U.S. INSPECT, LLC has sponsored the creation of one or more 401k plans.
Additional information about U.S. INSPECT, LLC
Submission information for form 5500 for 401k plan U.S. INSPECT, LLC BENEFIT PLAN
401k plan membership statisitcs for U.S. INSPECT, LLC BENEFIT PLAN
| Measure | Date | Value |
|---|
| 2015: U.S. INSPECT, LLC BENEFIT PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-06-01 | 180 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-06-01 | 198 |
| Number of retired or separated participants receiving benefits | 2015-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2015-06-01 | 0 |
| Total of all active and inactive participants | 2015-06-01 | 198 |
| 2014: U.S. INSPECT, LLC BENEFIT PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-06-01 | 165 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-06-01 | 180 |
| Number of retired or separated participants receiving benefits | 2014-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2014-06-01 | 0 |
| Total of all active and inactive participants | 2014-06-01 | 180 |
| 2013: U.S. INSPECT, LLC BENEFIT PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-06-01 | 172 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-06-01 | 165 |
| Number of retired or separated participants receiving benefits | 2013-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2013-06-01 | 0 |
| Total of all active and inactive participants | 2013-06-01 | 165 |
| 2012: U.S. INSPECT, LLC BENEFIT PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-06-01 | 231 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-06-01 | 172 |
| Number of retired or separated participants receiving benefits | 2012-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2012-06-01 | 0 |
| Total of all active and inactive participants | 2012-06-01 | 172 |
| 2011: U.S. INSPECT, LLC BENEFIT PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-06-01 | 237 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-06-01 | 231 |
| Number of retired or separated participants receiving benefits | 2011-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2011-06-01 | 0 |
| Total of all active and inactive participants | 2011-06-01 | 231 |
| 2009: U.S. INSPECT, LLC BENEFIT PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-06-01 | 188 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-06-01 | 178 |
| Number of retired or separated participants receiving benefits | 2009-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2009-06-01 | 0 |
| Total of all active and inactive participants | 2009-06-01 | 178 |
| Total participants | 2009-06-01 | 178 |
| 2015: U.S. INSPECT, LLC BENEFIT PLAN 2015 form 5500 responses |
|---|
| 2015-06-01 | Type of plan entity | Single employer plan |
| 2015-06-01 | Submission has been amended | No |
| 2015-06-01 | This submission is the final filing | No |
| 2015-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-06-01 | Plan is a collectively bargained plan | No |
| 2015-06-01 | Plan funding arrangement – Insurance | Yes |
| 2015-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: U.S. INSPECT, LLC BENEFIT PLAN 2014 form 5500 responses |
|---|
| 2014-06-01 | Type of plan entity | Single employer plan |
| 2014-06-01 | Submission has been amended | No |
| 2014-06-01 | This submission is the final filing | No |
| 2014-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-06-01 | Plan is a collectively bargained plan | No |
| 2014-06-01 | Plan funding arrangement – Insurance | Yes |
| 2014-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: U.S. INSPECT, LLC BENEFIT PLAN 2013 form 5500 responses |
|---|
| 2013-06-01 | Type of plan entity | Single employer plan |
| 2013-06-01 | Submission has been amended | No |
| 2013-06-01 | This submission is the final filing | No |
| 2013-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-06-01 | Plan is a collectively bargained plan | No |
| 2013-06-01 | Plan funding arrangement – Insurance | Yes |
| 2013-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: U.S. INSPECT, LLC BENEFIT PLAN 2012 form 5500 responses |
|---|
| 2012-06-01 | Type of plan entity | Single employer plan |
| 2012-06-01 | Submission has been amended | No |
| 2012-06-01 | This submission is the final filing | No |
| 2012-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-06-01 | Plan is a collectively bargained plan | No |
| 2012-06-01 | Plan funding arrangement – Insurance | Yes |
| 2012-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: U.S. INSPECT, LLC BENEFIT PLAN 2011 form 5500 responses |
|---|
| 2011-06-01 | Type of plan entity | Single employer plan |
| 2011-06-01 | Submission has been amended | No |
| 2011-06-01 | This submission is the final filing | No |
| 2011-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-06-01 | Plan is a collectively bargained plan | No |
| 2011-06-01 | Plan funding arrangement – Insurance | Yes |
| 2011-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: U.S. INSPECT, LLC BENEFIT PLAN 2009 form 5500 responses |
|---|
| 2009-06-01 | Type of plan entity | Single employer plan |
| 2009-06-01 | Submission has been amended | No |
| 2009-06-01 | This submission is the final filing | No |
| 2009-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-06-01 | Plan is a collectively bargained plan | No |
| 2009-06-01 | Plan funding arrangement – Insurance | Yes |
