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MCLAREN BAY REGION AMENDED AND RESTATED WELFARE BENEFIT PLAN 401k Plan overview

Plan NameMCLAREN BAY REGION AMENDED AND RESTATED WELFARE BENEFIT PLAN
Plan identification number 513

MCLAREN BAY REGION AMENDED AND RESTATED WELFARE BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)
  • Other welfare benefit cover
  • Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

MCLAREN BAY REGION has sponsored the creation of one or more 401k plans.

Company Name:MCLAREN BAY REGION
Employer identification number (EIN):381976271
NAIC Classification:622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MCLAREN BAY REGION AMENDED AND RESTATED WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5132016-01-01KELLEY ZWINGMAN
5132015-01-01DAMON SORENSEN
5132014-01-01DAMON SORENSEN
5132013-01-01STEPHEN J. SCANNELL
5132012-01-01STEPHEN J. SCANNELL
5132011-01-01BRIAN KAY
5132009-01-01BRIAN KAY

Plan Statistics for MCLAREN BAY REGION AMENDED AND RESTATED WELFARE BENEFIT PLAN

401k plan membership statisitcs for MCLAREN BAY REGION AMENDED AND RESTATED WELFARE BENEFIT PLAN

Measure Date Value
2016: MCLAREN BAY REGION AMENDED AND RESTATED WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-010
Total number of active participants reported on line 7a of the Form 55002016-01-010
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 participants2016-01-010
2015: MCLAREN BAY REGION AMENDED AND RESTATED WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-011,954
Total number of active participants reported on line 7a of the Form 55002015-01-011,890
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 participants2015-01-011,890
2014: MCLAREN BAY REGION AMENDED AND RESTATED WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-012,038
Total number of active participants reported on line 7a of the Form 55002014-01-011,829
Number of retired or separated participants receiving benefits2014-01-01125
Number of other retired or separated participants entitled to future benefits2014-01-010
Total of all active and inactive participants2014-01-011,954
2013: MCLAREN BAY REGION AMENDED AND RESTATED WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-012,123
Total number of active participants reported on line 7a of the Form 55002013-01-011,741
Number of retired or separated participants receiving benefits2013-01-01297
Number of other retired or separated participants entitled to future benefits2013-01-010
Total of all active and inactive participants2013-01-012,038
2012: MCLAREN BAY REGION AMENDED AND RESTATED WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-012,488
Total number of active participants reported on line 7a of the Form 55002012-01-011,832
Number of retired or separated participants receiving benefits2012-01-01291
Number of other retired or separated participants entitled to future benefits2012-01-010
Total of all active and inactive participants2012-01-012,123
2011: MCLAREN BAY REGION AMENDED AND RESTATED WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-012,413
Total number of active participants reported on line 7a of the Form 55002011-01-011,965
Number of retired or separated participants receiving benefits2011-01-01523
Number of other retired or separated participants entitled to future benefits2011-01-010
Total of all active and inactive participants2011-01-012,488
2009: MCLAREN BAY REGION AMENDED AND RESTATED WELFARE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-012,372
Total number of active participants reported on line 7a of the Form 55002009-01-011,889
Number of retired or separated participants receiving benefits2009-01-01493
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-012,382

Form 5500 Responses for MCLAREN BAY REGION AMENDED AND RESTATED WELFARE BENEFIT PLAN

