FERGUSON CONSTRUCTION COMPANY has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan LIFE/ACCIDENTAL DEATH & DISMEMBERMENT/ LOSS OF TIME/LONG-TERM DISABILITY
401k plan membership statisitcs for LIFE/ACCIDENTAL DEATH & DISMEMBERMENT/ LOSS OF TIME/LONG-TERM DISABILITY
| Measure | Date | Value |
|---|
| 2019: LIFE/ACCIDENTAL DEATH & DISMEMBERMENT/ LOSS OF TIME/LONG-TERM DISABILITY 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-04-01 | 261 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-04-01 | 0 |
| Number of retired or separated participants receiving benefits | 2019-04-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-04-01 | 0 |
| Total of all active and inactive participants | 2019-04-01 | 0 |
| 2018: LIFE/ACCIDENTAL DEATH & DISMEMBERMENT/ LOSS OF TIME/LONG-TERM DISABILITY 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-04-01 | 273 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-04-01 | 261 |
| Number of retired or separated participants receiving benefits | 2018-04-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-04-01 | 0 |
| Total of all active and inactive participants | 2018-04-01 | 261 |
| 2017: LIFE/ACCIDENTAL DEATH & DISMEMBERMENT/ LOSS OF TIME/LONG-TERM DISABILITY 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-04-01 | 286 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-04-01 | 273 |
| Number of retired or separated participants receiving benefits | 2017-04-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-04-01 | 0 |
| Total of all active and inactive participants | 2017-04-01 | 273 |
| 2016: LIFE/ACCIDENTAL DEATH & DISMEMBERMENT/ LOSS OF TIME/LONG-TERM DISABILITY 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-04-01 | 257 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-04-01 | 286 |
| Number of retired or separated participants receiving benefits | 2016-04-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2016-04-01 | 0 |
| Total of all active and inactive participants | 2016-04-01 | 286 |
| 2015: LIFE/ACCIDENTAL DEATH & DISMEMBERMENT/ LOSS OF TIME/LONG-TERM DISABILITY 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-04-01 | 233 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-04-01 | 257 |
| Number of retired or separated participants receiving benefits | 2015-04-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2015-04-01 | 0 |
| Total of all active and inactive participants | 2015-04-01 | 257 |
| 2014: LIFE/ACCIDENTAL DEATH & DISMEMBERMENT/ LOSS OF TIME/LONG-TERM DISABILITY 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-04-01 | 193 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-04-01 | 233 |
| Number of retired or separated participants receiving benefits | 2014-04-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2014-04-01 | 0 |
| Total of all active and inactive participants | 2014-04-01 | 233 |
| 2013: LIFE/ACCIDENTAL DEATH & DISMEMBERMENT/ LOSS OF TIME/LONG-TERM DISABILITY 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-04-01 | 197 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-04-01 | 193 |
| Number of retired or separated participants receiving benefits | 2013-04-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2013-04-01 | 0 |
| Total of all active and inactive participants | 2013-04-01 | 193 |
| 2012: LIFE/ACCIDENTAL DEATH & DISMEMBERMENT/ LOSS OF TIME/LONG-TERM DISABILITY 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-04-01 | 240 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-04-01 | 197 |
| Number of retired or separated participants receiving benefits | 2012-04-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2012-04-01 | 0 |
| Total of all active and inactive participants | 2012-04-01 | 197 |
| 2011: LIFE/ACCIDENTAL DEATH & DISMEMBERMENT/ LOSS OF TIME/LONG-TERM DISABILITY 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-04-01 | 241 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-04-01 | 240 |
| Number of retired or separated participants receiving benefits | 2011-04-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2011-04-01 | 0 |
| Total of all active and inactive participants | 2011-04-01 | 240 |
| 2009: LIFE/ACCIDENTAL DEATH & DISMEMBERMENT/ LOSS OF TIME/LONG-TERM DISABILITY 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-04-01 | 259 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-04-01 | 241 |
| Number of retired or separated participants receiving benefits | 2009-04-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2009-04-01 | 0 |
| Total of all active and inactive participants | 2009-04-01 | 241 |
| 2019: LIFE/ACCIDENTAL DEATH & DISMEMBERMENT/ LOSS OF TIME/LONG-TERM DISABILITY 2019 form 5500 responses |
|---|
| 2019-04-01 | Type of plan entity | Single employer plan |
| 2019-04-01 | This submission is the final filing | Yes |
| 2019-04-01 | Plan funding arrangement – Insurance | Yes |
| 2019-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: LIFE/ACCIDENTAL DEATH & DISMEMBERMENT/ LOSS OF TIME/LONG-TERM DISABILITY 2018 form 5500 responses |
|---|
| 2018-04-01 | Type of plan entity | Single employer plan |
| 2018-04-01 | Plan funding arrangement – Insurance | Yes |
| 2018-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: LIFE/ACCIDENTAL DEATH & DISMEMBERMENT/ LOSS OF TIME/LONG-TERM DISABILITY 2017 form 5500 responses |
|---|
| 2017-04-01 | Type of plan entity | Single employer plan |
| 2017-04-01 | Plan funding arrangement – Insurance | Yes |