| 2009-06-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2009-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-06-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | T3687 |
| Policy instance | 1 |
| Insurance contract or identification number | T3687 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2015-06-01 | | Insurance policy end date | 2016-05-31 | | Total amount of commissions paid to insurance broker | USD $122 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | CANCER, HOSPITAL, ACCIDENT INSURANCE | | Commission paid to Insurance Broker | USD $39 | | Insurance broker organization code? | 3 | | Insurance broker name | FRANKLIN R DAVIES |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G00ALQ1 |
| Policy instance | 2 |
| Insurance contract or identification number | G00ALQ1 | | Number of Individuals Covered | 198 | | Insurance policy start date | 2015-06-01 | | Insurance policy end date | 2016-05-31 | | Total amount of commissions paid to insurance broker | USD $12,292 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | VOLUNTARY LIFE | | Commission paid to Insurance Broker | USD $12,292 | | Insurance broker organization code? | 3 | | Insurance broker name | KERXTON INSURANCE AGENCY INC. |
|
| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
| Policy contract number | 0008529027 |
| Policy instance | 3 |
| Insurance contract or identification number | 0008529027 | | Number of Individuals Covered | 18 | | Insurance policy start date | 2015-06-01 | | Insurance policy end date | 2016-05-31 | | Total amount of commissions paid to insurance broker | USD $96 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | ACCIDENT (VWB) | | Commission paid to Insurance Broker | USD $96 | | Insurance broker organization code? | 3 | | Insurance broker name | KERXTON INSURANCE AGENCY |
|
| NATIONAL CAPITAL ADMINISTRATIVE SERVICES, LLC (National Association of Insurance Commissioners NAIC id number: 23700 ) |
| Policy contract number | USI |
| Policy instance | 4 |
| Insurance contract or identification number | USI | | Number of Individuals Covered | 109 | | Insurance policy start date | 2015-06-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $18,023 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Commission paid to Insurance Broker | USD $18,023 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Insurance broker name | KERXTON INSURANCE |
|
| GROUP BENEFIT SERVICES (National Association of Insurance Commissioners NAIC id number: 52429 ) |
| Policy contract number | 31044-16 |
| Policy instance | 5 |
| Insurance contract or identification number | 31044-16 | | Number of Individuals Covered | 133 | | Insurance policy start date | 2016-01-01 | | Insurance policy end date | 2016-05-31 | | Total amount of commissions paid to insurance broker | USD $16,555 | | Total amount of fees paid to insurance company | USD $22,792 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Commission paid to Insurance Broker | USD $1,505 | | Amount paid for insurance broker fees | 22792 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE FEES PAID; IMPLEMENTATION FEES PAID | | Insurance broker organization code? | 3 | | Insurance broker name | KERXTON INSURANCE AGENCY |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | R0348359 |
| Policy instance | 6 |
| Insurance contract or identification number | R0348359 | | Number of Individuals Covered | 9 | | Insurance policy start date | 2015-06-01 | | Insurance policy end date | 2016-05-31 | | Total amount of commissions paid to insurance broker | USD $363 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Commission paid to Insurance Broker | USD $363 | | Insurance broker organization code? | 3 | | Insurance broker name | KERXTON INSURANCE AGENCY INC. |
|
| NATIONAL CAPITAL ADMINISTRATIVE SERVICES, LLC (National Association of Insurance Commissioners NAIC id number: 23700 ) |
| Policy contract number | USI |
| Policy instance | 6 |
| Insurance contract or identification number | USI | | Number of Individuals Covered | 101 | | Insurance policy start date | 2014-06-01 | | Insurance policy end date | 2015-05-31 | | Total amount of commissions paid to insurance broker | USD $28,643 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Commission paid to Insurance Broker | USD $28,643 | | Insurance broker organization code? | 3 | | Insurance broker name | KERXTON INSURANCE |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G00ALQ1 |
| Policy instance | 5 |
| Insurance contract or identification number | G00ALQ1 | | Number of Individuals Covered | 180 | | Insurance policy start date | 2014-06-01 | | Insurance policy end date | 2015-05-31 | | Total amount of commissions paid to insurance broker | USD $11,779 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Commission paid to Insurance Broker | USD $11,779 | | Insurance broker organization code? | 3 | | Insurance broker name | KERXTON INSURANCE AGENCY INC. |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | R0348359 |
| Policy instance | 4 |
| Insurance contract or identification number | R0348359 | | Number of Individuals Covered | 13 | | Insurance policy start date | 2014-06-01 | | Insurance policy end date | 2015-05-31 | | Total amount of commissions paid to insurance broker | USD $524 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Commission paid to Insurance Broker | USD $524 | | Insurance broker organization code? | 3 | | Insurance broker name | KERXTON INSURANCE AGENCY INC. |