2016: MCLAREN BAY REGION AMENDED AND RESTATED WELFARE BENEFIT PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01This submission is the final filingYes
2016-01-01Plan funding arrangement – General assets of the sponsorYes
2016-01-01Plan benefit arrangement – General assets of the sponsorYes
2015: MCLAREN BAY REGION AMENDED AND RESTATED WELFARE BENEFIT PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – General assets of the sponsorYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – General assets of the sponsorYes
2014: MCLAREN BAY REGION AMENDED AND RESTATED WELFARE BENEFIT PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – General assets of the sponsorYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – General assets of the sponsorYes
2013: MCLAREN BAY REGION AMENDED AND RESTATED WELFARE BENEFIT PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – General assets of the sponsorYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – General assets of the sponsorYes
2012: MCLAREN BAY REGION AMENDED AND RESTATED WELFARE BENEFIT PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – General assets of the sponsorYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – General assets of the sponsorYes
2011: MCLAREN BAY REGION AMENDED AND RESTATED WELFARE BENEFIT PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – General assets of the sponsorYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – General assets of the sponsorYes
2009: MCLAREN BAY REGION AMENDED AND RESTATED WELFARE BENEFIT PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – General assets of the sponsorYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberFF828
Policy instance 3
Insurance contract or identification numberFF828
Number of Individuals Covered92
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $10,619
Other welfare benefits providedAFLAC
Welfare Benefit Premiums Paid to CarrierUSD $94,782
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,320
Insurance broker organization code?3
Insurance broker nameRACHEL E. WHITE
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010064028
Policy instance 2
Insurance contract or identification number000010064028
Number of Individuals Covered252
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $17,020
Total amount of fees paid to insurance companyUSD $8,234
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $188,399
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,722
Amount paid for insurance broker fees8234
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
Insurance broker nameTOWERS WATSON DELAWARE INC.
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberABL962868
Policy instance 1
Insurance contract or identification numberABL962868
Number of Individuals Covered51
Insurance policy start date2014-10-15
Insurance policy end date2015-10-15
Total amount of commissions paid to insurance brokerUSD $405
Other welfare benefits providedACCIDENTAL DEATH
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $405
Insurance broker organization code?3
Insurance broker nameCOVERYS INSURANCE SERVICE
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010064028
Policy instance 2
Insurance contract or identification number000010064028
Number of Individuals Covered264
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $19,645
Total amount of fees paid to insurance companyUSD $6,750
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $182,971
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,645
Amount paid for insurance broker fees6750
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
Insurance broker nameTIMBERLAND GROUP SERVICES INC.
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberFF828
Policy instance 3
Insurance contract or identification numberFF828
Number of Individuals Covered101
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $18,251
Total amount of fees paid to insurance companyUSD $618
Other welfare benefits providedAFLAC
Welfare Benefit Premiums Paid to CarrierUSD $144,413
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,983
Amount paid for insurance broker fees181
Additional information about fees paid to insurance brokerNON-MONETARY COMPENSATION
Insurance broker organization code?3
Insurance broker nameSUZANNE K. DEVIC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberABL962868
Policy instance 1
Insurance contract or identification numberABL962868
Number of Individuals Covered54
Insurance policy start date2013-10-15
Insurance policy end date2014-10-15
Other welfare benefits providedACCIDENTAL DEATH
Welfare Benefit Premiums Paid to CarrierUSD $2,700
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberFF828
Policy instance 3
Insurance contract or identification numberFF828
Number of Individuals Covered356
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $42,859
Other welfare benefits providedAFLAC
Welfare Benefit Premiums Paid to CarrierUSD $285,187
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,503
Insurance broker organization code?3
Insurance broker nameGREGORY CRAWFORD
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010064028
Policy instance 2
Insurance contract or identification number000010064028
Number of Individuals Covered277
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $34,713
Total amount of fees paid to insurance companyUSD $7,419
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $192,848
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $34,713
Amount paid for insurance broker fees7419
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
Insurance broker nameTIMBERLAND GROUP SERVICES INC.
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberABL635640
Policy instance 1
Insurance contract or identification numberABL635640
Number of Individuals Covered1694
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $1,322
Other welfare benefits providedACCIDENTAL DEATH
Welfare Benefit Premiums Paid to CarrierUSD $8,814
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,322
Insurance broker organization code?3
Insurance broker nameMOULTHROP CLIFT INC.
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberFD651
Policy instance 4
Insurance contract or identification numberFD651
Number of Individuals Covered19
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $1,661
Other welfare benefits providedAFLAC
Welfare Benefit Premiums Paid to CarrierUSD $14,037
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $513
Insurance broker organization code?3
Insurance broker nameTLANDA MCDONALD
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberABL635640
Policy instance 1
Insurance contract or identification numberABL635640
Number of Individuals Covered1754
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $1,322
Other welfare benefits providedACCIDENTAL DEATH
Welfare Benefit Premiums Paid to CarrierUSD $8,814
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,322
