BRETHREN VILLAGE has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan BRETHREN VILLAGE FLEXIBLE BENEFIT PLAN
Measure | Date | Value |
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2022: BRETHREN VILLAGE FLEXIBLE BENEFIT PLAN 2022 401k membership |
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Total participants, beginning-of-year | 2022-07-01 | 214 |
Total number of active participants reported on line 7a of the Form 5500 | 2022-07-01 | 200 |
Number of retired or separated participants receiving benefits | 2022-07-01 | 4 |
Number of other retired or separated participants entitled to future benefits | 2022-07-01 | 0 |
Total of all active and inactive participants | 2022-07-01 | 204 |
2021: BRETHREN VILLAGE FLEXIBLE BENEFIT PLAN 2021 401k membership |
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Total participants, beginning-of-year | 2021-07-01 | 268 |
Total number of active participants reported on line 7a of the Form 5500 | 2021-07-01 | 214 |
Number of retired or separated participants receiving benefits | 2021-07-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2021-07-01 | 0 |
Total of all active and inactive participants | 2021-07-01 | 214 |
2020: BRETHREN VILLAGE FLEXIBLE BENEFIT PLAN 2020 401k membership |
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Total participants, beginning-of-year | 2020-07-01 | 295 |
Total number of active participants reported on line 7a of the Form 5500 | 2020-07-01 | 268 |
Number of retired or separated participants receiving benefits | 2020-07-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2020-07-01 | 0 |
Total of all active and inactive participants | 2020-07-01 | 268 |
2019: BRETHREN VILLAGE FLEXIBLE BENEFIT PLAN 2019 401k membership |
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Total participants, beginning-of-year | 2019-07-01 | 311 |
Total number of active participants reported on line 7a of the Form 5500 | 2019-07-01 | 292 |
Number of retired or separated participants receiving benefits | 2019-07-01 | 3 |
Number of other retired or separated participants entitled to future benefits | 2019-07-01 | 0 |
Total of all active and inactive participants | 2019-07-01 | 295 |
2018: BRETHREN VILLAGE FLEXIBLE BENEFIT PLAN 2018 401k membership |
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Total participants, beginning-of-year | 2018-07-01 | 312 |
Total number of active participants reported on line 7a of the Form 5500 | 2018-07-01 | 311 |
Number of retired or separated participants receiving benefits | 2018-07-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2018-07-01 | 0 |
Total of all active and inactive participants | 2018-07-01 | 311 |
2017: BRETHREN VILLAGE FLEXIBLE BENEFIT PLAN 2017 401k membership |
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Total participants, beginning-of-year | 2017-07-01 | 298 |
Total number of active participants reported on line 7a of the Form 5500 | 2017-07-01 | 311 |
Number of retired or separated participants receiving benefits | 2017-07-01 | 1 |
Number of other retired or separated participants entitled to future benefits | 2017-07-01 | 0 |
Total of all active and inactive participants | 2017-07-01 | 312 |
2016: BRETHREN VILLAGE FLEXIBLE BENEFIT PLAN 2016 401k membership |
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Total participants, beginning-of-year | 2016-07-01 | 276 |
Total number of active participants reported on line 7a of the Form 5500 | 2016-07-01 | 298 |
Number of retired or separated participants receiving benefits | 2016-07-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2016-07-01 | 0 |
Total of all active and inactive participants | 2016-07-01 | 298 |
2015: BRETHREN VILLAGE FLEXIBLE BENEFIT PLAN 2015 401k membership |
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Total participants, beginning-of-year | 2015-07-01 | 261 |
Total number of active participants reported on line 7a of the Form 5500 | 2015-07-01 | 275 |
Number of retired or separated participants receiving benefits | 2015-07-01 | 1 |
Number of other retired or separated participants entitled to future benefits | 2015-07-01 | 0 |
Total of all active and inactive participants | 2015-07-01 | 276 |
2014: BRETHREN VILLAGE FLEXIBLE BENEFIT PLAN 2014 401k membership |
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Total participants, beginning-of-year | 2014-07-01 | 277 |
Total number of active participants reported on line 7a of the Form 5500 | 2014-07-01 | 261 |
Number of retired or separated participants receiving benefits | 2014-07-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2014-07-01 | 0 |
Total of all active and inactive participants | 2014-07-01 | 261 |
Total participants, beginning-of-year | 2014-01-01 | 277 |
Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 266 |
Number of retired or separated participants receiving benefits | 2014-01-01 | 3 |
Total of all active and inactive participants | 2014-01-01 | 269 |
2013: BRETHREN VILLAGE FLEXIBLE BENEFIT PLAN 2013 401k membership |
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Total participants, beginning-of-year | 2013-01-01 | 267 |
Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 274 |
Number of retired or separated participants receiving benefits | 2013-01-01 | 3 |
Total of all active and inactive participants | 2013-01-01 | 277 |
