GREAT LAKES CHEESE CO., INC has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan GREAT LAKES CHEESE CO., INC EMPLOYEE GROUP BENEFIT PLAN
401k plan membership statisitcs for GREAT LAKES CHEESE CO., INC EMPLOYEE GROUP BENEFIT PLAN
| DELTA DENTAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 54402 ) |
| Policy contract number | 9699 |
| Policy instance | 1 |
| Insurance contract or identification number | 9699 | | Number of Individuals Covered | 6181 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $32,528 | | Dental Insurance Welfare Benefit | Yes | | Commission paid to Insurance Broker | USD $32,528 | | Additional information about fees paid to insurance broker | NA | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | OK970518 |
| Policy instance | 11 |
| Insurance contract or identification number | OK970518 | | Number of Individuals Covered | 3940 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $18,393 | | Life Insurance Welfare Benefit | Yes | | Commission paid to Insurance Broker | USD $18,393 | | Insurance broker organization code? | 7 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | AI961618 |
| Policy instance | 2 |
| Insurance contract or identification number | AI961618 | | Number of Individuals Covered | 1184 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $47,829 | | Total amount of fees paid to insurance company | USD $10,803 | | Other welfare benefits provided | ACCIDENTAL INJURY | | Commission paid to Insurance Broker | USD $913 | | Amount paid for insurance broker fees | 10803 | | Additional information about fees paid to insurance broker | SERVICE FEE | | Insurance broker organization code? | 7 |
|
| FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 ) |
| Policy contract number | R0403634 |
| Policy instance | 3 |
| Insurance contract or identification number | R0403634 | | Number of Individuals Covered | 73 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $1,919 | | Life Insurance Welfare Benefit | Yes | | Commission paid to Insurance Broker | USD $1,083 | | Insurance broker organization code? | 7 |
|
| CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 ) |
| Policy contract number | NYD075669 |
| Policy instance | 4 |
| Insurance contract or identification number | NYD075669 | | Number of Individuals Covered | 425 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $8,690 | | Temporary Disability Insurance Welfare Benefit | Yes | | Commission paid to Insurance Broker | USD $8,690 | | Additional information about fees paid to insurance broker | STANDARD COMMISSIONS | | Insurance broker organization code? | 7 |
|
| COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 ) |
| Policy contract number | W51003 |
| Policy instance | 5 |
| Insurance contract or identification number | W51003 | | Number of Individuals Covered | 2977 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30036563 |
| Policy instance | 6 |
| Insurance contract or identification number | 30036563 | | Number of Individuals Covered | 2411 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $5,209 | | Vision Insurance Welfare Benefit | Yes | | Commission paid to Insurance Broker | USD $5,209 | | Insurance broker organization code? | 7 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | LK752539 |
| Policy instance | 10 |
| Insurance contract or identification number | LK752539 | | Number of Individuals Covered | 3174 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $135,815 | | Temporary Disability Insurance Welfare Benefit | Yes | | Commission paid to Insurance Broker | USD $135,815 | | Insurance broker organization code? | 7 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | LK966042 |
| Policy instance | 9 |
| Insurance contract or identification number | LK966042 | | Number of Individuals Covered | 2328 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $48,355 | | Long Term Disability Insurance Welfare Benefit | Yes | | Commission paid to Insurance Broker | USD $48,355 | | Insurance broker organization code? | 7 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLX969060 |
| Policy instance | 8 |
| Insurance contract or identification number | FLX969060 | | Number of Individuals Covered | 3940 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $89,771 | | Life Insurance Welfare Benefit | Yes | | Commission paid to Insurance Broker | USD $89,771 | | Insurance broker organization code? | 7 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | CI961539 |
| Policy instance | 7 |
| Insurance contract or identification number | CI961539 | | Number of Individuals Covered | 1053 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $55,541 | | Total amount of fees paid to insurance company | USD $12,552 | | Other welfare benefits provided | VOLUNTARY CRITICAL ILLNESS | | Commission paid to Insurance Broker | USD $1,067 | | Amount paid for insurance broker fees | 12552 | | Additional information about fees paid to insurance broker | SERVICE FEE | | Insurance broker organization code? | 7 |
|
| DELTA DENTAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 54402 ) |
| Policy contract number | 9699 |
| Policy instance | 1 |
| Insurance contract or identification number | 9699 | | Number of Individuals Covered | 5858 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $34,154 | | Dental Insurance Welfare Benefit | Yes | | Commission paid to Insurance Broker | USD $34,154 | | Insurance broker organization code? | 7 |
|
| FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 ) |
