JENCO, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan JENCO, INC.
401k plan membership statisitcs for JENCO, INC.
| Measure | Date | Value |
|---|
| 2022: JENCO, INC. 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-05-01 | 109 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-05-01 | 134 |
| Number of retired or separated participants receiving benefits | 2022-05-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2022-05-01 | 0 |
| Total of all active and inactive participants | 2022-05-01 | 134 |
| Number of employers contributing to the scheme | 2022-05-01 | 0 |
| 2021: JENCO, INC. 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-05-01 | 115 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-05-01 | 109 |
| Number of retired or separated participants receiving benefits | 2021-05-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-05-01 | 0 |
| Total of all active and inactive participants | 2021-05-01 | 109 |
| Number of employers contributing to the scheme | 2021-05-01 | 0 |
| 2020: JENCO, INC. 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-05-01 | 159 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-05-01 | 99 |
| Number of retired or separated participants receiving benefits | 2020-05-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2020-05-01 | 0 |
| Total of all active and inactive participants | 2020-05-01 | 99 |
| Number of employers contributing to the scheme | 2020-05-01 | 0 |
| 2019: JENCO, INC. 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-05-01 | 125 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-05-01 | 159 |
| Number of retired or separated participants receiving benefits | 2019-05-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-05-01 | 0 |
| Total of all active and inactive participants | 2019-05-01 | 159 |
| Number of employers contributing to the scheme | 2019-05-01 | 0 |
| 2018: JENCO, INC. 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-05-01 | 130 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-05-01 | 125 |
| Number of retired or separated participants receiving benefits | 2018-05-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-05-01 | 0 |
| Total of all active and inactive participants | 2018-05-01 | 125 |
| Number of employers contributing to the scheme | 2018-05-01 | 0 |
| 2017: JENCO, INC. 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-05-01 | 103 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-05-01 | 124 |
| Total of all active and inactive participants | 2017-05-01 | 124 |
| 2016: JENCO, INC. 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-05-01 | 84 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-05-01 | 103 |
| Total of all active and inactive participants | 2016-05-01 | 103 |
| 2015: JENCO, INC. 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-05-01 | 110 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-05-01 | 84 |
| Total of all active and inactive participants | 2015-05-01 | 84 |
| 2014: JENCO, INC. 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-05-01 | 150 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-05-01 | 110 |
| Total of all active and inactive participants | 2014-05-01 | 110 |
| 2013: JENCO, INC. 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-05-01 | 209 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-05-01 | 212 |
| Number of retired or separated participants receiving benefits | 2013-05-01 | 2 |
| Number of other retired or separated participants entitled to future benefits | 2013-05-01 | 14 |
| Total of all active and inactive participants | 2013-05-01 | 228 |
| Total participants | 2013-05-01 | 0 |
| 2012: JENCO, INC. 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-05-01 | 272 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-05-01 | 208 |
| Number of retired or separated participants receiving benefits | 2012-05-01 | 5 |
| Number of other retired or separated participants entitled to future benefits | 2012-05-01 | 18 |
| Total of all active and inactive participants | 2012-05-01 | 231 |
| Total participants | 2012-05-01 | 0 |
| 2011: JENCO, INC. 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-05-01 | 272 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-05-01 | 228 |
| Number of retired or separated participants receiving benefits | 2011-05-01 | 4 |
| Number of other retired or separated participants entitled to future benefits | 2011-05-01 | 26 |
| Total of all active and inactive participants | 2011-05-01 | 258 |
| Total participants | 2011-05-01 | 258 |
| 2010: JENCO, INC. 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-05-01 | 200 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-05-01 | 268 |
| Number of retired or separated participants receiving benefits | 2010-05-01 | 4 |
| Total of all active and inactive participants | 2010-05-01 | 272 |
| Total participants | 2010-05-01 | 272 |
| 2009: JENCO, INC. 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-05-01 | 147 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-05-01 | 187 |
| Number of retired or separated participants receiving benefits | 2009-05-01 | 8 |
| Number of other retired or separated participants entitled to future benefits | 2009-05-01 | 5 |
| Total of all active and inactive participants | 2009-05-01 | 200 |
| Total participants | 2009-05-01 | 200 |
| Measure | Date | Value |
|---|
| 2014 : JENCO, INC. 2014 401k financial data |
|---|
