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DENTAL ASSOCIATES BASIC LIFE AND ACC DEATH AND DISMEMBERMENT 401k Plan overview

Plan NameDENTAL ASSOCIATES BASIC LIFE AND ACC DEATH AND DISMEMBERMENT
Plan identification number 503

DENTAL ASSOCIATES BASIC LIFE AND ACC DEATH AND DISMEMBERMENT Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Life insurance
  • Death benefits (include travel accident but not life insurance)
  • Other welfare benefit cover

401k Sponsoring company profile

DENTAL ASSOCIATES FAMILY AND SPECIALITY CARE, LLC has sponsored the creation of one or more 401k plans.

Company Name:DENTAL ASSOCIATES FAMILY AND SPECIALITY CARE, LLC
Employer identification number (EIN):270339413
NAIC Classification:621210
NAIC Description:Offices of Dentists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DENTAL ASSOCIATES BASIC LIFE AND ACC DEATH AND DISMEMBERMENT

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5032022-04-01
5032021-04-01
5032020-04-01
5032019-04-01
5032018-04-01
5032017-04-01PAUL SEUBERT
5032016-04-01PAUL SEUBERT PAUL SEUBERT2017-07-10
5032015-04-01PAUL SEUBERT
5032014-04-01PAUL SEUBERT
5032013-04-01PAUL SEUBERT
5032012-04-01PAUL SEUBERT
5032011-04-01PAUL SEUBERT
5032009-04-01PAUL SEUBERT
5032009-04-01 PAUL SEUBERT2010-07-06

Plan Statistics for DENTAL ASSOCIATES BASIC LIFE AND ACC DEATH AND DISMEMBERMENT

401k plan membership statisitcs for DENTAL ASSOCIATES BASIC LIFE AND ACC DEATH AND DISMEMBERMENT

Measure Date Value
2022: DENTAL ASSOCIATES BASIC LIFE AND ACC DEATH AND DISMEMBERMENT 2022 401k membership
Total participants, beginning-of-year2022-04-01624
Total number of active participants reported on line 7a of the Form 55002022-04-010
Number of retired or separated participants receiving benefits2022-04-010
Number of other retired or separated participants entitled to future benefits2022-04-010
Total of all active and inactive participants2022-04-010
2021: DENTAL ASSOCIATES BASIC LIFE AND ACC DEATH AND DISMEMBERMENT 2021 401k membership
Total participants, beginning-of-year2021-04-01625
Total number of active participants reported on line 7a of the Form 55002021-04-01624
Total of all active and inactive participants2021-04-01624
Total participants2021-04-01624
2020: DENTAL ASSOCIATES BASIC LIFE AND ACC DEATH AND DISMEMBERMENT 2020 401k membership
Total participants, beginning-of-year2020-04-01736
Total number of active participants reported on line 7a of the Form 55002020-04-01637
Total of all active and inactive participants2020-04-01637
Total participants2020-04-01637
2019: DENTAL ASSOCIATES BASIC LIFE AND ACC DEATH AND DISMEMBERMENT 2019 401k membership
Total participants, beginning-of-year2019-04-01703
Total number of active participants reported on line 7a of the Form 55002019-04-01734
Total of all active and inactive participants2019-04-01734
Total participants2019-04-01734
2018: DENTAL ASSOCIATES BASIC LIFE AND ACC DEATH AND DISMEMBERMENT 2018 401k membership
Total participants, beginning-of-year2018-04-01724
Total number of active participants reported on line 7a of the Form 55002018-04-01710
Total of all active and inactive participants2018-04-01710
2017: DENTAL ASSOCIATES BASIC LIFE AND ACC DEATH AND DISMEMBERMENT 2017 401k membership
Total participants, beginning-of-year2017-04-01690
Total number of active participants reported on line 7a of the Form 55002017-04-01728
Total of all active and inactive participants2017-04-01728
2016: DENTAL ASSOCIATES BASIC LIFE AND ACC DEATH AND DISMEMBERMENT 2016 401k membership
Total participants, beginning-of-year2016-04-01662
Total number of active participants reported on line 7a of the Form 55002016-04-01692
Total of all active and inactive participants2016-04-01692
Total participants2016-04-01692
2015: DENTAL ASSOCIATES BASIC LIFE AND ACC DEATH AND DISMEMBERMENT 2015 401k membership
Total participants, beginning-of-year2015-04-01683
Total number of active participants reported on line 7a of the Form 55002015-04-01680
Total of all active and inactive participants2015-04-01680
Total participants2015-04-01680
2014: DENTAL ASSOCIATES BASIC LIFE AND ACC DEATH AND DISMEMBERMENT 2014 401k membership
Total participants, beginning-of-year2014-04-01668
Total number of active participants reported on line 7a of the Form 55002014-04-01682
Total of all active and inactive participants2014-04-01682
Total participants2014-04-01682
2013: DENTAL ASSOCIATES BASIC LIFE AND ACC DEATH AND DISMEMBERMENT 2013 401k membership
Total participants, beginning-of-year2013-04-01664
Total number of active participants reported on line 7a of the Form 55002013-04-01673
Total of all active and inactive participants2013-04-01673
Total participants2013-04-01673
2012: DENTAL ASSOCIATES BASIC LIFE AND ACC DEATH AND DISMEMBERMENT 2012 401k membership
Total participants, beginning-of-year2012-04-01702
Total number of active participants reported on line 7a of the Form 55002012-04-01675
Total of all active and inactive participants2012-04-01675
Total participants2012-04-01675
2011: DENTAL ASSOCIATES BASIC LIFE AND ACC DEATH AND DISMEMBERMENT 2011 401k membership
Total participants, beginning-of-year2011-04-01648
Total number of active participants reported on line 7a of the Form 55002011-04-01702
Total of all active and inactive participants2011-04-01702
Total participants2011-04-01702
2009: DENTAL ASSOCIATES BASIC LIFE AND ACC DEATH AND DISMEMBERMENT 2009 401k membership
Total participants, beginning-of-year2009-04-01651
Total number of active participants reported on line 7a of the Form 55002009-04-01645
Total of all active and inactive participants2009-04-01645
Total participants2009-04-01645