| Policy contract number | R0403634 |
| Policy instance | 3 |
| Insurance contract or identification number | R0403634 | | Number of Individuals Covered | 86 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2022-01-01 | | Total amount of commissions paid to insurance broker | USD $2,092 | | Life Insurance Welfare Benefit | Yes | | Commission paid to Insurance Broker | USD $1,353 | | Insurance broker organization code? | 7 |
|
| CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 ) |
| Policy contract number | NYD075669 |
| Policy instance | 4 |
| Insurance contract or identification number | NYD075669 | | Number of Individuals Covered | 350 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2022-01-01 | | Total amount of commissions paid to insurance broker | USD $7,791 | | Total amount of fees paid to insurance company | USD $2,880 | | Temporary Disability Insurance Welfare Benefit | Yes | | Commission paid to Insurance Broker | USD $7,791 | | Amount paid for insurance broker fees | 2880 | | Additional information about fees paid to insurance broker | OVERRIDE | | Insurance broker organization code? | 7 |
|
| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
| Policy contract number | 0007409260 |
| Policy instance | 5 |
| Insurance contract or identification number | 0007409260 | | Number of Individuals Covered | 636 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2022-01-01 | | Total amount of commissions paid to insurance broker | USD $15,501 | | Total amount of fees paid to insurance company | USD $284 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Commission paid to Insurance Broker | USD $10,023 | | Insurance broker organization code? | 7 | | Amount paid for insurance broker fees | 284 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | R0403634 |
| Policy instance | 6 |
| Insurance contract or identification number | R0403634 | | Number of Individuals Covered | 125 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2022-01-01 | | Total amount of commissions paid to insurance broker | USD $1,017 | | Total amount of fees paid to insurance company | USD $14 | | Temporary Disability Insurance Welfare Benefit | Yes | | Commission paid to Insurance Broker | USD $636 | | Insurance broker organization code? | 7 | | Amount paid for insurance broker fees | 14 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION |
|
| COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 ) |
| Policy contract number | 003321190 |
| Policy instance | 7 |
| Insurance contract or identification number | 003321190 | | Number of Individuals Covered | 2883 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30036563 |
| Policy instance | 8 |
| Insurance contract or identification number | 30036563 | | Number of Individuals Covered | 2436 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $5,109 | | Vision Insurance Welfare Benefit | Yes | | Commission paid to Insurance Broker | USD $5,109 | | Insurance broker organization code? | 7 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | AI961618 |
| Policy instance | 2 |
| Insurance contract or identification number | AI961618 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $35,750 | | Temporary Disability Insurance Welfare Benefit | Yes | | Commission paid to Insurance Broker | USD $35,750 | | Insurance broker organization code? | 7 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | OK970518 |
| Policy instance | 13 |
| Insurance contract or identification number | OK970518 | | Number of Individuals Covered | 3376 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2022-01-01 | | Total amount of commissions paid to insurance broker | USD $18,096 | | Total amount of fees paid to insurance company | USD $5,407 | | Temporary Disability Insurance Welfare Benefit | Yes | | Commission paid to Insurance Broker | USD $18,096 | | Amount paid for insurance broker fees | 5407 | | Additional information about fees paid to insurance broker | OVERRIDE | | Insurance broker organization code? | 7 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | LK752539 |
| Policy instance | 12 |
| Insurance contract or identification number | LK752539 | | Number of Individuals Covered | 2977 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2022-01-01 | | Total amount of commissions paid to insurance broker | USD $123,443 | | Total amount of fees paid to insurance company | USD $19,050 | | Temporary Disability Insurance Welfare Benefit | Yes | | Commission paid to Insurance Broker | USD $123,443 | | Amount paid for insurance broker fees | 19050 | | Additional information about fees paid to insurance broker | OVERRIDE | | Insurance broker organization code? | 7 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | LK966042 |
| Policy instance | 11 |
| Insurance contract or identification number | LK966042 | | Number of Individuals Covered | 2157 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2022-01-01 | | Total amount of commissions paid to insurance broker | USD $46,341 | | Total amount of fees paid to insurance company | USD $14,471 | | Long Term Disability Insurance Welfare Benefit | Yes | | Commission paid to Insurance Broker | USD $46,341 | | Amount paid for insurance broker fees | 14471 | | Additional information about fees paid to insurance broker | OVERRIDE | | Insurance broker organization code? | 7 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLX969060 |
| Policy instance | 10 |
