EPISCOPAL RETIREMENT HOMES, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan EPISCOPAL RETIREMENT HOMES, INC. SELECTIVE BENEFITS PLAN
401k plan membership statisitcs for EPISCOPAL RETIREMENT HOMES, INC. SELECTIVE BENEFITS PLAN
2022: EPISCOPAL RETIREMENT HOMES, INC. SELECTIVE BENEFITS PLAN 2022 form 5500 responses |
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2022-01-01 | Type of plan entity | Single employer plan |
2022-01-01 | Submission has been amended | No |
2022-01-01 | This submission is the final filing | No |
2022-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2022-01-01 | Plan is a collectively bargained plan | No |
2022-01-01 | Plan funding arrangement – Insurance | Yes |
2022-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2022-01-01 | Plan benefit arrangement – Insurance | Yes |
2022-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2021: EPISCOPAL RETIREMENT HOMES, INC. SELECTIVE BENEFITS PLAN 2021 form 5500 responses |
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2021-01-01 | Type of plan entity | Single employer plan |
2021-01-01 | Submission has been amended | No |
2021-01-01 | This submission is the final filing | No |
2021-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2021-01-01 | Plan is a collectively bargained plan | No |
2021-01-01 | Plan funding arrangement – Insurance | Yes |
2021-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2021-01-01 | Plan benefit arrangement – Insurance | Yes |
2021-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2020: EPISCOPAL RETIREMENT HOMES, INC. SELECTIVE BENEFITS PLAN 2020 form 5500 responses |
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2020-01-01 | Type of plan entity | Single employer plan |
2020-01-01 | Submission has been amended | No |
2020-01-01 | This submission is the final filing | No |
2020-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2020-01-01 | Plan is a collectively bargained plan | No |
2020-01-01 | Plan funding arrangement – Insurance | Yes |
2020-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2020-01-01 | Plan benefit arrangement – Insurance | Yes |
2020-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2019: EPISCOPAL RETIREMENT HOMES, INC. SELECTIVE BENEFITS PLAN 2019 form 5500 responses |
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2019-01-01 | Type of plan entity | Single employer plan |
2019-01-01 | Submission has been amended | No |
2019-01-01 | This submission is the final filing | No |
2019-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2019-01-01 | Plan is a collectively bargained plan | No |
2019-01-01 | Plan funding arrangement – Insurance | Yes |
2019-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2019-01-01 | Plan benefit arrangement – Insurance | Yes |
2019-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2018: EPISCOPAL RETIREMENT HOMES, INC. SELECTIVE BENEFITS PLAN 2018 form 5500 responses |
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2018-01-01 | Type of plan entity | Single employer plan |
2018-01-01 | Submission has been amended | No |
2018-01-01 | This submission is the final filing | No |
2018-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2018-01-01 | Plan is a collectively bargained plan | No |
2018-01-01 | Plan funding arrangement – Insurance | Yes |
2018-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2018-01-01 | Plan benefit arrangement – Insurance | Yes |
2018-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2017: EPISCOPAL RETIREMENT HOMES, INC. SELECTIVE BENEFITS PLAN 2017 form 5500 responses |
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2017-01-01 | Type of plan entity | Single employer plan |
2017-01-01 | Submission has been amended | No |
2017-01-01 | This submission is the final filing | No |
2017-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2017-01-01 | Plan is a collectively bargained plan | No |
2017-01-01 | Plan funding arrangement – Insurance | Yes |
2017-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2017-01-01 | Plan benefit arrangement – Insurance | Yes |
2017-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2016: EPISCOPAL RETIREMENT HOMES, INC. SELECTIVE BENEFITS PLAN 2016 form 5500 responses |
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2016-01-01 | Type of plan entity | Single employer plan |
2016-01-01 | First time form 5500 has been submitted | Yes |
2016-01-01 | Plan is a collectively bargained plan | Yes |
2016-01-01 | Plan funding arrangement – Insurance | Yes |
2016-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2016-01-01 | Plan benefit arrangement – Insurance | Yes |
2016-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2015: EPISCOPAL RETIREMENT HOMES, INC. SELECTIVE BENEFITS PLAN 2015 form 5500 responses |
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2015-01-01 | Type of plan entity | Single employer plan |
2015-01-01 | First time form 5500 has been submitted | Yes |
2015-01-01 | Plan is a collectively bargained plan | Yes |
2015-01-01 | Plan funding arrangement – Insurance | Yes |
2015-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2015-01-01 | Plan benefit arrangement – Insurance | Yes |
2015-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2011: EPISCOPAL RETIREMENT HOMES, INC. SELECTIVE BENEFITS PLAN 2011 form 5500 responses |
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2011-01-01 | Type of plan entity | Single employer plan |
2011-01-01 | Plan is a collectively bargained plan | Yes |
2011-01-01 | Plan funding arrangement – Insurance | Yes |
2011-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2011-01-01 | Plan benefit arrangement – Insurance | Yes |
2011-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2009: EPISCOPAL RETIREMENT HOMES, INC. SELECTIVE BENEFITS PLAN 2009 form 5500 responses |
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2009-01-01 | Type of plan entity | Single employer plan |