| Value of total assets at end of year | 2014-04-30 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2014-04-30 | No |
| Was this plan covered by a fidelity bond | 2014-04-30 | No |
| If this is an individual account plan, was there a blackout period | 2014-04-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2014-04-30 | No |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-04-30 | No |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2014-04-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2014-04-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2014-04-30 | No |
| Value of interest in common/collective trusts at end of year | 2014-04-30 | $0 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2014-04-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2014-04-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2014-04-30 | No |
| Did the plan have assets held for investment | 2014-04-30 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-04-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2014-04-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2014-04-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2014-04-30 | Disclaimer |
| Accountancy firm name | 2014-04-30 | PITTMAN & MURDOUGH |
| Accountancy firm EIN | 2014-04-30 | 860639261 |
| 2013 : JENCO, INC. 2013 401k financial data |
|---|
| Value of total assets at end of year | 2013-04-30 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2013-04-30 | No |
| Was this plan covered by a fidelity bond | 2013-04-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2013-04-30 | No |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-04-30 | No |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2013-04-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2013-04-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2013-04-30 | No |
| Value of interest in common/collective trusts at end of year | 2013-04-30 | $0 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2013-04-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2013-04-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2013-04-30 | No |
| Did the plan have assets held for investment | 2013-04-30 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-04-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2013-04-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2013-04-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2013-04-30 | Disclaimer |
| Accountancy firm name | 2013-04-30 | PITTMAN & MURDOUGH |
| Accountancy firm EIN | 2013-04-30 | 860639261 |
| 2012 : JENCO, INC. 2012 401k financial data |
|---|
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2012-04-30 | No |
| Was this plan covered by a fidelity bond | 2012-04-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2012-04-30 | No |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-04-30 | No |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2012-04-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2012-04-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2012-04-30 | No |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2012-04-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2012-04-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2012-04-30 | No |
| Did the plan have assets held for investment | 2012-04-30 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-04-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2012-04-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2012-04-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2012-04-30 | Disclaimer |
| Accountancy firm name | 2012-04-30 | PITTMAN & MURDOUGH |
| Accountancy firm EIN | 2012-04-30 | 860639261 |
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 10270206 |
| Policy instance | 5 |
| Insurance contract or identification number | 10270206 | | Number of Individuals Covered | 116 | | Insurance policy start date | 2022-05-01 | | Insurance policy end date | 2023-04-30 | | Total amount of commissions paid to insurance broker | USD $14,452 | | Total amount of fees paid to insurance company | USD $5,051 | | 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 | ACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM | | Welfare Benefit Premiums Paid to Carrier | USD $110,692 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,970 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Additional information about fees paid to insurance broker | OVERRIDES, BROKER BONUS |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 175966 |
| Policy instance | 4 |
| Insurance contract or identification number | 175966 | | Number of Individuals Covered | 3 | | Insurance policy start date | 2022-05-01 | | Insurance policy end date | 2023-04-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $765 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $15,557 | | 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 | 765 | | Additional information about fees paid to insurance broker | DIRECT COMPENSATION | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 5395564 |
| Policy instance | 3 |
| Insurance contract or identification number | 5395564 | | Number of Individuals Covered | 190 | | Insurance policy start date | 2022-05-01 | | Insurance policy end date | 2023-04-30 | | Total amount of commissions paid to insurance broker | USD $6,435 | | Total amount of fees paid to insurance company | USD $1,092 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $69,900 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,435 | | Amount paid for insurance broker fees | 1092 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| BANNER HEALTH AND AETNA HEALTH (National Association of Insurance Commissioners NAIC id number: 16058 ) |