|
| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
| Policy contract number | 0008529027 |
| Policy instance | 3 |
| Insurance contract or identification number | 0008529027 | | Number of Individuals Covered | 23 | | Insurance policy start date | 2014-06-01 | | Insurance policy end date | 2015-05-31 | | Total amount of commissions paid to insurance broker | USD $118 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | ACCIDENT (VWB) | | Commission paid to Insurance Broker | USD $118 | | Insurance broker organization code? | 3 | | Insurance broker name | KERXTON INSURANCE AGENCY |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | T3687 |
| Policy instance | 2 |
| Insurance contract or identification number | T3687 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2014-06-01 | | Insurance policy end date | 2015-05-31 | | Total amount of commissions paid to insurance broker | USD $128 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | CANCER, HOSPITAL, ACCIDENT INSURANCE | | Commission paid to Insurance Broker | USD $42 | | Insurance broker organization code? | 3 | | Insurance broker name | FRANKLIN R DAVIES |
|
| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
| Policy contract number | 0008529027 |
| Policy instance | 6 |
| Insurance contract or identification number | 0008529027 | | Number of Individuals Covered | 26 | | Insurance policy start date | 2013-06-01 | | Insurance policy end date | 2014-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | ACCIDENT (VWB) | | Insurance broker organization code? | 3 | | Insurance broker name | MERCER HEALTH AND BENEFITS |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G00ALQ1 |
| Policy instance | 4 |
| Insurance contract or identification number | G00ALQ1 | | Number of Individuals Covered | 165 | | Insurance policy start date | 2013-06-01 | | Insurance policy end date | 2014-05-31 | | Total amount of commissions paid to insurance broker | USD $10,730 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Commission paid to Insurance Broker | USD $10,730 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Insurance broker name | KERXTON INSURANCE AGENCY INC. |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | R0348359 |
| Policy instance | 3 |
| Insurance contract or identification number | R0348359 | | Number of Individuals Covered | 13 | | Insurance policy start date | 2013-06-01 | | Insurance policy end date | 2014-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Insurance broker organization code? | 3 | | Insurance broker name | KERXTON INSURANCE AGENCY INC. |
|
| NATIONAL CAPITAL ADMINISTRATIVE SERVICES, LLC (National Association of Insurance Commissioners NAIC id number: 23700 ) |
| Policy contract number | USI |
| Policy instance | 1 |
| Insurance contract or identification number | USI | | Number of Individuals Covered | 165 | | Insurance policy start date | 2013-06-01 | | Insurance policy end date | 2014-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Insurance broker organization code? | 3 | | Insurance broker name | KERXTON INSURANCE |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | T3687 |
| Policy instance | 5 |
| Insurance contract or identification number | T3687 | | Number of Individuals Covered | 3 | | Insurance policy start date | 2013-06-01 | | Insurance policy end date | 2014-05-31 | | Total amount of commissions paid to insurance broker | USD $199 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | CANCER, HOSPITAL, ACCIDENT INSURANCE | | Commission paid to Insurance Broker | USD $77 | | Insurance broker organization code? | 3 | | Insurance broker name | FRANKLIN R DAVIES |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G00ALQ1 |
| Policy instance | 1 |
| Insurance contract or identification number | G00ALQ1 | | Number of Individuals Covered | 172 | | Insurance policy start date | 2012-06-01 | | Insurance policy end date | 2013-05-31 | | Total amount of commissions paid to insurance broker | USD $10,940 | | Total amount of fees paid to insurance company | USD $1,312 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Commission paid to Insurance Broker | USD $10,940 | | Amount paid for insurance broker fees | 1312 | | Insurance broker organization code? | 3 | | Insurance broker name | KERXTON INSURANCE AGENCY INC. |
|
| NATIONAL CAPITAL ADMINISTRATIVE SERVICES, LLC (National Association of Insurance Commissioners NAIC id number: 23700 ) |
| Policy contract number | USI |
| Policy instance | 5 |
| Insurance contract or identification number | USI | | Number of Individuals Covered | 172 | | Insurance policy start date | 2012-06-01 | | Insurance policy end date | 2013-05-31 | | Total amount of commissions paid to insurance broker | USD $29,515 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Commission paid to Insurance Broker | USD $29,515 | | Insurance broker organization code? | 3 | | Insurance broker name | KERXTON INSURANCE |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | T3687 |
| Policy instance | 6 |
| Insurance contract or identification number | T3687 | | Number of Individuals Covered | 4 | | Insurance policy start date | 2012-06-01 | | Insurance policy end date | 2013-05-31 | | Total amount of commissions paid to insurance broker | USD $287 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | CANCER, HOSPITAL, ACCIDENT INSURANCE | | Commission paid to Insurance Broker | USD $141 | | Insurance broker organization code? | 3 | | Insurance broker name | JAMES HILL SR |