Insurance broker organization code?3
Insurance broker nameMOULTHROP CLIFT INC.
FIDELITY SECURITY LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 67288 )
Policy contract number9831660
Policy instance 7
Insurance contract or identification number9831660
Number of Individuals Covered1294
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $3,494
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $65,364
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,494
Insurance broker organization code?3
Insurance broker nameTHE TIMBERLAND GROUP
FIDELITY SECURITY LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 67288 )
Policy contract number9831645
Policy instance 6
Insurance contract or identification number9831645
Number of Individuals Covered198
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $114
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,068
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $114
Insurance broker organization code?3
Insurance broker nameTHE TIMBERLAND GROUP
FIDELITY SECURITY LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 67288 )
Policy contract number9831652
Policy instance 5
Insurance contract or identification number9831652
Number of Individuals Covered1161
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $5,289
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $102,666
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,289
Insurance broker organization code?3
Insurance broker nameTHE TIMBERLAND GROUP
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberFD651
Policy instance 4
Insurance contract or identification numberFD651
Number of Individuals Covered20
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $2,125
Other welfare benefits providedAFLAC
Welfare Benefit Premiums Paid to CarrierUSD $15,935
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $721
Insurance broker organization code?3
Insurance broker nameDENNIS HARTIN
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberFF828
Policy instance 3
Insurance contract or identification numberFF828
Number of Individuals Covered400
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $44,156
Total amount of fees paid to insurance companyUSD $19
Other welfare benefits providedAFLAC
Welfare Benefit Premiums Paid to CarrierUSD $315,969
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,534
Insurance broker organization code?3
Amount paid for insurance broker fees12
Additional information about fees paid to insurance brokerNON-MONETARY COMPENSATION
Insurance broker nameLARRY E. KESSELRING
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010064028
Policy instance 2
Insurance contract or identification number000010064028
Number of Individuals Covered289
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $29,677
Total amount of fees paid to insurance companyUSD $2,989
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $164,873
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $29,677
Amount paid for insurance broker fees2989
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
Insurance broker nameTIMBERLAND GROUP SERVICES INC.
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberFF828
Policy instance 3
Insurance contract or identification numberFF828
Number of Individuals Covered395
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $51,199
Total amount of fees paid to insurance companyUSD $1,971
Other welfare benefits providedAFLAC
Welfare Benefit Premiums Paid to CarrierUSD $317,014
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010064028
Policy instance 2
Insurance contract or identification number000010064028
Number of Individuals Covered165
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $10,761
Total amount of fees paid to insurance companyUSD $3,268
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $59,782
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberABL635640
Policy instance 1
Insurance contract or identification numberABL635640
Number of Individuals Covered1878
Insurance policy start date2010-07-01
Insurance policy end date2011-06-30
Total amount of commissions paid to insurance brokerUSD $1,322
Other welfare benefits providedACCIDENTAL DEATH
Welfare Benefit Premiums Paid to CarrierUSD $8,814
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberFD651
Policy instance 4
Insurance contract or identification numberFD651
Number of Individuals Covered22
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $3,046
Other welfare benefits providedAFLAC
Welfare Benefit Premiums Paid to CarrierUSD $16,690
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberFD651
Policy instance 4
Insurance contract or identification numberFD651
Number of Individuals Covered23
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $1,578
Total amount of fees paid to insurance companyUSD $30
Other welfare benefits providedAFLAC
Welfare Benefit Premiums Paid to CarrierUSD $14,274
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $589
Amount paid for insurance broker fees4
Additional information about fees paid to insurance brokerNONMONETARY COMP
Insurance broker organization code?3
Insurance broker nameBRADLEY LOWRAN
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberFF828
Policy instance 3
Insurance contract or identification numberFF828
Number of Individuals Covered384
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $48,699
Total amount of fees paid to insurance companyUSD $1,376
Other welfare benefits providedAFLAC
Welfare Benefit Premiums Paid to CarrierUSD $302,907
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,430
Amount paid for insurance broker fees294
Additional information about fees paid to insurance brokerNONMONETARY COMP
Insurance broker organization code?3
Insurance broker nameMARY MANNING
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberABL635640
Policy instance 1
Insurance contract or identification numberABL635640
Number of Individuals Covered1812
Insurance policy start date2009-07-01
Insurance policy end date2010-06-30
Total amount of commissions paid to insurance brokerUSD $1,322
Other welfare benefits providedACCIDENTAL DEATH
Welfare Benefit Premiums Paid to CarrierUSD $8,814
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,322
Insurance broker organization code?3
Insurance broker nameMOULTHROP-CLIFT, INC.
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010064028
Policy instance 2
Insurance contract or identification number000010064028
Number of Individuals Covered140
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $11,765
Total amount of fees paid to insurance companyUSD $1,868
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $65,359
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,765
Amount paid for insurance broker fees1868
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
Insurance broker nameTIMBERLAND GROUP SERVICES INC.

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