2012: BRETHREN VILLAGE FLEXIBLE BENEFIT PLAN 2012 401k membership |
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Total participants, beginning-of-year | 2012-01-01 | 301 |
Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 262 |
Number of retired or separated participants receiving benefits | 2012-01-01 | 5 |
Total of all active and inactive participants | 2012-01-01 | 267 |
2011: BRETHREN VILLAGE FLEXIBLE BENEFIT PLAN 2011 401k membership |
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Total participants, beginning-of-year | 2011-01-01 | 299 |
Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 301 |
Number of retired or separated participants receiving benefits | 2011-01-01 | 0 |
Total of all active and inactive participants | 2011-01-01 | 301 |
2009: BRETHREN VILLAGE FLEXIBLE BENEFIT PLAN 2009 401k membership |
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Total participants, beginning-of-year | 2009-01-01 | 253 |
Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 248 |
Number of retired or separated participants receiving benefits | 2009-01-01 | 4 |
Total of all active and inactive participants | 2009-01-01 | 252 |
2022: BRETHREN VILLAGE FLEXIBLE BENEFIT PLAN 2022 form 5500 responses |
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2022-07-01 | Type of plan entity | Single employer plan |
2022-07-01 | Submission has been amended | No |
2022-07-01 | This submission is the final filing | No |
2022-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2022-07-01 | Plan is a collectively bargained plan | No |
2022-07-01 | Plan funding arrangement – Insurance | Yes |
2022-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2022-07-01 | Plan benefit arrangement – Insurance | Yes |
2022-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2021: BRETHREN VILLAGE FLEXIBLE BENEFIT PLAN 2021 form 5500 responses |
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2021-07-01 | Type of plan entity | Single employer plan |
2021-07-01 | Submission has been amended | No |
2021-07-01 | This submission is the final filing | No |
2021-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2021-07-01 | Plan is a collectively bargained plan | No |
2021-07-01 | Plan funding arrangement – Insurance | Yes |
2021-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2021-07-01 | Plan benefit arrangement – Insurance | Yes |
2021-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2020: BRETHREN VILLAGE FLEXIBLE BENEFIT PLAN 2020 form 5500 responses |
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2020-07-01 | Type of plan entity | Single employer plan |
2020-07-01 | Submission has been amended | No |
2020-07-01 | This submission is the final filing | No |
2020-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2020-07-01 | Plan is a collectively bargained plan | No |
2020-07-01 | Plan funding arrangement – Insurance | Yes |
2020-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2020-07-01 | Plan benefit arrangement – Insurance | Yes |
2020-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2019: BRETHREN VILLAGE FLEXIBLE BENEFIT PLAN 2019 form 5500 responses |
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2019-07-01 | Type of plan entity | Single employer plan |
2019-07-01 | Submission has been amended | No |
2019-07-01 | This submission is the final filing | No |
2019-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2019-07-01 | Plan is a collectively bargained plan | No |
2019-07-01 | Plan funding arrangement – Insurance | Yes |
2019-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2019-07-01 | Plan benefit arrangement – Insurance | Yes |
2019-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2018: BRETHREN VILLAGE FLEXIBLE BENEFIT PLAN 2018 form 5500 responses |
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2018-07-01 | Type of plan entity | Single employer plan |
2018-07-01 | Submission has been amended | No |
2018-07-01 | This submission is the final filing | No |
2018-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2018-07-01 | Plan is a collectively bargained plan | No |
2018-07-01 | Plan funding arrangement – Insurance | Yes |
2018-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2018-07-01 | Plan benefit arrangement – Insurance | Yes |
2018-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2017: BRETHREN VILLAGE FLEXIBLE BENEFIT PLAN 2017 form 5500 responses |
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2017-07-01 | Type of plan entity | Single employer plan |
2017-07-01 | Submission has been amended | No |
2017-07-01 | This submission is the final filing | No |
2017-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2017-07-01 | Plan is a collectively bargained plan | No |
2017-07-01 | Plan funding arrangement – Insurance | Yes |
2017-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2017-07-01 | Plan benefit arrangement – Insurance | Yes |
2017-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2016: BRETHREN VILLAGE FLEXIBLE BENEFIT PLAN 2016 form 5500 responses |
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2016-07-01 | Type of plan entity | Single employer plan |
2016-07-01 | Submission has been amended | No |
2016-07-01 | This submission is the final filing | No |
2016-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2016-07-01 | Plan is a collectively bargained plan | No |