| 2017-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: LIFE/ACCIDENTAL DEATH & DISMEMBERMENT/ LOSS OF TIME/LONG-TERM DISABILITY 2016 form 5500 responses |
|---|
| 2016-04-01 | Type of plan entity | Single employer plan |
| 2016-04-01 | Plan funding arrangement – Insurance | Yes |
| 2016-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: LIFE/ACCIDENTAL DEATH & DISMEMBERMENT/ LOSS OF TIME/LONG-TERM DISABILITY 2015 form 5500 responses |
|---|
| 2015-04-01 | Type of plan entity | Single employer plan |
| 2015-04-01 | Plan funding arrangement – Insurance | Yes |
| 2015-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: LIFE/ACCIDENTAL DEATH & DISMEMBERMENT/ LOSS OF TIME/LONG-TERM DISABILITY 2014 form 5500 responses |
|---|
| 2014-04-01 | Type of plan entity | Single employer plan |
| 2014-04-01 | Plan funding arrangement – Insurance | Yes |
| 2014-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: LIFE/ACCIDENTAL DEATH & DISMEMBERMENT/ LOSS OF TIME/LONG-TERM DISABILITY 2013 form 5500 responses |
|---|
| 2013-04-01 | Type of plan entity | Single employer plan |
| 2013-04-01 | Plan funding arrangement – Insurance | Yes |
| 2013-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: LIFE/ACCIDENTAL DEATH & DISMEMBERMENT/ LOSS OF TIME/LONG-TERM DISABILITY 2012 form 5500 responses |
|---|
| 2012-04-01 | Type of plan entity | Single employer plan |
| 2012-04-01 | Plan funding arrangement – Insurance | Yes |
| 2012-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: LIFE/ACCIDENTAL DEATH & DISMEMBERMENT/ LOSS OF TIME/LONG-TERM DISABILITY 2011 form 5500 responses |
|---|
| 2011-04-01 | Type of plan entity | Single employer plan |
| 2011-04-01 | Plan funding arrangement – Insurance | Yes |
| 2011-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: LIFE/ACCIDENTAL DEATH & DISMEMBERMENT/ LOSS OF TIME/LONG-TERM DISABILITY 2009 form 5500 responses |
|---|
| 2009-04-01 | Type of plan entity | Single employer plan |
| 2009-04-01 | Plan funding arrangement – Insurance | Yes |
| 2009-04-01 | Plan benefit arrangement – Insurance | Yes |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 404853 2 |
| Policy instance | 2 |
| Insurance contract or identification number | 404853 2 | | Insurance policy start date | 2019-04-01 | | Insurance policy end date | 2020-03-31 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability 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 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 404853 1 |
| Policy instance | 1 |
| Insurance contract or identification number | 404853 1 | | Insurance policy start date | 2019-04-01 | | Insurance policy end date | 2020-03-31 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability 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 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 404853 2 |
| Policy instance | 2 |
| Insurance contract or identification number | 404853 2 | | Number of Individuals Covered | 13 | | Insurance policy start date | 2018-04-01 | | Insurance policy end date | 2019-03-31 | | Total amount of commissions paid to insurance broker | USD $431 | | Total amount of fees paid to insurance company | USD $219 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $7,258 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $431 | | Amount paid for insurance broker fees | 219 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 404853 1 |
| Policy instance | 1 |
| Insurance contract or identification number | 404853 1 | | Number of Individuals Covered | 261 | | Insurance policy start date | 2018-04-01 | | Insurance policy end date | 2019-03-31 | | Total amount of commissions paid to insurance broker | USD $11,075 | | Total amount of fees paid to insurance company | USD $4,967 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $174,106 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,075 | | Amount paid for insurance broker fees | 4967 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 404853 |
| Policy instance | 1 |
| Insurance contract or identification number | 404853 | | Number of Individuals Covered | 273 | | Insurance policy start date | 2017-04-01 | | Insurance policy end date | 2018-03-31 | | Total amount of commissions paid to insurance broker | USD $12,056 | | Total amount of fees paid to insurance company | USD $2,642 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $207,747 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $12,056 | | Amount paid for insurance broker fees | 2642 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | MCGOHAN BRABENDER AGENCY INC |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 404853 |
| Policy instance | 1 |
| Insurance contract or identification number | 404853 | | Number of Individuals Covered | 257 | | Insurance policy start date | 2015-04-01 | | Insurance policy end date | 2016-03-31 | | Total amount of commissions paid to insurance broker | USD $11,398 | | Total amount of fees paid to insurance company | USD $4,039 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $179,593 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,398 | | Amount paid for insurance broker fees | 4039 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | MCGOHAN BRABENDER AGENCY INC |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 404853 |
| Policy instance | 2 |