| Insurance contract or identification number | FLX969060 | | Number of Individuals Covered | 834 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2022-01-01 | | Total amount of commissions paid to insurance broker | USD $87,137 | | Total amount of fees paid to insurance company | USD $15,000 | | Life Insurance Welfare Benefit | Yes | | Commission paid to Insurance Broker | USD $87,137 | | Amount paid for insurance broker fees | 15000 | | Additional information about fees paid to insurance broker | OVERRIDE | | Insurance broker organization code? | 7 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | CI961539 |
| Policy instance | 9 |
| Insurance contract or identification number | CI961539 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $41,605 | | Long Term Disability Insurance Welfare Benefit | Yes | | Commission paid to Insurance Broker | USD $41,605 | | Insurance broker organization code? | 7 |
|
| DELTA DENTAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 54402 ) |
| Policy contract number | 9699 |
| Policy instance | 1 |
| Insurance contract or identification number | 9699 | | Number of Individuals Covered | 5677 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $27,957 | | Total amount of fees paid to insurance company | USD $11,222 | | Dental Insurance Welfare Benefit | Yes | | Commission paid to Insurance Broker | USD $27,957 | | Amount paid for insurance broker fees | 11222 | | Additional information about fees paid to insurance broker | NEW BUSINESS BONUS, RETENTION BONUS | | Insurance broker organization code? | 3 |
|
| FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 ) |
| Policy contract number | R0403634 |
| Policy instance | 2 |
| Insurance contract or identification number | R0403634 | | Number of Individuals Covered | 94 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2021-01-01 | | Total amount of commissions paid to insurance broker | USD $6,193 | | Life Insurance Welfare Benefit | Yes | | Commission paid to Insurance Broker | USD $4,006 |
|
| CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 ) |
| Policy contract number | NYD075669 |
| Policy instance | 3 |
| Insurance contract or identification number | NYD075669 | | Number of Individuals Covered | 350 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2021-01-01 | | Total amount of commissions paid to insurance broker | USD $5,032 | | Temporary Disability Insurance Welfare Benefit | Yes | | Commission paid to Insurance Broker | USD $5,032 | | Additional information about fees paid to insurance broker | SALES AND SERVICE |
|
| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
| Policy contract number | 0007409260 |
| Policy instance | 4 |
| Insurance contract or identification number | 0007409260 | | Number of Individuals Covered | 1033 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2021-01-01 | | Total amount of commissions paid to insurance broker | USD $50,805 | | Total amount of fees paid to insurance company | USD $1,229 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Commission paid to Insurance Broker | USD $32,725 | | Amount paid for insurance broker fees | 1229 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | R0403634 |
| Policy instance | 5 |
| Insurance contract or identification number | R0403634 | | Number of Individuals Covered | 1582 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2021-01-01 | | Total amount of commissions paid to insurance broker | USD $59,962 | | Total amount of fees paid to insurance company | USD $1,546 | | Temporary Disability Insurance Welfare Benefit | Yes | | Commission paid to Insurance Broker | USD $38,381 | | Amount paid for insurance broker fees | 1546 |
|
| COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 ) |
| Policy contract number | 003321190 |
| Policy instance | 6 |
| Insurance contract or identification number | 003321190 | | Number of Individuals Covered | 5944 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30036563 |
| Policy instance | 7 |
| Insurance contract or identification number | 30036563 | | Number of Individuals Covered | 2304 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $5,018 | | Vision Insurance Welfare Benefit | Yes | | Commission paid to Insurance Broker | USD $5,018 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLX969060 |
| Policy instance | 8 |
| Insurance contract or identification number | FLX969060 | | Number of Individuals Covered | 3311 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2021-01-01 | | Total amount of commissions paid to insurance broker | USD $77,332 | | Life Insurance Welfare Benefit | Yes | | Commission paid to Insurance Broker | USD $77,332 | | Additional information about fees paid to insurance broker | SALES AND SERVICE |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | LK966042 |
| Policy instance | 9 |
| Insurance contract or identification number | LK966042 | | Number of Individuals Covered | 2174 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2021-01-01 | | Total amount of commissions paid to insurance broker | USD $40,837 | | Long Term Disability Insurance Welfare Benefit | Yes | | Commission paid to Insurance Broker | USD $40,837 | | Additional information about fees paid to insurance broker | SALES AND SERVICE |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | LK752539 |
| Policy instance | 10 |