2016-07-01 | Plan funding arrangement – Insurance | Yes |
2016-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2016-07-01 | Plan benefit arrangement – Insurance | Yes |
2016-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2015: BRETHREN VILLAGE FLEXIBLE BENEFIT PLAN 2015 form 5500 responses |
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2015-07-01 | Type of plan entity | Single employer plan |
2015-07-01 | Submission has been amended | No |
2015-07-01 | This submission is the final filing | No |
2015-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2015-07-01 | Plan is a collectively bargained plan | No |
2015-07-01 | Plan funding arrangement – Insurance | Yes |
2015-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2015-07-01 | Plan benefit arrangement – Insurance | Yes |
2015-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2014: BRETHREN VILLAGE FLEXIBLE BENEFIT PLAN 2014 form 5500 responses |
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2014-07-01 | Type of plan entity | Single employer plan |
2014-07-01 | Submission has been amended | No |
2014-07-01 | This submission is the final filing | No |
2014-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2014-07-01 | Plan is a collectively bargained plan | No |
2014-07-01 | Plan funding arrangement – Insurance | Yes |
2014-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2014-07-01 | Plan benefit arrangement – Insurance | Yes |
2014-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2014-01-01 | Type of plan entity | Single employer plan |
2014-01-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
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: BRETHREN VILLAGE FLEXIBLE BENEFIT PLAN 2013 form 5500 responses |
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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: BRETHREN VILLAGE FLEXIBLE BENEFIT PLAN 2012 form 5500 responses |
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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: BRETHREN VILLAGE FLEXIBLE BENEFIT PLAN 2011 form 5500 responses |
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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 |
2009: BRETHREN VILLAGE FLEXIBLE BENEFIT PLAN 2009 form 5500 responses |
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2009-01-01 | Type of plan entity | Single employer plan |
2009-01-01 | This submission is the final filing | No |
2009-01-01 | Plan funding arrangement – Insurance | Yes |
2009-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2009-01-01 | Plan benefit arrangement – Insurance | Yes |
2009-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 ) |
Policy contract number | G00619765 |
Policy instance | 2 |
Insurance contract or identification number | G00619765 | Number of Individuals Covered | 200 | Insurance policy start date | 2022-07-01 | Insurance policy end date | 2023-06-30 | Total amount of commissions paid to insurance broker | USD $15,013 | Total amount of fees paid to insurance company | USD $4,177 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $101,680 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $15,013 | Amount paid for insurance broker fees | 4177 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | Insurance broker organization code? | 3 |
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WELLSPAN (National Association of Insurance Commissioners NAIC id number: 62111 ) |
Policy contract number | 00 |
Policy instance | 1 |
Insurance contract or identification number | 00 | Number of Individuals Covered | 462 | Insurance policy start date | 2022-07-01 | Insurance policy end date | 2023-06-30 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | EAP | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $3,026 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
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AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 ) |
Policy contract number | G00619765 |
Policy instance | 2 |
Insurance contract or identification number | G00619765 | Number of Individuals Covered | 214 | Insurance policy start date | 2021-07-01 | Insurance policy end date | 2022-06-30 | Total amount of commissions paid to insurance broker | USD $16,786 | Total amount of fees paid to insurance company | USD $1,779 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $114,018 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $16,786 | Amount paid for insurance broker fees | 1779 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | Insurance broker organization code? | 3 |
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WELLSPAN (National Association of Insurance Commissioners NAIC id number: 62111 ) |
Policy contract number | 00 |
Policy instance | 1 |
Insurance contract or identification number | 00 | Number of Individuals Covered | 409 | Insurance policy start date | 2021-07-01 | Insurance policy end date | 2022-06-30 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | EAP | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $5,234 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
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AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 ) |
Policy contract number | G00619765 |
Policy instance | 2 |