2009-01-01 | Plan funding arrangement – Insurance | Yes |
2009-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2009-01-01 | Plan benefit arrangement – Insurance | Yes |
2009-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
DELTA DENTAL OF KENTUCKY (National Association of Insurance Commissioners NAIC id number: 54674 ) |
Policy contract number | DU8024 |
Policy instance | 2 |
Insurance contract or identification number | DU8024 | Number of Individuals Covered | 366 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $2,785 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,785 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
Policy contract number | 895386G |
Policy instance | 1 |
Insurance contract or identification number | 895386G | Number of Individuals Covered | 327 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $21,011 | Total amount of fees paid to insurance company | USD $1,684 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D, CRITICAL ILLNESS, ACCIDENT | Welfare Benefit Premiums Paid to Carrier | USD $130,964 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $21,011 | Amount paid for insurance broker fees | 1684 | Additional information about fees paid to insurance broker | BONUS PAID | Insurance broker organization code? | 3 |
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EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 98942471001 |
Policy instance | 3 |
Insurance contract or identification number | 98942471001 | Number of Individuals Covered | 353 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $2,370 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $25,450 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,370 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | SGM601210 |
Policy instance | 4 |
Insurance contract or identification number | SGM601210 | Number of Individuals Covered | 343 | Insurance policy start date | 2020-03-01 | Insurance policy end date | 2021-02-28 | Total amount of commissions paid to insurance broker | USD $1,832 | Total amount of fees paid to insurance company | USD $161 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $21,673 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,832 | Amount paid for insurance broker fees | 161 | Additional information about fees paid to insurance broker | OVERRIDE | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GLTD091F4 |
Policy instance | 1 |
Insurance contract or identification number | GLTD091F4 | Number of Individuals Covered | 2 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $0 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GVTL091F4 |
Policy instance | 2 |
Insurance contract or identification number | GVTL091F4 | Number of Individuals Covered | 17 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $1,368 | Total amount of fees paid to insurance company | USD $580 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $9,123 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,368 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Additional information about fees paid to insurance broker | OTHER COMPENSATION |
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DELTA DENTAL OF KENTUCKY (National Association of Insurance Commissioners NAIC id number: 54674 ) |
Policy contract number | DU8024 |
Policy instance | 3 |
Insurance contract or identification number | DU8024 | Number of Individuals Covered | 404 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $4,197 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,197 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 98942471001 |
Policy instance | 5 |
Insurance contract or identification number | 98942471001 | Number of Individuals Covered | 395 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $2,098 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $20,652 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,098 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
Policy contract number | 0008463884 |
Policy instance | 6 |
Insurance contract or identification number | 0008463884 | Number of Individuals Covered | 60 | Insurance policy start date | 2020-05-01 | Insurance policy end date | 2021-04-30 | Total amount of commissions paid to insurance broker | USD $629 | Total amount of fees paid to insurance company | USD $63 | Temporary Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENT | Welfare Benefit Premiums Paid to Carrier | USD $17,437 | 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 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION PAID |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 136923 |
Policy instance | 7 |
Insurance contract or identification number | 136923 | Number of Individuals Covered | 63 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $3,386 | Total amount of fees paid to insurance company | USD $452 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $22,576 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,386 | Amount paid for insurance broker fees | 452 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION PAID | Insurance broker organization code? | 3 |
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LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | SGD601086 |
Policy instance | 8 |
Insurance contract or identification number | SGD601086 | Number of Individuals Covered | 320 | Insurance policy start date | 2020-03-01 | Insurance policy end date | 2021-02-28 | Total amount of commissions paid to insurance broker | USD $2,958 | Total amount of fees paid to insurance company | USD $244 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $28,430 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,958 | Amount paid for insurance broker fees | 244 | Additional information about fees paid to insurance broker | OVERRIDE | Insurance broker organization code? | 3 |
