance policy start date	2020-04-01
Insurance policy end date	2021-04-01
Total amount of commissions paid to insurance broker	USD $8,526
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	LONG TERM CARE
Welfare Benefit Premiums Paid to Carrier	USD $56,838
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,526
Insurance broker organization code?	3

MARKEL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 38970 )

Policy contract number

4102AH020348-14

Policy instance

Insurance contract or identification number	4102AH020348-14
Number of Individuals Covered	403
Insurance policy start date	2020-04-01
Insurance policy end date	2021-03-31
Total amount of commissions paid to insurance broker	USD $105
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $350
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $105
Insurance broker organization code?	4

GREAT NORTHERN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20303 )

Policy contract number

64094954

Policy instance

Insurance contract or identification number	64094954
Number of Individuals Covered	204
Insurance policy start date	2020-04-01
Insurance policy end date	2021-04-01
Total amount of commissions paid to insurance broker	USD $231
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $1,539
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $231
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

VDT601674

Policy instance

Insurance contract or identification number	VDT601674
Number of Individuals Covered	18
Insurance policy start date	2020-01-01
Insurance policy end date	2021-01-01
Total amount of commissions paid to insurance broker	USD $636
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	SHORT TERM DISIABILITY
Welfare Benefit Premiums Paid to Carrier	USD $5,993
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $636
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

VDT601675

Policy instance

Insurance contract or identification number	VDT601675
Number of Individuals Covered	18
Insurance policy start date	2019-01-01
Insurance policy end date	2020-01-01
Total amount of commissions paid to insurance broker	USD $1,530
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $9,756
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,530
Insurance broker organization code?	3

GREAT NORTHERN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20303 )

Policy contract number

64094954

Policy instance

Insurance contract or identification number	64094954
Number of Individuals Covered	204
Insurance policy start date	2019-04-01
Insurance policy end date	2020-04-01
Total amount of commissions paid to insurance broker	USD $231
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $1,539
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $231
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

535562

Policy instance

Insurance contract or identification number	535562
Number of Individuals Covered	39
Insurance policy start date	2019-04-01
Insurance policy end date	2020-04-01
Total amount of commissions paid to insurance broker	USD $8,100
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	LONG TERM CARE
Welfare Benefit Premiums Paid to Carrier	USD $54,814
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,100
Insurance broker organization code?	3

MARKEL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 38970 )

Policy contract number

4102AH02034-13

Policy instance

Insurance contract or identification number	4102AH02034-13
Number of Individuals Covered	113
Insurance policy start date	2019-04-01
Insurance policy end date	2020-03-31
Total amount of commissions paid to insurance broker	USD $105
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $350
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $105
Insurance broker organization code?	4

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

00412744

Policy instance

Insurance contract or identification number	00412744
Number of Individuals Covered	108
Insurance policy start date	2019-03-01
Insurance policy end date	2020-03-01
Total amount of commissions paid to insurance broker	USD $6,056
Total amount of fees paid to insurance company	USD $1,287
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $102,983
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,056
Amount paid for insurance broker fees	1287
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION PAID
Insurance broker organization code?	3

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00522328

Policy instance

Insurance contract or identification number	00522328
Number of Individuals Covered	196
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $8,281
Total amount of fees paid to insurance company	USD $3,693
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $113,842
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,281
Amount paid for insurance broker fees	3693
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION PAID
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

VDT601674

Policy instance

Insurance contract or identification number	VDT601674
Number of Individuals Covered	15
Insurance policy start date	2019-01-01
Insurance policy end date	2020-01-01
Total amount of commissions paid to insurance broker	USD $689
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	SHORT TERM DISIABILITY
Welfare Benefit Premiums Paid to Carrier	USD $6,447
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $689
Insurance broker organization code?	3

FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )

Policy contract number

64094954

Policy instance

Insurance contract or identification number	64094954
Number of Individuals Covered	200
Insurance policy start date	2018-04-01
Insurance policy end date	2019-04-01
Total amount of commissions paid to insurance broker	USD $231
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $1,539
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $231
Insurance broker organization code?	3

MARKEL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 38970 )

Policy contract number

4102AH020348

Policy instance

Insurance contract or identification number	4102AH020348
Number of Individuals Covered	203
Insurance policy start date	2018-04-01
Insurance policy end date	2019-03-31
Total amount of commissions paid to insurance broker	USD $105
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $350
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $105
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

535562

Policy instance

Insurance contract or identification number	535562
Number of Individuals Covered	39
Insurance policy start date	2018-04-01
Insurance policy end date	2019-04-01
Total amount of commissions paid to insurance broker	USD $8,595
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	LONG TERM CARE
Welfare Benefit Premiums Paid to Carrier	USD $54,905
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,595
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

