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SERVICE EMPLOYEES INTERNATIONAL UNION BENEFIT PLAN 401k Plan overview

Plan NameSERVICE EMPLOYEES INTERNATIONAL UNION BENEFIT PLAN
Plan identification number 501

SERVICE EMPLOYEES INTERNATIONAL UNION BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Dental
  • Vision
  • Long-term disability cover
  • Other welfare benefit cover

401k Sponsoring company profile

SERVICE EMPLOYEES INTL UNION has sponsored the creation of one or more 401k plans.

Company Name:SERVICE EMPLOYEES INTL UNION
Employer identification number (EIN):360852885
NAIC Classification:813930
NAIC Description:Labor Unions and Similar Labor Organizations

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SERVICE EMPLOYEES INTERNATIONAL UNION BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01MEGAN SWEENEY2023-10-10
5012021-01-01MEGAN SWEENEY2022-09-25
5012020-01-01MEGAN SWEENEY2021-10-03
5012019-01-01ARUN IVATURY2020-09-29
5012018-01-01ARUN IVATURY2019-10-08
5012017-01-01
5012016-01-01WILLIAM DEMPSEY
5012015-01-01BILL DEMPSEY
5012014-01-01STEPHEN ABRECHT
5012013-01-01
5012012-01-01STEPHEN ABRECHT
5012011-01-01STEPHEN ABRECHT
5012009-01-01KEITH MESTRICH
5012009-01-01MARY KAY HENRY
5012008-01-01KEITH MESTRICH
5012007-01-01KEITH MESTRICH
5012006-01-01KEITH MESTRICH
5012005-01-01KEITH MESTRICH
5012004-01-01KEITH MESTRICH
5012003-01-01KEITH MESTRICH
5012002-01-01KEITH MESTRICH
5012001-01-01KEITH MESTRICH
5012000-01-01KEITH MESTRICH
5011999-01-01KEITH MESTRICH

Plan Statistics for SERVICE EMPLOYEES INTERNATIONAL UNION BENEFIT PLAN

401k plan membership statisitcs for SERVICE EMPLOYEES INTERNATIONAL UNION BENEFIT PLAN