| Insurance contract or identification number | LK752539 | | Number of Individuals Covered | 2573 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2021-01-01 | | Total amount of commissions paid to insurance broker | USD $97,326 | | Temporary Disability Insurance Welfare Benefit | Yes | | Commission paid to Insurance Broker | USD $97,326 | | Additional information about fees paid to insurance broker | SALES AND SERVICE |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | OK970518 |
| Policy instance | 11 |
| Insurance contract or identification number | OK970518 | | Number of Individuals Covered | 3311 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2021-01-01 | | Total amount of commissions paid to insurance broker | USD $15,051 | | Temporary Disability Insurance Welfare Benefit | Yes | | Commission paid to Insurance Broker | USD $15,051 | | Additional information about fees paid to insurance broker | SALES AND SERVICE |
|
| DELTA DENTAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 54402 ) |
| Policy contract number | 9699 |
| Policy instance | 1 |
| Insurance contract or identification number | 9699 | | Number of Individuals Covered | 5481 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $29,632 | | 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 $29,632 | | Insurance broker organization code? | 3 |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 211439 |
| Policy instance | 2 |
| Insurance contract or identification number | 211439 | | Number of Individuals Covered | 3012 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $171,406 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,866,218 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $171,406 | | Insurance broker organization code? | 3 |
|
| FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 ) |
| Policy contract number | 0007409260 |
| Policy instance | 3 |
| Insurance contract or identification number | 0007409260 | | Number of Individuals Covered | 84 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $4,443 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $27,783 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,874 | | Insurance broker organization code? | 3 |
|
| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
| Policy contract number | 0007409260 |
| Policy instance | 4 |
| Insurance contract or identification number | 0007409260 | | Number of Individuals Covered | 1024 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $34,880 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $305,461 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $22,412 | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | R0403634 |
| Policy instance | 5 |
| Insurance contract or identification number | R0403634 | | Number of Individuals Covered | 1380 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $53,743 | | Total amount of fees paid to insurance company | USD $1,029 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $354,270 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $34,408 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 1029 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION |
|
| COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 ) |
| Policy contract number | 003321190 |
| Policy instance | 6 |
| Insurance contract or identification number | 003321190 | | Number of Individuals Covered | 5742 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $1,393,889 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47029 ) |
| Policy contract number | 30036563 |
| Policy instance | 7 |
| Insurance contract or identification number | 30036563 | | Number of Individuals Covered | 1824 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $4,792 | | Vision 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 $4,792 | | Insurance broker organization code? | 3 |
|
| SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 ) |
| Policy contract number | 818785 |
| Policy instance | 8 |
| Insurance contract or identification number | 818785 | | Number of Individuals Covered | 358 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $3,643 | | Total amount of fees paid to insurance company | USD $443 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $56,481 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,643 | | Amount paid for insurance broker fees | 443 | | Additional information about fees paid to insurance broker | BONUSES AND ADDITIONAL PAYMENTS PAID | | Insurance broker organization code? | 3 |
|
| SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 ) |
| Policy contract number | 818785 |
| Policy instance | 8 |
| Insurance contract or identification number | 818785 | | Number of Individuals Covered | 347 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $2,451 | | Temporary Disability Insurance Welfare Benefit | Yes | | Commission paid to Insurance Broker | USD $2,451 | | Insurance broker organization code? | 3 | | Insurance broker name | FEDELI GROUP |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47029 ) |
| Policy contract number | 30036563 |
| Policy instance | 7 |
| Insurance contract or identification number | 30036563 | | Number of Individuals Covered | 1738 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $4,377 | | Vision Insurance Welfare Benefit | Yes | | Commission paid to Insurance Broker | USD $4,377 | | Insurance broker organization code? | 3 | | Insurance broker name | FEDELI GROUP INC |
|
| COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 ) |
| Policy contract number | 003321190 |
| Policy instance | 6 |