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LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | SOK600642 |
Policy instance | 9 |
Insurance contract or identification number | SOK600642 | Number of Individuals Covered | 343 | Insurance policy start date | 2020-03-01 | Insurance policy end date | 2021-02-28 | Total amount of commissions paid to insurance broker | USD $301 | Total amount of fees paid to insurance company | USD $20 | Other welfare benefits provided | ACCIDENTAL DEATH | Welfare Benefit Premiums Paid to Carrier | USD $2,504 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $301 | Amount paid for insurance broker fees | 20 | Additional information about fees paid to insurance broker | OVERRIDE | Insurance broker organization code? | 3 |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | R0219139 |
Policy instance | 10 |
Insurance contract or identification number | R0219139 | Number of Individuals Covered | 15 | Insurance policy start date | 2020-05-01 | Insurance policy end date | 2021-04-30 | Total amount of commissions paid to insurance broker | USD $220 | Total amount of fees paid to insurance company | USD $16 | Other welfare benefits provided | GROUP CRITICAL ILLNESS | Welfare Benefit Premiums Paid to Carrier | USD $3,081 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION PAID |
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LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | SGM601210 |
Policy instance | 3 |
Insurance contract or identification number | SGM601210 | Number of Individuals Covered | 461 | Insurance policy start date | 2019-03-01 | Insurance policy end date | 2020-02-28 | Total amount of commissions paid to insurance broker | USD $2,469 | Total amount of fees paid to insurance company | USD $527 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $29,380 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,469 | Amount paid for insurance broker fees | 527 | Additional information about fees paid to insurance broker | OVERRIDE | Insurance broker organization code? | 3 |
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EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 98942471001 |
Policy instance | 2 |
Insurance contract or identification number | 98942471001 | Number of Individuals Covered | 465 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $3,025 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $33,654 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,025 | Insurance broker organization code? | 3 |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 136923 |
Policy instance | 1 |
Insurance contract or identification number | 136923 | Number of Individuals Covered | 50 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $2,789 | Total amount of fees paid to insurance company | USD $372 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $17,125 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,789 | Amount paid for insurance broker fees | 372 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION PAID | Insurance broker organization code? | 3 |
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LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | SOK600642 |
Policy instance | 7 |
Insurance contract or identification number | SOK600642 | Number of Individuals Covered | 461 | Insurance policy start date | 2019-03-01 | Insurance policy end date | 2020-02-28 | Total amount of commissions paid to insurance broker | USD $407 | Total amount of fees paid to insurance company | USD $61 | Other welfare benefits provided | ACCIDENTAL DEATH | Welfare Benefit Premiums Paid to Carrier | USD $3,395 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $407 | Amount paid for insurance broker fees | 61 | Additional information about fees paid to insurance broker | OVERRIDE | Insurance broker organization code? | 3 |
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LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | SGD601086 |
Policy instance | 4 |
Insurance contract or identification number | SGD601086 | Number of Individuals Covered | 376 | Insurance policy start date | 2019-03-01 | Insurance policy end date | 2020-02-28 | Total amount of commissions paid to insurance broker | USD $4,039 | Total amount of fees paid to insurance company | USD $721 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $40,774 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,039 | Amount paid for insurance broker fees | 721 | Additional information about fees paid to insurance broker | OVERRIDE | Insurance broker organization code? | 3 |
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DELTA DENTAL OF KENTUCKY (National Association of Insurance Commissioners NAIC id number: 54674 ) |
Policy contract number | DU8024 |
Policy instance | 5 |
Insurance contract or identification number | DU8024 | Number of Individuals Covered | 480 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $4,201 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,201 | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GVTL091F4 |
Policy instance | 6 |
Insurance contract or identification number | GVTL091F4 | Number of Individuals Covered | 29 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $1,934 | Total amount of fees paid to insurance company | USD $595 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $12,892 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,934 | Amount paid for insurance broker fees | 595 | Additional information about fees paid to insurance broker | OTHER COMPANSATION | Insurance broker organization code? | 3 |
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PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
Policy contract number | 0008463884 |
Policy instance | 8 |