Measure Date Value
2022: SERVICE EMPLOYEES INTERNATIONAL UNION BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01403
Total number of active participants reported on line 7a of the Form 55002022-01-01408
Total of all active and inactive participants2022-01-01408
2021: SERVICE EMPLOYEES INTERNATIONAL UNION BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01395
Total number of active participants reported on line 7a of the Form 55002021-01-01403
Total of all active and inactive participants2021-01-01403
2020: SERVICE EMPLOYEES INTERNATIONAL UNION BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01341
Total number of active participants reported on line 7a of the Form 55002020-01-01395
Total of all active and inactive participants2020-01-01395
2019: SERVICE EMPLOYEES INTERNATIONAL UNION BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01362
Total number of active participants reported on line 7a of the Form 55002019-01-01341
Total of all active and inactive participants2019-01-01341
2018: SERVICE EMPLOYEES INTERNATIONAL UNION BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01466
Total number of active participants reported on line 7a of the Form 55002018-01-01362
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-01362
2017: SERVICE EMPLOYEES INTERNATIONAL UNION BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01506
Total number of active participants reported on line 7a of the Form 55002017-01-01466
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-01466
2016: SERVICE EMPLOYEES INTERNATIONAL UNION BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01538
Total number of active participants reported on line 7a of the Form 55002016-01-01506
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-01506
2015: SERVICE EMPLOYEES INTERNATIONAL UNION BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01541
Total number of active participants reported on line 7a of the Form 55002015-01-01538
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-010
Total of all active and inactive participants2015-01-01538
2014: SERVICE EMPLOYEES INTERNATIONAL UNION BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01537
Total number of active participants reported on line 7a of the Form 55002014-01-01541
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-010
Total of all active and inactive participants2014-01-01541
2013: SERVICE EMPLOYEES INTERNATIONAL UNION BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01558
Total number of active participants reported on line 7a of the Form 55002013-01-01537
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-010
Total of all active and inactive participants2013-01-01537
2012: SERVICE EMPLOYEES INTERNATIONAL UNION BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01537
Total number of active participants reported on line 7a of the Form 55002012-01-01558
Total of all active and inactive participants2012-01-01558
2011: SERVICE EMPLOYEES INTERNATIONAL UNION BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01477
Total number of active participants reported on line 7a of the Form 55002011-01-01537
Total of all active and inactive participants2011-01-01537
2009: SERVICE EMPLOYEES INTERNATIONAL UNION BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01665
Total number of active participants reported on line 7a of the Form 55002009-01-01594
Total of all active and inactive participants2009-01-01594
Number of employers contributing to the scheme2009-01-010
2008: SERVICE EMPLOYEES INTERNATIONAL UNION BENEFIT PLAN 2008 401k membership
Total participants, beginning-of-year2008-01-01606
Total number of active participants reported on line 7a of the Form 55002008-01-01665
Total of all active and inactive participants2008-01-01665
2007: SERVICE EMPLOYEES INTERNATIONAL UNION BENEFIT PLAN 2007 401k membership
Total participants, beginning-of-year2007-01-01575
Total number of active participants reported on line 7a of the Form 55002007-01-01606
Total of all active and inactive participants2007-01-01606
2006: SERVICE EMPLOYEES INTERNATIONAL UNION BENEFIT PLAN 2006 401k membership
Total participants, beginning-of-year2006-01-01541
Total number of active participants reported on line 7a of the Form 55002006-01-01575
Total of all active and inactive participants2006-01-01575
2005: SERVICE EMPLOYEES INTERNATIONAL UNION BENEFIT PLAN 2005 401k membership
Total participants, beginning-of-year2005-01-01546
Total number of active participants reported on line 7a of the Form 55002005-01-01541
Total of all active and inactive participants2005-01-01541
2004: SERVICE EMPLOYEES INTERNATIONAL UNION BENEFIT PLAN 2004 401k membership
Total participants, beginning-of-year2004-01-01496
Total number of active participants reported on line 7a of the Form 55002004-01-01546
Total of all active and inactive participants2004-01-01546
2003: SERVICE EMPLOYEES INTERNATIONAL UNION BENEFIT PLAN 2003 401k membership
Total participants, beginning-of-year2003-01-01347
Total number of active participants reported on line 7a of the Form 55002003-01-01496
Total of all active and inactive participants2003-01-01496
2002: SERVICE EMPLOYEES INTERNATIONAL UNION BENEFIT PLAN 2002 401k membership
Total participants, beginning-of-year2002-01-01331
Total number of active participants reported on line 7a of the Form 55002002-01-01347
Total of all active and inactive participants2002-01-01347
2001: SERVICE EMPLOYEES INTERNATIONAL UNION BENEFIT PLAN 2001 401k membership
Total participants, beginning-of-year2001-01-01331
Total number of active participants reported on line 7a of the Form 55002001-01-01331
Total of all active and inactive participants2001-01-01331
2000: SERVICE EMPLOYEES INTERNATIONAL UNION BENEFIT PLAN 2000 401k membership
Total participants, beginning-of-year2000-01-01345
Total number of active participants reported on line 7a of the Form 55002000-01-01331
Total of all active and inactive participants2000-01-01331
1999: SERVICE EMPLOYEES INTERNATIONAL UNION BENEFIT PLAN 1999 401k membership
Total participants, beginning-of-year1999-01-01347
Total number of active participants reported on line 7a of the Form 55001999-01-01345
Total of all active and inactive participants1999-01-01345