| Insurance contract or identification number | 003321190 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $1,800,878 | | Commission paid to Insurance Broker | USD $1,622,593 | | Insurance broker organization code? | 3 | | Insurance broker name | FEDELI GROUP INC |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | R0403634 |
| Policy instance | 5 |
| Insurance contract or identification number | R0403634 | | Number of Individuals Covered | 1381 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $57,743 | | Temporary Disability Insurance Welfare Benefit | Yes | | Commission paid to Insurance Broker | USD $36,249 | | Insurance broker organization code? | 3 | | Insurance broker name | SMITH, THOMAS, CHRISTOPHER |
|
| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
| Policy contract number | 0007409260 |
| Policy instance | 4 |
| Insurance contract or identification number | 0007409260 | | Number of Individuals Covered | 1214 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $57,220 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Commission paid to Insurance Broker | USD $36,484 | | Insurance broker organization code? | 3 | | Insurance broker name | SMITH, THOMAS, CHRISTOPHER |
|
| FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 ) |
| Policy contract number | 0007409260 |
| Policy instance | 3 |
| Insurance contract or identification number | 0007409260 | | Number of Individuals Covered | 90 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $5,670 | | Life Insurance Welfare Benefit | Yes | | Commission paid to Insurance Broker | USD $3,668 | | Insurance broker organization code? | 3 | | Insurance broker name | SMITH, THOMAS, CHRISTOPHER |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 211439 |
| Policy instance | 2 |
| Insurance contract or identification number | 211439 | | Number of Individuals Covered | 2874 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $197,906 | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Commission paid to Insurance Broker | USD $197,906 | | Insurance broker organization code? | 3 | | Insurance broker name | FEDELI GROUP INC |
|
| DELTA DENTAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 54402 ) |
| Policy contract number | 9699 |
| Policy instance | 1 |
| Insurance contract or identification number | 9699 | | Number of Individuals Covered | 5263 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $26,577 | | Dental Insurance Welfare Benefit | Yes | | Commission paid to Insurance Broker | USD $26,577 | | Insurance broker organization code? | 3 | | Insurance broker name | FEDELI GROUP INC |
|
| COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 ) |
| Policy contract number | 003321190 |
| Policy instance | 7 |
| Insurance contract or identification number | 003321190 | | Number of Individuals Covered | 4902 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $1,168,863 | | 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 | R0403634 |
| Policy instance | 6 |
| Insurance contract or identification number | R0403634 | | Number of Individuals Covered | 637 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $24,724 | | Total amount of fees paid to insurance company | USD $1,322 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $187,663 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,210 | | Amount paid for insurance broker fees | 524 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | THE FEDELI GROUP INC |
|
| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
| Policy contract number | 0007409260 |
| Policy instance | 5 |
| Insurance contract or identification number | 0007409260 | | Number of Individuals Covered | 704 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $17,748 | | Total amount of fees paid to insurance company | USD $351 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $182,122 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,421 | | Amount paid for insurance broker fees | 351 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | THE FEDELI GROUP INC |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 211439 |
| Policy instance | 4 |
| Insurance contract or identification number | 211439 | | Temporary Disability Insurance Welfare Benefit | Yes |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 211439 |
| Policy instance | 3 |
| Insurance contract or identification number | 211439 | | Long Term Disability Insurance Welfare Benefit | Yes |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 211439 |
| Policy instance | 2 |
| Insurance contract or identification number | 211439 | | Number of Individuals Covered | 2355 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $123,764 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 54402 ) |
| Policy contract number | 9699 |
| Policy instance | 1 |
| Insurance contract or identification number | 9699 | | Number of Individuals Covered | 4386 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $51,567 | | Dental 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 $51,567 | | Insurance broker organization code? | 3 | | Insurance broker name | THE FEDELI GROUP INC |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47029 ) |
| Policy contract number | 30036563 |
| Policy instance | 8 |
| Insurance contract or identification number | 30036563 | | Number of Individuals Covered | 1277 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $3,555 | | Vision 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 $3,555 | | Insurance broker organization code? | 3 | | Insurance broker name | THE FEDELI GROUP INC |
|
| SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 ) |