| Policy contract number | 175966BH |
| Policy instance | 2 |
| Insurance contract or identification number | 175966BH | | Number of Individuals Covered | 176 | | Insurance policy start date | 2022-05-01 | | Insurance policy end date | 2023-04-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $46,136 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $756,451 | | 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 | 46136 | | Additional information about fees paid to insurance broker | 2022 Q2 BANNER HEALTH JOINT VENTURE INCENTIVE RISK, DIRECT COMPENSATION | | Insurance broker organization code? | 3 |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 887993G |
| Policy instance | 1 |
| Insurance contract or identification number | 887993G | | Number of Individuals Covered | 51 | | Insurance policy start date | 2022-05-01 | | Insurance policy end date | 2023-04-30 | | Total amount of commissions paid to insurance broker | USD $4,348 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | ACCIDENT, CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $24,154 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,348 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 10261169 |
| Policy instance | 3 |
| Insurance contract or identification number | 10261169 | | Number of Individuals Covered | 61 | | Insurance policy start date | 2021-05-01 | | Insurance policy end date | 2022-04-30 | | Total amount of commissions paid to insurance broker | USD $10,818 | | Total amount of fees paid to insurance company | USD $5,031 | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $72,118 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,818 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Additional information about fees paid to insurance broker | OVERRIDES, BROKER BONUS |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 921202 |
| Policy instance | 2 |
| Insurance contract or identification number | 921202 | | Number of Individuals Covered | 109 | | Insurance policy start date | 2021-05-01 | | Insurance policy end date | 2022-04-30 | | Total amount of commissions paid to insurance broker | USD $8,627 | | Total amount of fees paid to insurance company | USD $94,037 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $1,000,391 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,627 | | Amount paid for insurance broker fees | 94037 | | Additional information about fees paid to insurance broker | SERVICE FEE AGREEMENT | | Insurance broker organization code? | 3 |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 887993G |
| Policy instance | 1 |
| Insurance contract or identification number | 887993G | | Number of Individuals Covered | 56 | | Insurance policy start date | 2021-05-01 | | Insurance policy end date | 2022-04-30 | | Total amount of commissions paid to insurance broker | USD $4,402 | | Total amount of fees paid to insurance company | USD $134 | | Other welfare benefits provided | ACCIDENT, CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $24,306 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,402 | | Amount paid for insurance broker fees | 134 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 921202 |
| Policy instance | 1 |
| Insurance contract or identification number | 921202 | | Number of Individuals Covered | 233 | | Insurance policy start date | 2020-05-01 | | Insurance policy end date | 2021-04-30 | | Total amount of commissions paid to insurance broker | USD $9,214 | | Total amount of fees paid to insurance company | USD $47,786 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $1,052,781 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,214 | | Amount paid for insurance broker fees | 47786 | | Additional information about fees paid to insurance broker | SERVICE FEE AGREEMENT | | Insurance broker organization code? | 3 |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 887993G |
| Policy instance | 2 |
| Insurance contract or identification number | 887993G | | Number of Individuals Covered | 76 | | Insurance policy start date | 2020-05-01 | | Insurance policy end date | 2021-04-30 | | Total amount of commissions paid to insurance broker | USD $4,671 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | ACCIDENT, CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $28,314 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,671 | | Insurance broker organization code? | 3 |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 10261169 |
| Policy instance | 3 |
| Insurance contract or identification number | 10261169 | | Number of Individuals Covered | 88 | | Insurance policy start date | 2020-05-01 | | Insurance policy end date | 2021-04-30 | | Total amount of commissions paid to insurance broker | USD $11,205 | | Total amount of fees paid to insurance company | USD $3,735 | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $74,699 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,205 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Additional information about fees paid to insurance broker | OVERRIDE |
|
| AVESIS INSURANCE INCORPORATED (National Association of Insurance Commissioners NAIC id number: 11163 ) |
| Policy contract number | 30781-1003 |
| Policy instance | 1 |