Insurance contract or identification number | G00619765 | Number of Individuals Covered | 268 | Insurance policy start date | 2020-07-01 | Insurance policy end date | 2021-06-30 | Total amount of commissions paid to insurance broker | USD $18,077 | Total amount of fees paid to insurance company | USD $7,608 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $123,119 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $18,077 | Amount paid for insurance broker fees | 7608 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | Insurance broker organization code? | 3 |
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WELLSPAN (National Association of Insurance Commissioners NAIC id number: 62111 ) |
Policy contract number | 00 |
Policy instance | 1 |
Insurance contract or identification number | 00 | Number of Individuals Covered | 417 | Insurance policy start date | 2020-07-01 | Insurance policy end date | 2021-06-30 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | EAP | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $6,329 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
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PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
Policy contract number | 53179 |
Policy instance | 1 |
Insurance contract or identification number | 53179 | Number of Individuals Covered | 292 | Insurance policy start date | 2019-07-01 | Insurance policy end date | 2020-06-30 | Total amount of commissions paid to insurance broker | USD $3,788 | Total amount of fees paid to insurance company | USD $93 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D, VOLUNTARY LIFE & AD&D, VOLUNTARY DEPENDENT & SPOUSAL LIFE | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $45,761 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,788 | Amount paid for insurance broker fees | 0 | Additional information about fees paid to insurance broker | NONE | Insurance broker organization code? | 3 |
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KANSAS CITY LIFE (National Association of Insurance Commissioners NAIC id number: 65129 ) |
Policy contract number | AS001-0184-KCL |
Policy instance | 3 |
Insurance contract or identification number | AS001-0184-KCL | Number of Individuals Covered | 136 | Insurance policy start date | 2019-07-01 | Insurance policy end date | 2020-06-30 | Total amount of commissions paid to insurance broker | USD $11,199 | Total amount of fees paid to insurance company | USD $6,896 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $114,934 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,488 | Amount paid for insurance broker fees | 0 | Additional information about fees paid to insurance broker | NONE | Insurance broker organization code? | 3 |
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WELLSPAN (National Association of Insurance Commissioners NAIC id number: 62111 ) |
Policy contract number | 00 |
Policy instance | 2 |
Insurance contract or identification number | 00 | Number of Individuals Covered | 462 | Insurance policy start date | 2019-07-01 | Insurance policy end date | 2020-06-30 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | EAP | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $6,764 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
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PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
Policy contract number | 53179 |
Policy instance | 1 |
Insurance contract or identification number | 53179 | Number of Individuals Covered | 311 | Insurance policy start date | 2018-07-01 | Insurance policy end date | 2019-06-30 | Total amount of commissions paid to insurance broker | USD $3,792 | Total amount of fees paid to insurance company | USD $112 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D, VOLUNTARY LIFE & AD&D, VOLUNTARY DEPENDENT & SPOUSAL LIFE | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $45,830 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,792 | Amount paid for insurance broker fees | 0 | Additional information about fees paid to insurance broker | NONE | Insurance broker organization code? | 3 |
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WELLSPAN (National Association of Insurance Commissioners NAIC id number: 62111 ) |
Policy contract number | 00 |
Policy instance | 2 |
Insurance contract or identification number | 00 | Number of Individuals Covered | 471 | Insurance policy start date | 2018-07-01 | Insurance policy end date | 2019-06-30 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | EAP | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $6,757 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
KANSAS CITY LIFE (National Association of Insurance Commissioners NAIC id number: 65129 ) |
Policy contract number | AS001-0184-KCL |
Policy instance | 3 |
Insurance contract or identification number | AS001-0184-KCL | Number of Individuals Covered | 146 | Insurance policy start date | 2018-07-01 | Insurance policy end date | 2019-06-30 | Total amount of commissions paid to insurance broker | USD $11,431 | Total amount of fees paid to insurance company | USD $6,499 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $109,185 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $0 | Amount paid for insurance broker fees | 6499 | Additional information about fees paid to insurance broker | TPA FEES | Insurance broker organization code? | 5 |