| Policy contract number | 818785 |
| Policy instance | 9 |
| Insurance contract or identification number | 818785 | | Number of Individuals Covered | 357 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $3,509 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $35,191 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,509 | | Insurance broker organization code? | 3 | | Insurance broker name | THE FEDELI GROUP INC |
|
| DELTA DENTAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 54402 ) |
| Policy contract number | 9699 |
| Policy instance | 1 |
| Insurance contract or identification number | 9699 | | Number of Individuals Covered | 4150 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $19,185 | | 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 $19,185 | | Insurance broker organization code? | 3 | | Insurance broker name | FEDELI GROUP INC |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 211439 |
| Policy instance | 3 |
| Insurance contract or identification number | 211439 | | Number of Individuals Covered | 587 | | Insurance policy start date | 2014-05-01 | | Insurance policy end date | 2015-04-30 | | Total amount of commissions paid to insurance broker | USD $17,569 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $178,642 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $17,569 | | Insurance broker organization code? | 3 | | Insurance broker name | FEDELI GROUP INC |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 211439 |
| Policy instance | 4 |
| Insurance contract or identification number | 211439 | | Number of Individuals Covered | 1956 | | Insurance policy start date | 2014-05-01 | | Insurance policy end date | 2015-04-30 | | Total amount of commissions paid to insurance broker | USD $33,878 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $478,791 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $33,878 | | Insurance broker organization code? | 3 | | Insurance broker name | FEDELI GROUP INC |
|
| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
| Policy contract number | 0007409260 |
| Policy instance | 5 |
| Insurance contract or identification number | 0007409260 | | Number of Individuals Covered | 738 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2015-01-01 | | Total amount of commissions paid to insurance broker | USD $27,374 | | Total amount of fees paid to insurance company | USD $538 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $175,383 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,066 | | Amount paid for insurance broker fees | 333 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | FEDELI GROUP INC |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | R0403634 |
| Policy instance | 6 |
| Insurance contract or identification number | R0403634 | | Number of Individuals Covered | 559 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2015-01-01 | | Total amount of commissions paid to insurance broker | USD $30,287 | | Total amount of fees paid to insurance company | USD $1,607 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $180,442 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,411 | | Amount paid for insurance broker fees | 65 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | THE FEDELI GROUP INC |
|
| SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 ) |
| Policy contract number | 818785 |
| Policy instance | 9 |
| Insurance contract or identification number | 818785 | | Number of Individuals Covered | 369 | | Insurance policy start date | 2014-05-01 | | Insurance policy end date | 2015-04-30 | | Total amount of commissions paid to insurance broker | USD $2,106 | | Total amount of fees paid to insurance company | USD $760 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $38,782 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,106 | | Amount paid for insurance broker fees | 760 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | FIDELI GROUP INC |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47029 ) |
| Policy contract number | 30036563 |
| Policy instance | 8 |
| Insurance contract or identification number | 30036563 | | Number of Individuals Covered | 1069 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $3,370 | | Vision 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 $3,370 | | Insurance broker organization code? | 3 | | Insurance broker name | FEDELI GROUP INC |
|
| COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 ) |
| Policy contract number | 003321190 |
| Policy instance | 7 |
| Insurance contract or identification number | 003321190 | | Number of Individuals Covered | 4734 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $75,582 | | Welfare Benefit Premiums Paid to Carrier | USD $1,036,317 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $75,582 | | Insurance broker organization code? | 3 | | Insurance broker name | JAMES B OSWALD COMPANY |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 211439 |
| Policy instance | 2 |
| Insurance contract or identification number | 211439 | | Number of Individuals Covered | 2299 | | Insurance policy start date | 2014-05-01 | | Insurance policy end date | 2015-04-30 | | Total amount of commissions paid to insurance broker | USD $43,987 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $404,186 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $43,987 | | Insurance broker organization code? | 3 | | Insurance broker name | FEDELI GROUP INC |
|
| SUN LIFE INSURANCE AND ANNUITY COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 80926 ) |