Form 5500 Responses for DENTAL ASSOCIATES BASIC LIFE AND ACC DEATH AND DISMEMBERMENT

2022: DENTAL ASSOCIATES BASIC LIFE AND ACC DEATH AND DISMEMBERMENT 2022 form 5500 responses
2022-04-01Type of plan entitySingle employer plan
2022-04-01Submission has been amendedNo
2022-04-01This submission is the final filingYes
2022-04-01This return/report is a short plan year return/report (less than 12 months)Yes
2022-04-01Plan is a collectively bargained planNo
2022-04-01Plan funding arrangement – InsuranceYes
2022-04-01Plan benefit arrangement – InsuranceYes
2021: DENTAL ASSOCIATES BASIC LIFE AND ACC DEATH AND DISMEMBERMENT 2021 form 5500 responses
2021-04-01Type of plan entitySingle employer plan
2021-04-01Submission has been amendedNo
2021-04-01This submission is the final filingNo
2021-04-01This return/report is a short plan year return/report (less than 12 months)No
2021-04-01Plan is a collectively bargained planNo
2021-04-01Plan funding arrangement – InsuranceYes
2021-04-01Plan benefit arrangement – InsuranceYes
2020: DENTAL ASSOCIATES BASIC LIFE AND ACC DEATH AND DISMEMBERMENT 2020 form 5500 responses
2020-04-01Type of plan entitySingle employer plan
2020-04-01Submission has been amendedNo
2020-04-01This submission is the final filingNo
2020-04-01This return/report is a short plan year return/report (less than 12 months)No
2020-04-01Plan is a collectively bargained planNo
2020-04-01Plan funding arrangement – InsuranceYes
2020-04-01Plan benefit arrangement – InsuranceYes
2019: DENTAL ASSOCIATES BASIC LIFE AND ACC DEATH AND DISMEMBERMENT 2019 form 5500 responses
2019-04-01Type of plan entitySingle employer plan
2019-04-01Submission has been amendedNo
2019-04-01This submission is the final filingNo
2019-04-01This return/report is a short plan year return/report (less than 12 months)No
2019-04-01Plan is a collectively bargained planNo
2019-04-01Plan funding arrangement – InsuranceYes
2019-04-01Plan benefit arrangement – InsuranceYes
2018: DENTAL ASSOCIATES BASIC LIFE AND ACC DEATH AND DISMEMBERMENT 2018 form 5500 responses
2018-04-01Type of plan entitySingle employer plan
2018-04-01Submission has been amendedNo
2018-04-01This submission is the final filingNo
2018-04-01This return/report is a short plan year return/report (less than 12 months)No
2018-04-01Plan is a collectively bargained planNo
2018-04-01Plan funding arrangement – InsuranceYes
2018-04-01Plan benefit arrangement – InsuranceYes
2017: DENTAL ASSOCIATES BASIC LIFE AND ACC DEATH AND DISMEMBERMENT 2017 form 5500 responses
2017-04-01Type of plan entitySingle employer plan
2017-04-01Submission has been amendedNo
2017-04-01This submission is the final filingNo
2017-04-01This return/report is a short plan year return/report (less than 12 months)No
2017-04-01Plan is a collectively bargained planNo
2017-04-01Plan funding arrangement – InsuranceYes
2017-04-01Plan benefit arrangement – InsuranceYes
2016: DENTAL ASSOCIATES BASIC LIFE AND ACC DEATH AND DISMEMBERMENT 2016 form 5500 responses
2016-04-01Type of plan entitySingle employer plan
2016-04-01Submission has been amendedNo
2016-04-01This submission is the final filingNo
2016-04-01This return/report is a short plan year return/report (less than 12 months)No
2016-04-01Plan is a collectively bargained planNo
2016-04-01Plan funding arrangement – InsuranceYes
2016-04-01Plan benefit arrangement – InsuranceYes
2015: DENTAL ASSOCIATES BASIC LIFE AND ACC DEATH AND DISMEMBERMENT 2015 form 5500 responses
2015-04-01Type of plan entitySingle employer plan
2015-04-01Submission has been amendedNo
2015-04-01This submission is the final filingNo
2015-04-01This return/report is a short plan year return/report (less than 12 months)No
2015-04-01Plan is a collectively bargained planNo
2015-04-01Plan funding arrangement – InsuranceYes
2015-04-01Plan benefit arrangement – InsuranceYes
2014: DENTAL ASSOCIATES BASIC LIFE AND ACC DEATH AND DISMEMBERMENT 2014 form 5500 responses
2014-04-01Type of plan entitySingle employer plan
2014-04-01Submission has been amendedNo
2014-04-01This submission is the final filingNo