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PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
Policy contract number | 53179 |
Policy instance | 1 |
Insurance contract or identification number | 53179 | Number of Individuals Covered | 311 | Insurance policy start date | 2017-07-01 | Insurance policy end date | 2018-06-30 | Total amount of commissions paid to insurance broker | USD $3,676 | Total amount of fees paid to insurance company | USD $119 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D, VOLUNTARY LIFE & AD&D, VOLUNTARY DEPENDENT & SPOUSAL LIFE | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $43,212 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,061 | Amount paid for insurance broker fees | 0 | Additional information about fees paid to insurance broker | NONE | Insurance broker organization code? | 3 | Insurance broker name | AXA ASSISTANCE, USA |
|
WELLSPAN (National Association of Insurance Commissioners NAIC id number: 62111 ) |
Policy contract number | 00 |
Policy instance | 2 |
Insurance contract or identification number | 00 | Number of Individuals Covered | 472 | Insurance policy start date | 2017-07-01 | Insurance policy end date | 2018-06-30 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | EAP | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $6,972 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
KANSAS CITY LIFE (National Association of Insurance Commissioners NAIC id number: 65129 ) |
Policy contract number | AS001-0184-KCL |
Policy instance | 3 |
Insurance contract or identification number | AS001-0184-KCL | Number of Individuals Covered | 149 | Insurance policy start date | 2017-07-01 | Insurance policy end date | 2018-06-30 | Total amount of commissions paid to insurance broker | USD $14,691 | Total amount of fees paid to insurance company | USD $5,900 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $98,336 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,473 | Amount paid for insurance broker fees | 0 | Additional information about fees paid to insurance broker | NONE | Insurance broker organization code? | 3 | Insurance broker name | EMERSON REID & COMPANY, INC |
|
PHILHAVEN (National Association of Insurance Commissioners NAIC id number: 00 ) |
Policy contract number | 00 |
Policy instance | 2 |
Insurance contract or identification number | 00 | Number of Individuals Covered | 262 | Insurance policy start date | 2015-07-01 | Insurance policy end date | 2016-06-30 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | EAP | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $6,235 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
Policy contract number | 53179 |
Policy instance | 1 |
Insurance contract or identification number | 53179 | Number of Individuals Covered | 275 | Insurance policy start date | 2015-07-01 | Insurance policy end date | 2016-06-30 | Total amount of commissions paid to insurance broker | USD $3,411 | Total amount of fees paid to insurance company | USD $98 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D, VOLUNTARY LIFE & AD&D, VOLUNTARY DEPENDENT & SPOUSAL LIFE | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $36,346 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,411 | Amount paid for insurance broker fees | 0 | Additional information about fees paid to insurance broker | NONE | Insurance broker organization code? | 3 | Insurance broker name | AXA ASSISTANCE, USA |
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KANSAS CITY LIFE (National Association of Insurance Commissioners NAIC id number: 65129 ) |
Policy contract number | AS001-0184-KCL |
Policy instance | 3 |
Insurance contract or identification number | AS001-0184-KCL | Number of Individuals Covered | 139 | Insurance policy start date | 2015-07-01 | Insurance policy end date | 2016-06-30 | Total amount of commissions paid to insurance broker | USD $13,932 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $86,380 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,217 | Amount paid for insurance broker fees | 0 | Additional information about fees paid to insurance broker | NONE | Insurance broker organization code? | 3 | Insurance broker name | EMERSON REID & COMPANY, INC |
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PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
Policy contract number | 53179 |
Policy instance | 1 |
Insurance contract or identification number | 53179 | Number of Individuals Covered | 254 | Insurance policy start date | 2014-07-01 | Insurance policy end date | 2015-06-30 | Total amount of commissions paid to insurance broker | USD $3,143 | Total amount of fees paid to insurance company | USD $95 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $66,706 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,143 | Amount paid for insurance broker fees | 0 | Additional information about fees paid to insurance broker | SALES AND SERVICE COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | AXA ASSITANCE, USA |
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KANSAS CITY LIFE (National Association of Insurance Commissioners NAIC id number: 65129 ) |
Policy contract number | AS001-0184-KCL |
Policy instance | 5 |