Insurance contract or identification number | 0008463884 | Number of Individuals Covered | 64 | Insurance policy start date | 2019-05-01 | Insurance policy end date | 2020-04-30 | Total amount of commissions paid to insurance broker | USD $1,144 | Total amount of fees paid to insurance company | USD $135 | Temporary Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENT | Welfare Benefit Premiums Paid to Carrier | USD $18,762 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $51 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 135 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION PAID |
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PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 127605 |
Policy instance | 9 |
Insurance contract or identification number | 127605 | Number of Individuals Covered | 4 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $82 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | LEGAL SERVICES PLAN MEMBERSHIPS | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $82 | Insurance broker organization code? | 4 |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 0008463884 |
Policy instance | 10 |
Insurance contract or identification number | 0008463884 | Number of Individuals Covered | 19 | Insurance policy start date | 2019-05-01 | Insurance policy end date | 2020-04-30 | Total amount of commissions paid to insurance broker | USD $300 | Total amount of fees paid to insurance company | USD $19 | Other welfare benefits provided | GROUP CRITICAL ILLNESS | Welfare Benefit Premiums Paid to Carrier | USD $4,389 | 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 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 19 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION PAID |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | R0219139 |
Policy instance | 11 |
Insurance contract or identification number | R0219139 | Number of Individuals Covered | 19 | Insurance policy start date | 2018-05-01 | Insurance policy end date | 2019-04-30 | Total amount of commissions paid to insurance broker | USD $358 | Total amount of fees paid to insurance company | USD $27 | Other welfare benefits provided | GROUP CRITICAL ILLNESS | Welfare Benefit Premiums Paid to Carrier | USD $5,085 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $28 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 27 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION PAID |
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PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 127605 |
Policy instance | 10 |
Insurance contract or identification number | 127605 | Number of Individuals Covered | 6 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $117 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | LEGAL SERVICES PLAN MEMBERSHIPS | Welfare Benefit Premiums Paid to Carrier | USD $1,231 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $88 | Insurance broker organization code? | 4 |
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PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
Policy contract number | 0008463884 |
Policy instance | 9 |
Insurance contract or identification number | 0008463884 | Number of Individuals Covered | 65 | Insurance policy start date | 2018-05-01 | Insurance policy end date | 2019-04-30 | Total amount of commissions paid to insurance broker | USD $968 | Total amount of fees paid to insurance company | USD $106 | Temporary Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENT | Welfare Benefit Premiums Paid to Carrier | USD $21,381 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $78 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 106 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION PAID |
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LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | SOK600642 |
Policy instance | 8 |
Insurance contract or identification number | SOK600642 | Number of Individuals Covered | 421 | Insurance policy start date | 2018-03-01 | Insurance policy end date | 2019-02-28 | Total amount of commissions paid to insurance broker | USD $488 | Total amount of fees paid to insurance company | USD $25 | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $4,063 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $488 | Amount paid for insurance broker fees | 18 | Additional information about fees paid to insurance broker | OVERRIDE | Insurance broker organization code? | 3 |
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COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E3313046 |
Policy instance | 7 |
Insurance contract or identification number | E3313046 | Number of Individuals Covered | 2 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $4 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $0 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2 | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GVTL091F4 |
Policy instance | 6 |
Insurance contract or identification number | GVTL091F4 | Number of Individuals Covered | 35 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $1,984 | Total amount of fees paid to insurance company | USD $721 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $13,223 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,984 | Amount paid for insurance broker fees | 721 | Insurance broker organization code? | 3 |
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DELTA DENTAL OF KENTUCKY (National Association of Insurance Commissioners NAIC id number: 54674 ) |
Policy contract number | DU8024 |
Policy instance | 5 |
Insurance contract or identification number | DU8024 | Number of Individuals Covered | 493 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $4,677 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,677 | Insurance broker organization code? | 3 |
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LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | SGD601086 |
Policy instance | 4 |