2014-04-01This return/report is a short plan year return/report (less than 12 months)No
2014-04-01Plan is a collectively bargained planNo
2014-04-01Plan funding arrangement – InsuranceYes
2014-04-01Plan benefit arrangement – InsuranceYes
2013: DENTAL ASSOCIATES BASIC LIFE AND ACC DEATH AND DISMEMBERMENT 2013 form 5500 responses
2013-04-01Type of plan entitySingle employer plan
2013-04-01Submission has been amendedNo
2013-04-01This submission is the final filingNo
2013-04-01This return/report is a short plan year return/report (less than 12 months)No
2013-04-01Plan is a collectively bargained planNo
2013-04-01Plan funding arrangement – InsuranceYes
2013-04-01Plan benefit arrangement – InsuranceYes
2012: DENTAL ASSOCIATES BASIC LIFE AND ACC DEATH AND DISMEMBERMENT 2012 form 5500 responses
2012-04-01Type of plan entitySingle employer plan
2012-04-01First time form 5500 has been submittedYes
2012-04-01Submission has been amendedNo
2012-04-01This submission is the final filingNo
2012-04-01This return/report is a short plan year return/report (less than 12 months)No
2012-04-01Plan is a collectively bargained planNo
2012-04-01Plan funding arrangement – InsuranceYes
2012-04-01Plan benefit arrangement – InsuranceYes
2011: DENTAL ASSOCIATES BASIC LIFE AND ACC DEATH AND DISMEMBERMENT 2011 form 5500 responses
2011-04-01Type of plan entitySingle employer plan
2011-04-01First time form 5500 has been submittedYes
2011-04-01Submission has been amendedNo
2011-04-01This submission is the final filingNo
2011-04-01This return/report is a short plan year return/report (less than 12 months)No
2011-04-01Plan is a collectively bargained planNo
2011-04-01Plan funding arrangement – InsuranceYes
2011-04-01Plan benefit arrangement – InsuranceYes
2009: DENTAL ASSOCIATES BASIC LIFE AND ACC DEATH AND DISMEMBERMENT 2009 form 5500 responses
2009-04-01Type of plan entitySingle employer plan
2009-04-01First time form 5500 has been submittedYes
2009-04-01Submission has been amendedYes
2009-04-01This submission is the final filingNo
2009-04-01This return/report is a short plan year return/report (less than 12 months)No
2009-04-01Plan is a collectively bargained planNo
2009-04-01Plan funding arrangement – InsuranceYes
2009-04-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number309845
Policy instance 1
Insurance contract or identification number309845
Number of Individuals Covered617
Insurance policy start date2022-04-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $15,784
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $115,976
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,784
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number309845
Policy instance 2
Insurance contract or identification number309845
Number of Individuals Covered624
Insurance policy start date2022-01-01
Insurance policy end date2022-03-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&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 CarrierUSD $27,988
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX960436
Policy instance 1
Insurance contract or identification numberFLX960436
Number of Individuals Covered654
Insurance policy start date2021-04-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $4,590
Total amount of fees paid to insurance companyUSD $1,683
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&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 CarrierUSD $45,901
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,590
Amount paid for insurance broker fees1683
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX960436
Policy instance 1
Insurance contract or identification numberFLX960436
Number of Individuals Covered637
Insurance policy start date2020-04-01
Insurance policy end date2021-03-31
Total amount of commissions paid to insurance brokerUSD $2,428
Total amount of fees paid to insurance companyUSD $1,884
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&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 CarrierUSD $24,282
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,428
Amount paid for insurance broker fees1884