| Insurance contract or identification number | 30781-1003 | | Number of Individuals Covered | 206 | | Insurance policy start date | 2019-05-01 | | Insurance policy end date | 2020-04-30 | | Total amount of commissions paid to insurance broker | USD $1,303 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $13,029 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,303 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 03X7332 |
| Policy instance | 2 |
| Insurance contract or identification number | 03X7332 | | Number of Individuals Covered | 258 | | Insurance policy start date | 2019-05-01 | | Insurance policy end date | 2020-04-30 | | Total amount of commissions paid to insurance broker | USD $54,848 | | Total amount of fees paid to insurance company | USD $764 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $823,994 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $39,140 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Additional information about fees paid to insurance broker | BONUS |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010-045014 |
| Policy instance | 3 |
| Insurance contract or identification number | 010-045014 | | Number of Individuals Covered | 299 | | Insurance policy start date | 2019-05-01 | | Insurance policy end date | 2020-04-30 | | Total amount of commissions paid to insurance broker | USD $6,695 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $66,950 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,695 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 ) |
| Policy contract number | 618539 |
| Policy instance | 4 |
| Insurance contract or identification number | 618539 | | Number of Individuals Covered | 159 | | Insurance policy start date | 2019-05-01 | | Insurance policy end date | 2020-04-30 | | Total amount of commissions paid to insurance broker | USD $12,855 | | Total amount of fees paid to insurance company | USD $33 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $85,884 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $12,855 | | Amount paid for insurance broker fees | 33 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 887993G |
| Policy instance | 5 |
| Insurance contract or identification number | 887993G | | Number of Individuals Covered | 85 | | Insurance policy start date | 2019-05-01 | | Insurance policy end date | 2020-04-30 | | Total amount of commissions paid to insurance broker | USD $4,001 | | Total amount of fees paid to insurance company | USD $1,136 | | Other welfare benefits provided | ACCIDENT, CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $26,677 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,001 | | Amount paid for insurance broker fees | 1136 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 750654 |
| Policy instance | 4 |
| Insurance contract or identification number | 750654 | | Number of Individuals Covered | 130 | | Insurance policy start date | 2018-05-01 | | Insurance policy end date | 2019-04-30 | | Total amount of commissions paid to insurance broker | USD $5,254 | | Total amount of fees paid to insurance company | USD $8 | | 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 | ACCIDENTAL DEATH AND DISMEMBERMENT,ACCIDENT, CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $35,869 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,578 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION |
|
| AVESIS INSURANCE INCORPORATED (National Association of Insurance Commissioners NAIC id number: 11163 ) |
| Policy contract number | 30781-1003 |
| Policy instance | 3 |
| Insurance contract or identification number | 30781-1003 | | Number of Individuals Covered | 148 | | Insurance policy start date | 2018-05-01 | | Insurance policy end date | 2019-04-30 | | Total amount of commissions paid to insurance broker | USD $734 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $7,343 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $734 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010-045014 |
| Policy instance | 2 |
| Insurance contract or identification number | 010-045014 | | Number of Individuals Covered | 215 | | Insurance policy start date | 2018-05-01 | | Insurance policy end date | 2019-04-30 | | Total amount of commissions paid to insurance broker | USD $4,773 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $47,730 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,773 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 03X7332 |
| Policy instance | 1 |
| Insurance contract or identification number | 03X7332 | | Number of Individuals Covered | 182 | | Insurance policy start date | 2018-05-01 | | Insurance policy end date | 2019-04-30 | | Total amount of commissions paid to insurance broker | USD $37,814 | | Total amount of fees paid to insurance company | USD $318 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $556,640 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $26,440 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Additional information about fees paid to insurance broker | BONUS |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 10-045014 |
| Policy instance | 3 |
| Insurance contract or identification number | 10-045014 | | Number of Individuals Covered | 180 | | Insurance policy start date | 2017-05-01 | | Insurance policy end date | 2018-04-30 | | Total amount of commissions paid to insurance broker | USD $4,250 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $42,499 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 750645 |