Insurance contract or identification number | SGD601086 | Number of Individuals Covered | 356 | Insurance policy start date | 2018-03-01 | Insurance policy end date | 2019-02-28 | Total amount of commissions paid to insurance broker | USD $4,404 | Total amount of fees paid to insurance company | USD $293 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $48,072 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,404 | Amount paid for insurance broker fees | 212 | Additional information about fees paid to insurance broker | OVERRIDE | Insurance broker organization code? | 3 |
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LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | SGM601210 |
Policy instance | 3 |
Insurance contract or identification number | SGM601210 | Number of Individuals Covered | 421 | Insurance policy start date | 2018-03-01 | Insurance policy end date | 2019-02-28 | Total amount of commissions paid to insurance broker | USD $2,758 | Total amount of fees paid to insurance company | USD $211 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $35,164 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,758 | Amount paid for insurance broker fees | 153 | Additional information about fees paid to insurance broker | OVERRIDE | Insurance broker organization code? | 3 |
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EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 98942471001 |
Policy instance | 2 |
Insurance contract or identification number | 98942471001 | Number of Individuals Covered | 465 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $2,811 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $28,179 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,811 | Insurance broker organization code? | 3 |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 136923 |
Policy instance | 1 |
Insurance contract or identification number | 136923 | Number of Individuals Covered | 47 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $2,681 | Total amount of fees paid to insurance company | USD $357 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $17,722 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,681 | Amount paid for insurance broker fees | 357 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION PAID | Insurance broker organization code? | 3 |
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LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | SOK600642 |
Policy instance | 8 |
Insurance contract or identification number | SOK600642 | Number of Individuals Covered | 431 | Insurance policy start date | 2017-03-01 | Insurance policy end date | 2018-02-28 | Total amount of commissions paid to insurance broker | USD $488 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $3,726 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $245 | Insurance broker organization code? | 3 |
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PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
Policy contract number | 0008463884 |
Policy instance | 9 |
Insurance contract or identification number | 0008463884 | Number of Individuals Covered | 62 | Insurance policy start date | 2017-05-01 | Insurance policy end date | 2018-04-30 | Total amount of commissions paid to insurance broker | USD $1,613 | Total amount of fees paid to insurance company | USD $249 | Temporary Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENT | Welfare Benefit Premiums Paid to Carrier | USD $20,777 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,028 | Amount paid for insurance broker fees | 122 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION PAID | Insurance broker organization code? | 3 |
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PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 127605 |
Policy instance | 10 |
Insurance contract or identification number | 127605 | Number of Individuals Covered | 7 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $192 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | LEGAL SERVICES PLAN MEMBERSHIPS | Welfare Benefit Premiums Paid to Carrier | USD $1,328 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $163 | Insurance broker organization code? | 4 |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | R0219139 |
Policy instance | 11 |
Insurance contract or identification number | R0219139 | Number of Individuals Covered | 20 | Insurance policy start date | 2017-05-01 | Insurance policy end date | 2018-04-30 | Total amount of commissions paid to insurance broker | USD $432 | Total amount of fees paid to insurance company | USD $114 | Other welfare benefits provided | GROUP CRITICAL ILLNESS | Welfare Benefit Premiums Paid to Carrier | USD $5,008 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $202 | Amount paid for insurance broker fees | 21 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION PAID | Insurance broker organization code? | 3 |
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COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E3313046 |
Policy instance | 7 |
Insurance contract or identification number | E3313046 | Number of Individuals Covered | 2 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $79 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,137 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $32 | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G00091F4 |
Policy instance | 6 |
Insurance contract or identification number | G00091F4 | Number of Individuals Covered | 45 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $2,404 | Total amount of fees paid to insurance company | USD $854 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $16,025 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,404 | Amount paid for insurance broker fees | 854 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
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DELTA DENTAL OF KENTUCKY (National Association of Insurance Commissioners NAIC id number: 54674 ) |
Policy contract number | DU8024 |
Policy instance | 5 |