Financial Data on SERVICE EMPLOYEES INTERNATIONAL UNION BENEFIT PLAN

Measure Date Value
2010 : SERVICE EMPLOYEES INTERNATIONAL UNION BENEFIT PLAN 2010 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-10-18$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-10-18$61,938
Total income from all sources (including contributions)2010-10-18$92,965
Total of all expenses incurred2010-10-18$64,328
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2010-10-18$60,795
Total contributions o plan (from employers,participants, others, non cash contrinutions)2010-10-18$91,527
Value of total assets at end of year2010-10-18$0
Value of total assets at beginning of year2010-10-18$33,301
Total of administrative expenses incurred including professional, contract, advisory and management fees2010-10-18$3,533
Total interest from all sources2010-10-18$42
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2010-10-18Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan2010-10-18$0
Administrative expenses professional fees incurred2010-10-18$3,334
Was this plan covered by a fidelity bond2010-10-18Yes
Value of fidelity bond cover2010-10-18$500,000
If this is an individual account plan, was there a blackout period2010-10-18No
Were there any nonexempt tranactions with any party-in-interest2010-10-18No
Contributions received from participants2010-10-18$91,527
Participant contributions at end of year2010-10-18$0
Participant contributions at beginning of year2010-10-18$59
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2010-10-18$3,608
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2010-10-18$28,969
Other income not declared elsewhere2010-10-18$1,396
Administrative expenses (other) incurred2010-10-18$199
Liabilities. Value of operating payables at end of year2010-10-18$0
Liabilities. Value of operating payables at beginning of year2010-10-18$32,969
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2010-10-18No
Value of net income/loss2010-10-18$28,637
Value of net assets at end of year (total assets less liabilities)2010-10-18$0
Value of net assets at beginning of year (total assets less liabilities)2010-10-18$-28,637
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2010-10-18No
Were any loans by the plan or fixed income obligations due to the plan in default2010-10-18No
Were any leases to which the plan was party in default or uncollectible2010-10-18No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2010-10-18$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2010-10-18$29,634
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2010-10-18$29,634
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2010-10-18$42
Expenses. Payments to insurance carriers foe the provision of benefits2010-10-18$60,795
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2010-10-18No
Was there a failure to transmit to the plan any participant contributions2010-10-18No
Has the plan failed to provide any benefit when due under the plan2010-10-18No
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32010-10-18No
Did the plan have assets held for investment2010-10-18No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2010-10-18No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2010-10-18No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2010-10-18No
Opinion of an independent qualified public accountant for this plan2010-10-18Unqualified
Accountancy firm name2010-10-18CALIBRE CPA GROUP PLLC
Accountancy firm EIN2010-10-18470900880