| Policy instance | 2 |
| Insurance contract or identification number | 750645 | | Number of Individuals Covered | 124 | | Insurance policy start date | 2017-05-01 | | Insurance policy end date | 2018-04-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $987 | | Health Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $8,441 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 3X7332 |
| Policy instance | 1 |
| Insurance contract or identification number | 3X7332 | | Number of Individuals Covered | 103 | | Insurance policy start date | 2017-05-01 | | Insurance policy end date | 2018-04-30 | | Total amount of commissions paid to insurance broker | USD $32,666 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $591,275 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 00613401 |
| Policy instance | 1 |
| Insurance contract or identification number | 00613401 | | Number of Individuals Covered | 84 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $21,592 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $170,749 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $17,807 | | Insurance broker organization code? | 3 | | Insurance broker name | EMPLOYEE BENEFITS INTERNATIONAL INC |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 750645 |
| Policy instance | 2 |
| Insurance contract or identification number | 750645 | | Number of Individuals Covered | 85 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $2,312 | | Total amount of fees paid to insurance company | USD $80 | | Health Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,179 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,890 | | Amount paid for insurance broker fees | 80 | | Insurance broker organization code? | 3 | | Insurance broker name | EMPLOYEE BENEFITS INTERNATIONAL INC |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 10128331 |
| Policy instance | 1 |
| Insurance contract or identification number | 10128331 | | Number of Individuals Covered | 102 | | Insurance policy start date | 2014-05-01 | | Insurance policy end date | 2015-04-30 | | Total amount of commissions paid to insurance broker | USD $574 | | Total amount of fees paid to insurance company | USD $153 | | 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 $4,286 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $289 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 153 | | Insurance broker name | EXPRESSLINK GENERAL AGENCY LLC |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 744436 |
| Policy instance | 2 |
| Insurance contract or identification number | 744436 | | Number of Individuals Covered | 143 | | Insurance policy start date | 2014-05-01 | | Insurance policy end date | 2015-04-30 | | Total amount of commissions paid to insurance broker | USD $7,462 | | Total amount of fees paid to insurance company | USD $17,629 | | 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 $587,635 | | 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 | 9212 | | Additional information about fees paid to insurance broker | SERVICE FEE AGREEMENTSERVICE FEE AGREEMENT | | Insurance broker organization code? | 3 | | Insurance broker name | BLACK GOULD & ASSOCIATES INC |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | 1047262 |
| Policy instance | 4 |
| Insurance contract or identification number | 1047262 | | Number of Individuals Covered | 153 | | Insurance policy start date | 2014-10-01 | | Insurance policy end date | 2015-04-30 | | Total amount of commissions paid to insurance broker | USD $1,433 | | 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 $30,838 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,433 | | Insurance broker organization code? | 3 | | Insurance broker name | EMPLOYEE BENEFITS INTERNATIONAL INC |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | H09306 |
| Policy instance | 3 |
| Insurance contract or identification number | H09306 | | Number of Individuals Covered | 208 | | Insurance policy start date | 2014-05-01 | | Insurance policy end date | 2014-09-30 | | Total amount of commissions paid to insurance broker | USD $1,191 | | 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 $20,855 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $887 | | Insurance broker organization code? | 3 | | Insurance broker name | EMPLOYEE BENEFITS INTERNATIONAL INC |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 744436 |
| Policy instance | 1 |
| Insurance contract or identification number | 744436 | | Number of Individuals Covered | 239 | | Insurance policy start date | 2013-05-01 | | Insurance policy end date | 2014-04-30 | | Total amount of commissions paid to insurance broker | USD $-59 | | Total amount of fees paid to insurance company | USD $24,720 | | 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 $-59 | | Amount paid for insurance broker fees | 18472 | | Additional information about fees paid to insurance broker | SERVICE FEE AGREEMENT | | Insurance broker organization code? | 3 | | Insurance broker name | DHR INSURANCE SERVICES, LLC |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010128331 |
| Policy instance | 3 |
| Insurance contract or identification number | 000010128331 | | Number of Individuals Covered | 147 | | Insurance policy start date | 2013-05-01 | | Insurance policy end date | 2014-04-30 | | Total amount of commissions paid to insurance broker | USD $645 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability 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 $645 | | Insurance broker organization code? | 3 | | Insurance broker name | DHR INSURANCE SERVICES LLC |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | H9306 |