Insurance contract or identification number | DU8024 | Number of Individuals Covered | 488 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $3,822 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,822 | Insurance broker organization code? | 3 |
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LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | SGD601086 |
Policy instance | 4 |
Insurance contract or identification number | SGD601086 | Number of Individuals Covered | 373 | Insurance policy start date | 2017-03-01 | Insurance policy end date | 2018-02-28 | Total amount of commissions paid to insurance broker | USD $4,439 | Total amount of fees paid to insurance company | USD $0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $44,733 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,201 | Insurance broker organization code? | 3 |
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LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | SGM601210 |
Policy instance | 3 |
Insurance contract or identification number | SGM601210 | Number of Individuals Covered | 431 | Insurance policy start date | 2017-03-01 | Insurance policy end date | 2018-02-28 | Total amount of commissions paid to insurance broker | USD $2,816 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $32,245 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,737 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 98942471001 |
Policy instance | 2 |
Insurance contract or identification number | 98942471001 | Number of Individuals Covered | 444 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $3,042 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $28,789 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,042 | Insurance broker organization code? | 3 |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 136923 |
Policy instance | 1 |
Insurance contract or identification number | 136923 | Number of Individuals Covered | 44 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $2,451 | Total amount of fees paid to insurance company | USD $327 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $17,958 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,451 | Amount paid for insurance broker fees | 327 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION PAID | Insurance broker organization code? | 3 |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 136923 |
Policy instance | 2 |
Insurance contract or identification number | 136923 | Number of Individuals Covered | 30 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $1,456 | Total amount of fees paid to insurance company | USD $132 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $8,947 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $199 | Amount paid for insurance broker fees | 27 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | HORAN ASSOC INC |
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DENTAL CARE PLUS, INC. (National Association of Insurance Commissioners NAIC id number: 96265 ) |
Policy contract number | 6676201 6676501 |
Policy instance | 1 |
Insurance contract or identification number | 6676201 6676501 | Number of Individuals Covered | 315 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $6,112 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,397 | Insurance broker organization code? | 3 | Insurance broker name | HORAN & ASSOCIATES |
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EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 98942471001 |
Policy instance | 3 |
Insurance contract or identification number | 98942471001 | Number of Individuals Covered | 367 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $2,104 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $25,039 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,104 | Insurance broker organization code? | 3 | Insurance broker name | HORAN ASSOCIATES & HORAN SECURITIES |
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LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | SGM601210 |
Policy instance | 4 |
Insurance contract or identification number | SGM601210 | Number of Individuals Covered | 431 | Insurance policy start date | 2016-03-01 | Insurance policy end date | 2017-02-28 | Total amount of commissions paid to insurance broker | USD $2,100 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $22,860 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,100 | Insurance broker organization code? | 3 | Insurance broker name | CORNERSTONE BROKER |
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LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | SGD601086 |
Policy instance | 5 |
Insurance contract or identification number | SGD601086 | Number of Individuals Covered | 373 | Insurance policy start date | 2016-03-01 | Insurance policy end date | 2017-02-28 | Total amount of commissions paid to insurance broker | USD $3,578 | Total amount of fees paid to insurance company | USD $0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $31,579 | 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 | Insurance broker organization code? | 3 | Insurance broker name | CORNERSTONE BROKER |
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DELTA DENTAL OF KENTUCKY (National Association of Insurance Commissioners NAIC id number: 54674 ) |
Policy contract number | DU8024 |
Policy instance | 6 |
Insurance contract or identification number | DU8024 | Number of Individuals Covered | 129 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $2,453 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,336 | Insurance broker organization code? | 3 | Insurance broker name | LOCKTON COMPANIES |
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COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E3313046 |
Policy instance | 7 |