Insurance contract or identification number | AS001-0184-KCL | Number of Individuals Covered | 126 | Insurance policy start date | 2014-07-01 | Insurance policy end date | 2015-06-30 | Total amount of commissions paid to insurance broker | USD $16,336 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $81,110 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $9,984 | Amount paid for insurance broker fees | 0 | Additional information about fees paid to insurance broker | NONE | Insurance broker organization code? | 3 | Insurance broker name | EMERSON REID & COMPANY, INC |
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PHILHAVEN (National Association of Insurance Commissioners NAIC id number: 00 ) |
Policy contract number | 00 |
Policy instance | 4 |
Insurance contract or identification number | 00 | Number of Individuals Covered | 430 | Insurance policy start date | 2014-07-01 | Insurance policy end date | 2015-06-30 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | EMPLOYEE ASSISTANCE PLAN | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $6,235 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
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HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 ) |
Policy contract number | 404712 |
Policy instance | 3 |
Insurance contract or identification number | 404712 | Number of Individuals Covered | 225 | Insurance policy start date | 2014-07-01 | Insurance policy end date | 2015-06-30 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $281,894 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E7298318 |
Policy instance | 2 |
Insurance contract or identification number | E7298318 | Number of Individuals Covered | 8 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-12-31 | Total amount of commissions paid to insurance broker | USD $185 | Total amount of fees paid to insurance company | USD $19 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $4,347 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $80 | Amount paid for insurance broker fees | 7 | Additional information about fees paid to insurance broker | NONE | Insurance broker organization code? | 3 | Insurance broker name | LAWRENCE PRICHARD |
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PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
Policy contract number | 53179 |
Policy instance | 1 |
Insurance contract or identification number | 53179 | Number of Individuals Covered | 260 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $2,243 | Total amount of fees paid to insurance company | USD $48 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $34,859 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,243 | Additional information about fees paid to insurance broker | SALES AND SERVICE COMPENSATION | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 48 | Insurance broker name | AXA ASSISTANCE USA |
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KANSAS CITY LIFE (National Association of Insurance Commissioners NAIC id number: 65129 ) |
Policy contract number | AS001-0184-KCL |
Policy instance | 3 |
Insurance contract or identification number | AS001-0184-KCL | Number of Individuals Covered | 127 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-06-30 | Total amount of commissions paid to insurance broker | USD $8,560 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $41,995 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,127 | Insurance broker organization code? | 3 | Insurance broker name | EMERSON REID & COMPANY INC |
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DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 ) |
Policy contract number | 04567 |
Policy instance | 4 |
Insurance contract or identification number | 04567 | Number of Individuals Covered | 341 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-06-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Dental Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E7298318 |
Policy instance | 2 |
Insurance contract or identification number | E7298318 | Number of Individuals Covered | 10 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-06-30 | Total amount of commissions paid to insurance broker | USD $121 | Total amount of fees paid to insurance company | USD $1 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $2,315 | 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 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 1 | Insurance broker name | LAWRENCE PRICHARD |
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EBS-RMSCO, INC. (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 4567-1,2;025458 |
Policy instance | 6 |
Insurance contract or identification number | 4567-1,2;025458 | Number of Individuals Covered | 3 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-06-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Other welfare benefits provided | COBRA | Welfare Benefit Premiums Paid to Carrier | USD $1,517 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 ) |
Policy contract number | 404712 |
Policy instance | 5 |
Insurance contract or identification number | 404712 | Number of Individuals Covered | 219 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-06-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Other welfare benefits provided | SPECIFIC AND AGGREGATE STOP LOSS | Welfare Benefit Premiums Paid to Carrier | USD $129,554 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 ) |