| Insurance contract or identification number | 404853 | | Number of Individuals Covered | 233 | | Insurance policy start date | 2014-05-01 | | Insurance policy end date | 2015-04-01 | | Total amount of commissions paid to insurance broker | USD $11,920 | | Total amount of fees paid to insurance company | USD $8,047 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $162,110 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,920 | | Amount paid for insurance broker fees | 8047 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | MCGOHAN BRABENDER AGENCY INC |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 10157718 |
| Policy instance | 1 |
| Insurance contract or identification number | 10157718 | | Number of Individuals Covered | 191 | | Insurance policy start date | 2014-04-01 | | Insurance policy end date | 2014-04-30 | | Total amount of commissions paid to insurance broker | USD $866 | | Total amount of fees paid to insurance company | USD $337 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $6,744 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $866 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 337 | | Additional information about fees paid to insurance broker | OVERRIDES | | Insurance broker name | CENTERSTONE DBA BENEFIT MALL |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 10157718 |
| Policy instance | 2 |
| Insurance contract or identification number | 10157718 | | Number of Individuals Covered | 193 | | Insurance policy start date | 2013-04-01 | | Insurance policy end date | 2014-03-31 | | Total amount of commissions paid to insurance broker | USD $4,305 | | Total amount of fees paid to insurance company | USD $6,901 | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $91,393 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,305 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 2331 | | Additional information about fees paid to insurance broker | BROKER BONUS | | Insurance broker name | CENTERSTONE DBA BENEFIT MALL |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 10157717 |
| Policy instance | 1 |
| Insurance contract or identification number | 10157717 | | Number of Individuals Covered | 52 | | Insurance policy start date | 2013-04-01 | | Insurance policy end date | 2014-03-31 | | Total amount of commissions paid to insurance broker | USD $2,435 | | Total amount of fees paid to insurance company | USD $1,227 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $16,263 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,435 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 414 | | Additional information about fees paid to insurance broker | BROKER BONUS | | Insurance broker name | CENTERSTONE DBA BENEFIT MALL |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 10157717 |
| Policy instance | 3 |
| Insurance contract or identification number | 10157717 | | Number of Individuals Covered | 48 | | Insurance policy start date | 2012-04-01 | | Insurance policy end date | 2013-03-31 | | Total amount of commissions paid to insurance broker | USD $1,897 | | Total amount of fees paid to insurance company | USD $632 | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $12,645 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,897 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 632 | | Additional information about fees paid to insurance broker | OVERRIDES | | Insurance broker name | CENTERSTONE DBA BENEFIT MALL |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 10157718 |
| Policy instance | 2 |
| Insurance contract or identification number | 10157718 | | Number of Individuals Covered | 197 | | Insurance policy start date | 2012-04-01 | | Insurance policy end date | 2013-03-31 | | Total amount of commissions paid to insurance broker | USD $3,192 | | Total amount of fees paid to insurance company | USD $3,427 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $68,530 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,192 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 3427 | | Additional information about fees paid to insurance broker | OVERRIDES | | Insurance broker name | CENTERSTONE DBA BENEFIT MALL |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | GRH-850987 |
| Policy instance | 1 |
| Insurance contract or identification number | GRH-850987 | | Number of Individuals Covered | 197 | | Insurance policy start date | 2012-04-01 | | Insurance policy end date | 2013-03-31 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $8,055 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker name | BRUCE J DICKMAN |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | GRH-850987 |
| Policy instance | 1 |
| Insurance contract or identification number | GRH-850987 | | Number of Individuals Covered | 240 | | Insurance policy start date | 2011-04-01 | | Insurance policy end date | 2012-03-31 | | Total amount of commissions paid to insurance broker | USD $6,384 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $93,372 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | GRH-850987 |
| Policy instance | 1 |
| Insurance contract or identification number | GRH-850987 | | Number of Individuals Covered | 241 | | Insurance policy start date | 2010-04-01 | | Insurance policy end date | 2011-03-31 | | Total amount of commissions paid to insurance broker | USD $7,406 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $117,222 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,406 | | Insurance broker organization code? | 3 | | Insurance broker name | BRUCE J DICKMAN |
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