| Policy contract number | 089642 |
| Policy instance | 9 |
| Insurance contract or identification number | 089642 | | Number of Individuals Covered | 364 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $36,036 | | 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 | R0403634 |
| Policy instance | 6 |
| Insurance contract or identification number | R0403634 | | Number of Individuals Covered | 574 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2014-01-01 | | Total amount of commissions paid to insurance broker | USD $42,664 | | Total amount of fees paid to insurance company | USD $486 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $161,445 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $30,602 | | Amount paid for insurance broker fees | 486 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | THOMAS C SMITH |
|
| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
| Policy contract number | 0007409260 |
| Policy instance | 5 |
| Insurance contract or identification number | 0007409260 | | Number of Individuals Covered | 644 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2014-01-01 | | Total amount of commissions paid to insurance broker | USD $22,755 | | Total amount of fees paid to insurance company | USD $1,022 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $147,110 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,677 | | Amount paid for insurance broker fees | 693 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | THOMAS SMITH |
|
| DELTA DENTAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 54402 ) |
| Policy contract number | 9699 |
| Policy instance | 1 |
| Insurance contract or identification number | 9699 | | Number of Individuals Covered | 3904 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $16,724 | | 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 $16,724 | | Additional information about fees paid to insurance broker | SALES AND SERVICE COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 211439 |
| Policy instance | 3 |
| Insurance contract or identification number | 211439 | | Number of Individuals Covered | 2085 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $28,901 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $208,376 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $28,901 | | Insurance broker organization code? | 3 | | Insurance broker name | THE FEDELI GROUP |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47029 ) |
| Policy contract number | 30036563 |
| Policy instance | 8 |
| Insurance contract or identification number | 30036563 | | Number of Individuals Covered | 850 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $2,822 | | Vision 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 $2,822 | | Insurance broker organization code? | 3 | | Insurance broker name | THE FEDELI GROUP |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 211439 |
| Policy instance | 2 |
| Insurance contract or identification number | 211439 | | Number of Individuals Covered | 2085 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $70,705 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $498,581 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $70,705 | | Insurance broker organization code? | 3 | | Insurance broker name | THE FEDELI GROUP |
|
| COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 ) |
| Policy contract number | 003321190 |
| Policy instance | 7 |
| Insurance contract or identification number | 003321190 | | Number of Individuals Covered | 1799 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $121,386 | | Welfare Benefit Premiums Paid to Carrier | USD $981,159 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $121,386 | | Insurance broker organization code? | 3 | | Insurance broker name | THE JAMES B OSWALD COMPANY |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 211439 |
| Policy instance | 4 |
| Insurance contract or identification number | 211439 | | Number of Individuals Covered | 2085 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $50,480 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $435,016 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $50,480 | | Insurance broker organization code? | 3 | | Insurance broker name | THE FEDELI GROUP |
|
| DELTA DENTAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 54402 ) |
| Policy contract number | 9699 |
| Policy instance | 1 |
| Insurance contract or identification number | 9699 | | Number of Individuals Covered | 3759 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $18,582 | | 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 $18,582 | | Insurance broker organization code? | 3 | | Insurance broker name | THE FEDELI GROUP INC |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 211439 |
| Policy instance | 2 |
| Insurance contract or identification number | 211439 | | Number of Individuals Covered | 1644 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $15,116 | | Total amount of fees paid to insurance company | USD $5,113 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $407,806 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $15,116 | | Amount paid for insurance broker fees | 5113 | | Additional information about fees paid to insurance broker | BONUSES | | Insurance broker organization code? | 3 | | Insurance broker name | THE FEDELI GROUP INC |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 211439 |
| Policy instance | 3 |