| Policy instance | 2 |
| Insurance contract or identification number | H9306 | | Number of Individuals Covered | 255 | | Insurance policy start date | 2013-05-01 | | Insurance policy end date | 2014-04-30 | | Total amount of commissions paid to insurance broker | USD $2,846 | | 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 $1,423 | | Insurance broker organization code? | 3 | | Insurance broker name | BLACK GOULD & ASSOCIATES |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | H9306 |
| Policy instance | 2 |
| Insurance contract or identification number | H9306 | | Number of Individuals Covered | 251 | | Insurance policy start date | 2012-05-01 | | Insurance policy end date | 2013-04-30 | | Total amount of commissions paid to insurance broker | USD $3,582 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $76,083 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,582 | | Insurance broker organization code? | 3 | | Insurance broker name | DHR INSURANCE SERVICES, LLC |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010128331 |
| Policy instance | 1 |
| Insurance contract or identification number | 000010128331 | | Number of Individuals Covered | 143 | | Insurance policy start date | 2012-05-01 | | Insurance policy end date | 2013-04-30 | | Total amount of commissions paid to insurance broker | USD $560 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,169 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $560 | | Insurance broker organization code? | 3 | | Insurance broker name | DHR INSURANCE SERVICES LLC |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 744436 |
| Policy instance | 3 |
| Insurance contract or identification number | 744436 | | Number of Individuals Covered | 231 | | Insurance policy start date | 2012-05-01 | | Insurance policy end date | 2013-04-30 | | Total amount of commissions paid to insurance broker | USD $24,917 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $830,576 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $24,917 | | Insurance broker organization code? | 3 | | Insurance broker name | DHR INSURANCE SERVICES, LLC |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | H9306 |
| Policy instance | 1 |
| Insurance contract or identification number | H9306 | | Number of Individuals Covered | 291 | | Insurance policy start date | 2011-05-01 | | Insurance policy end date | 2012-04-30 | | Total amount of commissions paid to insurance broker | USD $3,684 | | Total amount of fees paid to insurance company | USD $1,132 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $79,449 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 482214 |
| Policy instance | 2 |
| Insurance contract or identification number | 482214 | | Number of Individuals Covered | 213 | | Insurance policy start date | 2011-05-01 | | Insurance policy end date | 2012-04-30 | | Total amount of commissions paid to insurance broker | USD $25,197 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $749,517 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 482214 |
| Policy instance | 1 |
| Insurance contract or identification number | 482214 | | Number of Individuals Covered | 272 | | Insurance policy start date | 2010-05-01 | | Insurance policy end date | 2011-04-30 | | Total amount of commissions paid to insurance broker | USD $23,227 | | 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 | Yes | | 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 $772,882 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | H9306 |
| Policy instance | 2 |
| Insurance contract or identification number | H9306 | | Number of Individuals Covered | 122 | | Insurance policy start date | 2010-05-01 | | Insurance policy end date | 2011-04-30 | | Total amount of commissions paid to insurance broker | USD $3,452 | | 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 | Yes | | 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 $71,710 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | H09306 |
| Policy instance | 2 |
| Insurance contract or identification number | H09306 | | Number of Individuals Covered | 102 | | Insurance policy start date | 2009-05-01 | | Insurance policy end date | 2010-04-30 | | Total amount of commissions paid to insurance broker | USD $3,638 | | 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 | Yes | | 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 | | 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 $67,580 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,638 | | Insurance broker organization code? | 3 | | Insurance broker name | DHR INSURANCE SERVICES, LLC |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 482214 |
| Policy instance | 1 |
| Insurance contract or identification number | 482214 | | Number of Individuals Covered | 190 | | Insurance policy start date | 2009-05-01 | | Insurance policy end date | 2010-04-30 | | Total amount of commissions paid to insurance broker | USD $17,660 | | 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 | Yes | | 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 $549,645 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $16,415 | | Insurance broker organization code? | 3 | | Insurance broker name | BENEFIT ADVISORS INC |
|