Policy contract number | 404712 |
Policy instance | 6 |
Insurance contract or identification number | 404712 | Number of Individuals Covered | 226 | Insurance policy start date | 2013-07-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $108,010 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 ) |
Policy contract number | 04567 |
Policy instance | 5 |
Insurance contract or identification number | 04567 | Number of Individuals Covered | 344 | Insurance policy start date | 2012-07-01 | Insurance policy end date | 2013-06-30 | Total amount of commissions paid to insurance broker | USD $2,465 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Dental Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,465 | Insurance broker organization code? | 3 | Insurance broker name | MURRAY RISK MANAGEMENT AND INSURANC |
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HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
Policy contract number | 089324 |
Policy instance | 3 |
Insurance contract or identification number | 089324 | Number of Individuals Covered | 356 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,022,699 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E7298318 |
Policy instance | 2 |
Insurance contract or identification number | E7298318 | Number of Individuals Covered | 12 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $271 | Total amount of fees paid to insurance company | USD $3 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $6,354 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $85 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 1 | Insurance broker name | LAWRENCE PRICHARD |
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PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
Policy contract number | 53179 |
Policy instance | 1 |
Insurance contract or identification number | 53179 | Number of Individuals Covered | 260 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $3,255 | Total amount of fees paid to insurance company | USD $93 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $70,216 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,255 | Additional information about fees paid to insurance broker | SALES AND SERVICE COMPENSATION | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 93 | Insurance broker name | AXA ASSITANCE, USA |
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KANSAS CITY LIFE (National Association of Insurance Commissioners NAIC id number: 65129 ) |
Policy contract number | AS001-0184-KCL |
Policy instance | 4 |
Insurance contract or identification number | AS001-0184-KCL | Number of Individuals Covered | 135 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $17,844 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $86,034 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $10,206 | Insurance broker organization code? | 3 | Insurance broker name | EMERSON REID & COMPANY INC |
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DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 ) |
Policy contract number | 04567 |
Policy instance | 5 |
Insurance contract or identification number | 04567 | Number of Individuals Covered | 355 | Insurance policy start date | 2011-07-01 | Insurance policy end date | 2012-06-30 | Total amount of commissions paid to insurance broker | USD $2,905 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Dental Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,905 | Insurance broker organization code? | 3 | Insurance broker name | MURRAY RISK MANAGEMENT AND INSURANC |
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KANSAS CITY LIFE (National Association of Insurance Commissioners NAIC id number: 65129 ) |
Policy contract number | AS001-0184-KCL |
Policy instance | 4 |
Insurance contract or identification number | AS001-0184-KCL | Number of Individuals Covered | 143 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $19,175 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $95,107 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $10,547 | Insurance broker organization code? | 3 | Insurance broker name | EMERSON REID & COMPANY INC |
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PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
Policy contract number | 53179 |
Policy instance | 1 |
Insurance contract or identification number | 53179 | Number of Individuals Covered | 257 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $3,428 | Total amount of fees paid to insurance company | USD $101 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $77,109 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,428 | Additional information about fees paid to insurance broker | SALES AND SERVICE COMPENSATION | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 101 | Insurance broker name | AXA ASSITANCE, USA |
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HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
Policy contract number | 89324 |
Policy instance | 3 |
Insurance contract or identification number | 89324 | Number of Individuals Covered | 363 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $2,338,720 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E7298318 |
Policy instance | 2 |