| Insurance contract or identification number | 211439 | | Number of Individuals Covered | 23 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $9,152 | | Total amount of fees paid to insurance company | USD $2,020 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $175,447 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,152 | | Amount paid for insurance broker fees | 2020 | | Additional information about fees paid to insurance broker | BONUSES | | Insurance broker organization code? | 3 | | Insurance broker name | THE FEDELI GROUP INC |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 211439 |
| Policy instance | 4 |
| Insurance contract or identification number | 211439 | | Number of Individuals Covered | 1933 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $19,812 | | Total amount of fees paid to insurance company | USD $4,558 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $413,400 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $19,812 | | Amount paid for insurance broker fees | 4558 | | Additional information about fees paid to insurance broker | BONUSES | | Insurance broker organization code? | 3 | | Insurance broker name | THE FEDELI GROUP |
|
| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
| Policy contract number | 0007409260 |
| Policy instance | 5 |
| Insurance contract or identification number | 0007409260 | | Number of Individuals Covered | 627 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $65,418 | | Total amount of fees paid to insurance company | USD $2,115 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $133,943 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $26,156 | | Amount paid for insurance broker fees | 1410 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | THE FEDELI GROUP INC |
|
| COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 ) |
| Policy contract number | 003321190 |
| Policy instance | 7 |
| Insurance contract or identification number | 003321190 | | Number of Individuals Covered | 1692 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $106,554 | | Welfare Benefit Premiums Paid to Carrier | USD $797,146 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $106,554 | | Insurance broker organization code? | 3 | | Insurance broker name | JAMES B OSWALD COMPANY |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | R0403634 |
| Policy instance | 6 |
| Insurance contract or identification number | R0403634 | | Number of Individuals Covered | 559 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $79,768 | | Total amount of fees paid to insurance company | USD $500 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $151,971 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $31,906 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 500 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker name | THE FEDELI GROUP INC |
|
| LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0122865 |
| Policy instance | 2 |
| Insurance contract or identification number | 0122865 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $3,035 | | Total amount of fees paid to insurance company | USD $604 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 27722 |
| Policy instance | 1 |
| Insurance contract or identification number | 27722 | | Number of Individuals Covered | 1308 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $14,392 | | Welfare Benefit Premiums Paid to Carrier | USD $138,746 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ANTHEM LIFE INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 65069 ) |
| Policy contract number | 00091202 |
| Policy instance | 3 |
| Insurance contract or identification number | 00091202 | | Number of Individuals Covered | 610 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $1,389 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 ) |
| Policy contract number | 003321190 |
| Policy instance | 4 |
| Insurance contract or identification number | 003321190 | | Number of Individuals Covered | 1584 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $60,115 | | Welfare Benefit Premiums Paid to Carrier | USD $456,940 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 ) |
| Policy contract number | 003321190 |
| Policy instance | 4 |
| Insurance contract or identification number | 003321190 | | Number of Individuals Covered | 1596 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $61,412 | | Welfare Benefit Premiums Paid to Carrier | USD $477,829 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ANTHEM LIFE INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 65069 ) |
| Policy contract number | 00091202 |
| Policy instance | 3 |
| Insurance contract or identification number | 00091202 | | Number of Individuals Covered | 614 | | Insurance policy start date | 2001-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $1,412 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0122865 |
| Policy instance | 2 |
| Insurance contract or identification number | 0122865 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $3,038 | | Total amount of fees paid to insurance company | USD $607 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 27722 |
| Policy instance | 1 |
| Insurance contract or identification number | 27722 | | Number of Individuals Covered | 1315 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $14,422 | | Welfare Benefit Premiums Paid to Carrier | USD $144,227 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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