|
| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
| Policy contract number | 0008529027 |
| Policy instance | 4 |
| Insurance contract or identification number | 0008529027 | | Number of Individuals Covered | 36 | | Insurance policy start date | 2012-06-01 | | Insurance policy end date | 2013-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | ACCIDENT (VWB) | | 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 | R0348359 |
| Policy instance | 3 |
| Insurance contract or identification number | R0348359 | | Number of Individuals Covered | 23 | | Insurance policy start date | 2012-06-01 | | Insurance policy end date | 2013-05-31 | | Total amount of commissions paid to insurance broker | USD $1,569 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Commission paid to Insurance Broker | USD $1,569 | | Insurance broker organization code? | 3 | | Insurance broker name | KERXTON INSURANCE AGENCY INC. |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | T3687 |
| Policy instance | 3 |
| Insurance contract or identification number | T3687 | | Number of Individuals Covered | 3 | | Insurance policy start date | 2011-06-01 | | Insurance policy end date | 2012-05-31 | | Total amount of commissions paid to insurance broker | USD $436 | | Total amount of fees paid to insurance company | USD $35 | | Other welfare benefits provided | CANCER, HOSPITAL, ACCIDENT INSURANCE | | 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? | Yes | | 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 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,838 | | Insurance broker organization code? | 7 | | Amount paid for insurance broker fees | 1759 | | Additional information about fees paid to insurance broker | TPA FEES |
|
| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
| Policy contract number | 0008529027 |
| Policy instance | 2 |
| Insurance contract or identification number | 0008529027 | | Insurance policy start date | 2011-06-01 | | Insurance policy end date | 2012-05-31 | | Total amount of commissions paid to insurance broker | USD $3,137 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes |
|
| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
| Policy contract number | R0091777 |
| Policy instance | 1 |
| Insurance contract or identification number | R0091777 | | Number of Individuals Covered | 231 | | Insurance policy start date | 2011-06-01 | | Insurance policy end date | 2012-05-31 | | Total amount of commissions paid to insurance broker | USD $11,484 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes |
|
| NATIONAL CAPITAL ADMINISTRATIVE SERVICES, LLC (National Association of Insurance Commissioners NAIC id number: 23700 ) |
| Policy contract number | USI |
| Policy instance | 4 |
| Insurance contract or identification number | USI | | Number of Individuals Covered | 231 | | Insurance policy start date | 2011-06-01 | | Insurance policy end date | 2012-05-31 | | Total amount of commissions paid to insurance broker | USD $27,860 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes |
|
| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
| Policy contract number | 0008529027 |
| Policy instance | 4 |
| Insurance contract or identification number | 0008529027 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2010-06-01 | | Insurance policy end date | 2011-05-31 | | Total amount of commissions paid to insurance broker | USD $64 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes |
|
| NATIONAL CAPITAL ADMINISTRATIVE SERVICES, LLC (National Association of Insurance Commissioners NAIC id number: 23700 ) |
| Policy contract number | USI |
| Policy instance | 5 |
| Insurance contract or identification number | USI | | Number of Individuals Covered | 237 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-05-31 | | Total amount of commissions paid to insurance broker | USD $11,314 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes |
|
| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
| Policy contract number | R0091777 |
| Policy instance | 2 |
| Insurance contract or identification number | R0091777 | | Number of Individuals Covered | 237 | | Insurance policy start date | 2010-06-01 | | Insurance policy end date | 2011-05-31 | | Total amount of commissions paid to insurance broker | USD $11,765 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | T3687 |
| Policy instance | 1 |
| Insurance contract or identification number | T3687 | | Number of Individuals Covered | 9 | | Insurance policy start date | 2010-06-01 | | Insurance policy end date | 2011-05-31 | | Total amount of commissions paid to insurance broker | USD $853 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | CANCER, HOSPITAL, ACCIDENT INSURANCE |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 0712225 |
| Policy instance | 3 |
| Insurance contract or identification number | 0712225 | | Number of Individuals Covered | 237 | | Insurance policy start date | 2010-06-01 | | Insurance policy end date | 2011-05-31 | | Total amount of commissions paid to insurance broker | USD $28,407 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes |
|