00412744

Policy instance

Insurance contract or identification number	00412744
Number of Individuals Covered	107
Insurance policy start date	2018-03-01
Insurance policy end date	2019-03-01
Total amount of commissions paid to insurance broker	USD $4,887
Total amount of fees paid to insurance company	USD $1,109
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $82,302
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,887
Amount paid for insurance broker fees	1109
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION PAID
Insurance broker organization code?	3

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00522328

Policy instance

Insurance contract or identification number	00522328
Number of Individuals Covered	194
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $9,814
Total amount of fees paid to insurance company	USD $3,618
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $131,990
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,814
Amount paid for insurance broker fees	3618
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION PAID
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

VDT601674

Policy instance

Insurance contract or identification number	VDT601674
Number of Individuals Covered	15
Insurance policy start date	2018-01-01
Insurance policy end date	2019-01-01
Total amount of commissions paid to insurance broker	USD $702
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	SHORT TERM DISIABILITY
Welfare Benefit Premiums Paid to Carrier	USD $6,596
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $702
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

VDT601675

Policy instance

Insurance contract or identification number	VDT601675
Number of Individuals Covered	18
Insurance policy start date	2018-01-01
Insurance policy end date	2019-01-01
Total amount of commissions paid to insurance broker	USD $1,713
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $10,928
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,713
Insurance broker organization code?	3

MARKEL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 38970 )

Policy contract number

4102AH020348

Policy instance

Insurance contract or identification number	4102AH020348
Number of Individuals Covered	153
Insurance policy start date	2017-04-01
Insurance policy end date	2018-03-31
Total amount of commissions paid to insurance broker	USD $105
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $350
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $105
Insurance broker organization code?	3
Insurance broker name	RPS BOLLINGER

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

535562

Policy instance

Insurance contract or identification number	535562
Number of Individuals Covered	24
Insurance policy start date	2016-08-01
Insurance policy end date	2017-08-01
Total amount of commissions paid to insurance broker	USD $9,249
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	LONG TERM CARE
Welfare Benefit Premiums Paid to Carrier	USD $55,820
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,249
Insurance broker organization code?	3
Insurance broker name	MERCER HEALTH AND BENEFITS

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

00412744

Policy instance

Insurance contract or identification number	00412744
Number of Individuals Covered	101
Insurance policy start date	2017-03-01
Insurance policy end date	2018-03-01
Total amount of commissions paid to insurance broker	USD $5,113
Total amount of fees paid to insurance company	USD $1,123
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $89,473
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,113
Amount paid for insurance broker fees	1123
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION PAID
Insurance broker organization code?	3
Insurance broker name	MERCER HEALTH AND BENEFITS

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00522328

Policy instance

Insurance contract or identification number	00522328
Number of Individuals Covered	193
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $8,447
Total amount of fees paid to insurance company	USD $3,108
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $114,095
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,447
Amount paid for insurance broker fees	3108
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION PAID
Insurance broker organization code?	3
Insurance broker name	MERCER HEALTH AND BENEFITS LLC

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

VDT601674

Policy instance

Insurance contract or identification number	VDT601674
Number of Individuals Covered	18
Insurance policy start date	2017-01-01
Insurance policy end date	2018-01-01
Total amount of commissions paid to insurance broker	USD $1,370
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	SHORT TERM DISIABILITY
Welfare Benefit Premiums Paid to Carrier	USD $6,173
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,370
Insurance broker organization code?	3
Insurance broker name	MERCER HEALTH AND BENEFITS

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

VDT601675

Policy instance

Insurance contract or identification number	VDT601675
Number of Individuals Covered	21
Insurance policy start date	2017-01-01
Insurance policy end date	2018-01-01
Total amount of commissions paid to insurance broker	USD $1,370
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $8,767
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,370
Insurance broker organization code?	3
Insurance broker name	MERCER HEALTH AND BENEFITS

FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )

Policy contract number

64094954

Policy instance

Insurance contract or identification number	64094954
Number of Individuals Covered	198
Insurance policy start date	2017-04-01
Insurance policy end date	2018-03-31
Total amount of commissions paid to insurance broker	USD $231
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $1,539
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $231
Insurance broker organization code?	3
Insurance broker name	ARTHUR GALLAGHER RISK MANAGEMENT

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Company Name:	PORZIO, BROMBERG & NEWMAN, P.C.
Employer identification number (EIN):	222005150
NAIC Classification:	541110
NAIC Description:	Offices of Lawyers