Form 5500 Responses for SERVICE EMPLOYEES INTERNATIONAL UNION BENEFIT PLAN

2022: SERVICE EMPLOYEES INTERNATIONAL UNION BENEFIT PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – InsuranceYes
2021: SERVICE EMPLOYEES INTERNATIONAL UNION BENEFIT PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – InsuranceYes
2020: SERVICE EMPLOYEES INTERNATIONAL UNION BENEFIT PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – InsuranceYes
2019: SERVICE EMPLOYEES INTERNATIONAL UNION BENEFIT PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – InsuranceYes
2018: SERVICE EMPLOYEES INTERNATIONAL UNION BENEFIT PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – InsuranceYes
2017: SERVICE EMPLOYEES INTERNATIONAL UNION BENEFIT PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – InsuranceYes
2016: SERVICE EMPLOYEES INTERNATIONAL UNION BENEFIT PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – InsuranceYes
2015: SERVICE EMPLOYEES INTERNATIONAL UNION BENEFIT PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: SERVICE EMPLOYEES INTERNATIONAL UNION BENEFIT PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: SERVICE EMPLOYEES INTERNATIONAL UNION BENEFIT PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: SERVICE EMPLOYEES INTERNATIONAL UNION BENEFIT PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: SERVICE EMPLOYEES INTERNATIONAL UNION BENEFIT PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – InsuranceYes
2009: SERVICE EMPLOYEES INTERNATIONAL UNION BENEFIT PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01This submission is the final filingNo
2009-01-01Plan is a collectively bargained planYes
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement - TrustYes
2008: SERVICE EMPLOYEES INTERNATIONAL UNION BENEFIT PLAN 2008 form 5500 responses
2008-01-01Type of plan entitySingle employer plan
2008-01-01This submission is the final filingNo
2008-01-01Plan funding arrangement – InsuranceYes
2008-01-01Plan benefit arrangement – InsuranceYes
2007: SERVICE EMPLOYEES INTERNATIONAL UNION BENEFIT PLAN 2007 form 5500 responses
2007-01-01Type of plan entitySingle employer plan
2007-01-01This submission is the final filingNo
2007-01-01Plan funding arrangement – InsuranceYes
2007-01-01Plan benefit arrangement – InsuranceYes
2006: SERVICE EMPLOYEES INTERNATIONAL UNION BENEFIT PLAN 2006 form 5500 responses
2006-01-01Type of plan entitySingle employer plan
2006-01-01This submission is the final filingNo
2006-01-01Plan funding arrangement – InsuranceYes
2006-01-01Plan benefit arrangement – InsuranceYes
2005: SERVICE EMPLOYEES INTERNATIONAL UNION BENEFIT PLAN 2005 form 5500 responses
2005-01-01Type of plan entitySingle employer plan
2005-01-01This submission is the final filingNo
2005-01-01Plan funding arrangement – InsuranceYes
2005-01-01Plan benefit arrangement – InsuranceYes
2004: SERVICE EMPLOYEES INTERNATIONAL UNION BENEFIT PLAN 2004 form 5500 responses
2004-01-01Type of plan entitySingle employer plan
2004-01-01This submission is the final filingNo
2004-01-01Plan funding arrangement – InsuranceYes
2004-01-01Plan benefit arrangement – InsuranceYes
2003: SERVICE EMPLOYEES INTERNATIONAL UNION BENEFIT PLAN 2003 form 5500 responses
2003-01-01Type of plan entitySingle employer plan
2003-01-01This submission is the final filingNo
2003-01-01Plan funding arrangement – InsuranceYes
2003-01-01Plan benefit arrangement – InsuranceYes
2002: SERVICE EMPLOYEES INTERNATIONAL UNION BENEFIT PLAN 2002 form 5500 responses
2002-01-01Type of plan entitySingle employer plan
2002-01-01This submission is the final filingNo
2002-01-01Plan funding arrangement – InsuranceYes
2002-01-01Plan benefit arrangement – InsuranceYes
2001: SERVICE EMPLOYEES INTERNATIONAL UNION BENEFIT PLAN 2001 form 5500 responses
2001-01-01Type of plan entitySingle employer plan
2001-01-01This submission is the final filingNo
2001-01-01Plan funding arrangement – InsuranceYes
2001-01-01Plan benefit arrangement – InsuranceYes
2000: SERVICE EMPLOYEES INTERNATIONAL UNION BENEFIT PLAN 2000 form 5500 responses
2000-01-01Type of plan entitySingle employer plan
2000-01-01This submission is the final filingNo
2000-01-01Plan funding arrangement – InsuranceYes
2000-01-01Plan benefit arrangement – InsuranceYes
1999: SERVICE EMPLOYEES INTERNATIONAL UNION BENEFIT PLAN 1999 form 5500 responses
1999-01-01Type of plan entitySingle employer plan
1999-01-01This submission is the final filingNo
1999-01-01Plan funding arrangement – InsuranceYes
1999-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number921533
Policy instance 2
Insurance contract or identification number921533
Number of Individuals Covered408
Insurance policy start date2021-11-01
Insurance policy end date2022-10-31
Total amount of commissions paid to insurance brokerUSD $5,218
Total amount of fees paid to insurance companyUSD $3,835
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $128,332
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,048
Amount paid for insurance broker fees3835
Additional information about fees paid to insurance brokerBONUS AND ADDITIONAL PAYMENT
Insurance broker organization code?3
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number52646-2
Policy instance 1
Insurance contract or identification number52646-2
Number of Individuals Covered3066
Insurance policy start date2021-10-01
Insurance policy end date2022-09-30
Total amount of commissions paid to insurance brokerUSD $159,607
Total amount of fees paid to insurance companyUSD $367,829
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $1,760,939
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $159,607
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerTHIRD PARTY ADMINISTRATION FEES
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number921533
Policy instance 2
Insurance contract or identification number921533
Number of Individuals Covered403
Insurance policy start date2020-11-01
Insurance policy end date2021-10-31
Total amount of commissions paid to insurance brokerUSD $5,520
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $184,326
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,520
Insurance broker organization code?3
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number52646-2
Policy instance 1
Insurance contract or identification number52646-2
Number of Individuals Covered8935
Insurance policy start date2020-10-01
Insurance policy end date2021-09-30
Total amount of commissions paid to insurance brokerUSD $108,871
Total amount of fees paid to insurance companyUSD $271,210
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $1,237,899
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $108,871
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerTHIRD PARTY ADMINISTRATION FEES
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number921533
Policy instance 2
Insurance contract or identification number921533