Insurance contract or identification number | E3313046 | Number of Individuals Covered | 4 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $121 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,759 | 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 | Insurance broker organization code? | 3 | Insurance broker name | BEYLAND CONSULTANTS INC |
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LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | SOK600642 |
Policy instance | 8 |
Insurance contract or identification number | SOK600642 | Number of Individuals Covered | 431 | Insurance policy start date | 2016-03-01 | Insurance policy end date | 2017-02-28 | Total amount of commissions paid to insurance broker | USD $317 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $2,642 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $317 | Insurance broker organization code? | 3 | Insurance broker name | CORNERSTONE BROKER |
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DENTAL CARE PLUS, INC. (National Association of Insurance Commissioners NAIC id number: 96265 ) |
Policy contract number | 6676201&6676501 |
Policy instance | 1 |
Insurance contract or identification number | 6676201&6676501 | Number of Individuals Covered | 269 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Dental Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E3313046 |
Policy instance | 2 |
Insurance contract or identification number | E3313046 | Number of Individuals Covered | 9 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $304 | Total amount of fees paid to insurance company | USD $10 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $4,791 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | SGM601210 |
Policy instance | 3 |
Insurance contract or identification number | SGM601210 | Insurance policy start date | 2013-03-01 | Insurance policy end date | 2014-03-01 | Total amount of commissions paid to insurance broker | USD $5,330 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $20,537 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | SGD601086 |
Policy instance | 4 |
Insurance contract or identification number | SGD601086 | Insurance policy start date | 2013-03-01 | Insurance policy end date | 2014-03-01 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $27,147 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | SOK600642 |
Policy instance | 5 |
Insurance contract or identification number | SOK600642 | Insurance policy start date | 2013-03-01 | Insurance policy end date | 2014-03-01 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $2,373 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
Policy contract number | 1080822 |
Policy instance | 6 |
Insurance contract or identification number | 1080822 | Number of Individuals Covered | 64 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Are there contracts with allocated funds for group deferred annuity? | Yes | Life Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 136923 |
Policy instance | 1 |
Insurance contract or identification number | 136923 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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DENTAL CARE PLUS, INC. (National Association of Insurance Commissioners NAIC id number: 96265 ) |
Policy contract number | 6676201&6676501 |
Policy instance | 4 |
Insurance contract or identification number | 6676201&6676501 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Dental Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E3313046 |
Policy instance | 3 |
Insurance contract or identification number | E3313046 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of fees paid to insurance company | USD $371 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $5,290 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | SGD601086 |
Policy instance | 2 |
Insurance contract or identification number | SGD601086 | Insurance policy start date | 2012-03-01 | Insurance policy end date | 2013-03-01 | Total amount of fees paid to insurance company | USD $4,838 | Life Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $40,363 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 ) |
Policy contract number | 00170427 |
Policy instance | 1 |
Insurance contract or identification number | 00170427 | Number of Individuals Covered | 272 | Insurance policy start date | 2010-08-01 | Insurance policy end date | 2011-07-31 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,388,468 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 136923 |
Policy instance | 2 |
Insurance contract or identification number | 136923 | Number of Individuals Covered | 15 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2012-01-01 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $4,860 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | SGD601086 |
Policy instance | 3 |
Insurance contract or identification number | SGD601086 | Insurance policy start date | 2011-03-01 | Insurance policy end date | 2012-03-01 | Total amount of commissions paid to insurance broker | USD $5,071 | Life Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $42,980 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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DENTAL CARE PLUS, INC. (National Association of Insurance Commissioners NAIC id number: 96265 ) |
Policy contract number | 6676201&6676501 |
Policy instance | 5 |
Insurance contract or identification number | 6676201&6676501 | Number of Individuals Covered | 252 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Dental Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E3313046 |
Policy instance | 4 |
Insurance contract or identification number | E3313046 | Number of Individuals Covered | 11 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Total amount of commissions paid to insurance broker | USD $616 | Total amount of fees paid to insurance company | USD $66 | Life Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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