Insurance contract or identification number | E7298318 | Number of Individuals Covered | 13 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $329 | Total amount of fees paid to insurance company | USD $5 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $7,816 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $117 | Amount paid for insurance broker fees | 1 | Insurance broker organization code? | 3 | Insurance broker name | LAWRENCE PRICHARD |
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PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
Policy contract number | 53179 |
Policy instance | 1 |
Insurance contract or identification number | 53179 | Number of Individuals Covered | 306 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Total amount of commissions paid to insurance broker | USD $3,482 | Total amount of fees paid to insurance company | USD $108 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $79,284 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 ) |
Policy contract number | 04567 |
Policy instance | 5 |
Insurance contract or identification number | 04567 | Number of Individuals Covered | 247 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Total amount of commissions paid to insurance broker | USD $3,003 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Dental Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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KANSAS CITY LIFE (National Association of Insurance Commissioners NAIC id number: 65129 ) |
Policy contract number | AS001-0184-KCL |
Policy instance | 4 |
Insurance contract or identification number | AS001-0184-KCL | Number of Individuals Covered | 154 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Total amount of commissions paid to insurance broker | USD $22,790 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $104,232 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
Policy contract number | 89324 |
Policy instance | 3 |
Insurance contract or identification number | 89324 | Number of Individuals Covered | 433 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Total amount of commissions paid to insurance broker | USD $66 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $2,595,560 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E7298318 |
Policy instance | 2 |
Insurance contract or identification number | E7298318 | Number of Individuals Covered | 19 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Total amount of commissions paid to insurance broker | USD $558 | Total amount of fees paid to insurance company | USD $80 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $9,010 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
Policy contract number | 89324 |
Policy instance | 3 |
Insurance contract or identification number | 89324 | Number of Individuals Covered | 430 | Insurance policy start date | 2010-01-01 | Insurance policy end date | 2010-12-31 | Total amount of commissions paid to insurance broker | USD $33 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,524,749 | 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 | Insurance broker organization code? | 3 | Insurance broker name | STOUDT ADVISORS |
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DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 ) |
Policy contract number | 4567 |
Policy instance | 4 |
Insurance contract or identification number | 4567 | Number of Individuals Covered | 214 | Insurance policy start date | 2010-01-01 | Insurance policy end date | 2010-12-31 | Total amount of commissions paid to insurance broker | USD $2,233 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $62,889 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,233 | Additional information about fees paid to insurance broker | ADMINISTRATION FEES | Insurance broker organization code? | 3 | Insurance broker name | CORPORATE HEALTH STRATEGIES, LLC |
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PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
Policy contract number | 53179 |
Policy instance | 1 |
Insurance contract or identification number | 53179 | Number of Individuals Covered | 281 | Insurance policy start date | 2010-01-01 | Insurance policy end date | 2010-12-31 | Total amount of commissions paid to insurance broker | USD $2,925 | Total amount of fees paid to insurance company | USD $91 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $67,873 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,925 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 91 | Insurance broker name | AXA ASSITANCE, USA |
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COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E7298318 |
Policy instance | 2 |
Insurance contract or identification number | E7298318 | Number of Individuals Covered | 20 | Insurance policy start date | 2010-01-01 | Insurance policy end date | 2010-12-31 | Total amount of commissions paid to insurance broker | USD $614 | Total amount of fees paid to insurance company | USD $3 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Temporary 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 $287 | Amount paid for insurance broker fees | 3 | Insurance broker organization code? | 3 | Insurance broker name | ARDENA MCVICKER |
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