Number of Individuals Covered395
Insurance policy start date2019-11-01
Insurance policy end date2020-10-31
Total amount of commissions paid to insurance brokerUSD $5,876
Total amount of fees paid to insurance companyUSD $5,808
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $177,469
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,876
Amount paid for insurance broker fees5808
Additional information about fees paid to insurance brokerBASIC LONG TERM DISABILITY
Insurance broker organization code?3
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number52646-2
Policy instance 1
Insurance contract or identification number52646-2
Number of Individuals Covered2475
Insurance policy start date2019-10-01
Insurance policy end date2020-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $131,207
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $663,048
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees131207
Additional information about fees paid to insurance brokerTHIRD PARTY ADMINISTRATION FEES
Insurance broker organization code?5
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number921533
Policy instance 1
Insurance contract or identification number921533
Number of Individuals Covered341
Insurance policy start date2018-11-01
Insurance policy end date2019-10-31
Total amount of commissions paid to insurance brokerUSD $5,245
Total amount of fees paid to insurance companyUSD $5,074
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $166,179
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,245
Amount paid for insurance broker fees5074
Additional information about fees paid to insurance brokerBASIC LONG TERM DISABILITY
Insurance broker organization code?3
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number52646-2
Policy instance 1
Insurance contract or identification number52646-2
Number of Individuals Covered1212
Insurance policy start date2017-10-01
Insurance policy end date2018-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $38,549
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $166,017
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees38549
Additional information about fees paid to insurance brokerTHIRD PARTY ADMINISTRATION FEES
Insurance broker organization code?5
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number921533
Policy instance 2
Insurance contract or identification number921533
Number of Individuals Covered362
Insurance policy start date2018-11-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $130,066
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Insurance broker organization code?3
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5469244
Policy instance 1
Insurance contract or identification number5469244
Number of Individuals Covered466
Insurance policy start date2016-11-01
Insurance policy end date2017-10-31
Total amount of commissions paid to insurance brokerUSD $5,407
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $152,906
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,407
Insurance broker organization code?3
Insurance broker nameGALLAGHER BENEFIT SERVICES
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5469244
Policy instance 1
Insurance contract or identification number5469244
Number of Individuals Covered506
Insurance policy start date2015-11-01
Insurance policy end date2016-10-31
Total amount of commissions paid to insurance brokerUSD $5,358
Total amount of fees paid to insurance companyUSD $346
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $135,805
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,358
Amount paid for insurance broker fees346
Additional information about fees paid to insurance brokerNON MONETARY COMP WHICH REPRESENTS A PROPORTIONATE SHARE OF FAIR MARKET VALUE OF NON MONETARY COMP
Insurance broker organization code?3
Insurance broker nameGALLAGHER BENEFIT SERVICES
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5469244
Policy instance 1
Insurance contract or identification number5469244
Number of Individuals Covered538
Insurance policy start date2014-11-01
Insurance policy end date2015-10-31
Total amount of commissions paid to insurance brokerUSD $5,496
Total amount of fees paid to insurance companyUSD $6,291
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $109,005
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,718
Amount paid for insurance broker fees6291
Additional information about fees paid to insurance brokerPRODUCER BONUS PROGRAM
Insurance broker organization code?3
Insurance broker nameGALLAGHER BENEFIT SERVICES
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5469244
Policy instance 1
Insurance contract or identification number5469244
Number of Individuals Covered541
Insurance policy start date2013-11-01
Insurance policy end date2014-10-31
Total amount of commissions paid to insurance brokerUSD $5,110
Total amount of fees paid to insurance companyUSD $1,082
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $110,996
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,110
Amount paid for insurance broker fees1082
Additional information about fees paid to insurance brokerPRODUCER BONUS PROGRAM - $1,005 NON MONETARY COMPENSATION - $77
Insurance broker organization code?3
Insurance broker nameINDEPENDENT BENEFIT SERVS
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number146378
Policy instance 1
Insurance contract or identification number146378
Number of Individuals Covered537
Insurance policy start date2012-10-01
Insurance policy end date2013-09-30
Total amount of commissions paid to insurance brokerUSD $5,852
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,443
Insurance broker organization code?3
Insurance broker nameINDEPENDENT BENEFIT SERVICES
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number146378
Policy instance 1
Insurance contract or identification number146378
Number of Individuals Covered558
Insurance policy start date2011-10-01
Insurance policy end date2012-09-30
Total amount of commissions paid to insurance brokerUSD $5,788
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,788
Insurance broker organization code?3
Insurance broker nameMARVIN A ADDRESS ASSOCIATION, INC.
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number146378
Policy instance 1
Insurance contract or identification number146378
Number of Individuals Covered537
Insurance policy start date2010-10-01
Insurance policy end date2011-09-30
Total amount of commissions paid to insurance brokerUSD $4,968
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number146378
Policy instance 1
Insurance contract or identification number146378
Number of Individuals Covered477
Insurance policy start date2009-10-01
Insurance policy end date2010-09-30
Total amount of commissions paid to insurance brokerUSD $5,123
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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