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX960436
Policy instance 1
Insurance contract or identification numberFLX960436
Number of Individuals Covered734
Insurance policy start date2019-04-01
Insurance policy end date2020-03-31
Total amount of commissions paid to insurance brokerUSD $6,807
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&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 CarrierUSD $68,074
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,807
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX960436
Policy instance 1
Insurance contract or identification numberFLX960436
Number of Individuals Covered710
Insurance policy start date2018-04-01
Insurance policy end date2019-03-31
Total amount of commissions paid to insurance brokerUSD $6,679
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $66,787
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,679
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX960436
Policy instance 1
Insurance contract or identification numberFLX960436
Number of Individuals Covered728
Insurance policy start date2017-04-01
Insurance policy end date2018-03-31
Total amount of commissions paid to insurance brokerUSD $6,980
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $69,801
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,071
Insurance broker organization code?3
Insurance broker nameHUB INTERNATIONAL MIDWEST
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX960436
Policy instance 1
Insurance contract or identification numberFLX960436
Number of Individuals Covered680
Insurance policy start date2015-04-01
Insurance policy end date2016-04-01
Total amount of commissions paid to insurance brokerUSD $6,469
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $64,688
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,469
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerSALES AND SERVICES
Insurance broker nameHUB INTERNATIONAL MIDWEST
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX960436
Policy instance 1
Insurance contract or identification numberFLX960436
Number of Individuals Covered682
Insurance policy start date2014-04-01
Insurance policy end date2015-04-01
Total amount of commissions paid to insurance brokerUSD $5,410
Total amount of fees paid to insurance companyUSD $895
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $54,103
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,410
Amount paid for insurance broker fees895
Additional information about fees paid to insurance brokerSALES AND SERVICES
Insurance broker nameBURTON CONSULTING DBA LBU
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX 960436
Policy instance 1
Insurance contract or identification numberFLX 960436
Number of Individuals Covered673
Insurance policy start date2013-04-01
Insurance policy end date2014-04-01
Total amount of commissions paid to insurance brokerUSD $3,950
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $49,203
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,344
Insurance broker nameFIRST BENEFITS CORPORATION
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX960436
Policy instance 1
Insurance contract or identification numberFLX960436
Number of Individuals Covered675
Insurance policy start date2012-04-01
Insurance policy end date2013-04-01
Total amount of commissions paid to insurance brokerUSD $3,577
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $57,708
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,577
Additional information about fees paid to insurance brokerSALES AND SERVICES
Insurance broker nameFIRST BENEFITS CORPORATION
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX960436
Policy instance 1
Insurance contract or identification numberFLX960436
Number of Individuals Covered702
Insurance policy start date2011-04-01
Insurance policy end date2012-04-01
Total amount of commissions paid to insurance brokerUSD $3,694
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $69,950
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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