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MICHAUD COOLEY ERICKSON AND ASSOCIATES LLC WELFARE BENEFIT PLAN 401k Plan overview

Plan NameMICHAUD COOLEY ERICKSON AND ASSOCIATES LLC WELFARE BENEFIT PLAN
Plan identification number 501

MICHAUD COOLEY ERICKSON AND ASSOCIATES LLC WELFARE BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

MICHAUD COOLEY ERICKSON AND ASSOCIATES INC has sponsored the creation of one or more 401k plans.

Company Name:MICHAUD COOLEY ERICKSON AND ASSOCIATES INC
Employer identification number (EIN):410832180
NAIC Classification:541330
NAIC Description:Engineering Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MICHAUD COOLEY ERICKSON AND ASSOCIATES LLC WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012023-01-01
5012022-01-01
5012021-01-01
5012020-01-01
5012019-01-01
5012018-01-01
5012017-01-01DOUGLAS COOLEY DOUGLAS COOLEY2018-07-26
5012016-01-01VANESSA TENNYSON VANESSA TENNYSON2017-06-16
5012015-01-01VANESSA TENNYSON VANESSA TENNYSON2016-07-06
5012014-01-01JOSEPH TENNYSON JOSEPH TENNYSON2015-07-09
5012013-01-01JOSEPH TENNYSON JOSEPH TENNYSON2014-07-15
5012012-01-01JOSEPH TENNYSON JOSEPH TENNYSON2013-07-17
5012011-01-01JOSEPH TENNYSON JOSEPH TENNYSON2012-07-27
5012010-01-01JOSEPH A TENNYSON
5012009-01-01JOSEPH TENNYSON JOSEPH TENNYSON2010-07-08

Plan Statistics for MICHAUD COOLEY ERICKSON AND ASSOCIATES LLC WELFARE BENEFIT PLAN

401k plan membership statisitcs for MICHAUD COOLEY ERICKSON AND ASSOCIATES LLC WELFARE BENEFIT PLAN

Measure Date Value
2023: MICHAUD COOLEY ERICKSON AND ASSOCIATES LLC WELFARE BENEFIT PLAN 2023 401k membership
Total participants, beginning-of-year2023-01-01108
Total number of active participants reported on line 7a of the Form 55002023-01-01115
Number of retired or separated participants receiving benefits2023-01-013
Total of all active and inactive participants2023-01-01118
2022: MICHAUD COOLEY ERICKSON AND ASSOCIATES LLC WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01107
Total number of active participants reported on line 7a of the Form 55002022-01-01107
Number of retired or separated participants receiving benefits2022-01-010
Total of all active and inactive participants2022-01-01107
2021: MICHAUD COOLEY ERICKSON AND ASSOCIATES LLC WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01113
Total number of active participants reported on line 7a of the Form 55002021-01-01102
Number of retired or separated participants receiving benefits2021-01-012
Total of all active and inactive participants2021-01-01104
2020: MICHAUD COOLEY ERICKSON AND ASSOCIATES LLC WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01121
Total number of active participants reported on line 7a of the Form 55002020-01-01107
Number of retired or separated participants receiving benefits2020-01-016
Total of all active and inactive participants2020-01-01113
2019: MICHAUD COOLEY ERICKSON AND ASSOCIATES LLC WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01121
Total number of active participants reported on line 7a of the Form 55002019-01-01124
Number of retired or separated participants receiving benefits2019-01-012
Total of all active and inactive participants2019-01-01126
2018: MICHAUD COOLEY ERICKSON AND ASSOCIATES LLC WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01123
Total number of active participants reported on line 7a of the Form 55002018-01-01119
Number of retired or separated participants receiving benefits2018-01-013
Total of all active and inactive participants2018-01-01122
2017: MICHAUD COOLEY ERICKSON AND ASSOCIATES LLC WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01118
Total number of active participants reported on line 7a of the Form 55002017-01-01120
Number of retired or separated participants receiving benefits2017-01-011
Total of all active and inactive participants2017-01-01121
2016: MICHAUD COOLEY ERICKSON AND ASSOCIATES LLC WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01109
Total number of active participants reported on line 7a of the Form 55002016-01-01118
Total of all active and inactive participants2016-01-01118
2015: MICHAUD COOLEY ERICKSON AND ASSOCIATES LLC WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01104
Total number of active participants reported on line 7a of the Form 55002015-01-01109
Total of all active and inactive participants2015-01-01109
2014: MICHAUD COOLEY ERICKSON AND ASSOCIATES LLC WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01101
Total number of active participants reported on line 7a of the Form 55002014-01-01103
Number of retired or separated participants receiving benefits2014-01-011
Total of all active and inactive participants2014-01-01104
2013: MICHAUD COOLEY ERICKSON AND ASSOCIATES LLC WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01123
Total number of active participants reported on line 7a of the Form 55002013-01-01102
Number of retired or separated participants receiving benefits2013-01-012
Total of all active and inactive participants2013-01-01104
2012: MICHAUD COOLEY ERICKSON AND ASSOCIATES LLC WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01112
Total number of active participants reported on line 7a of the Form 55002012-01-01123
Total of all active and inactive participants2012-01-01123
2011: MICHAUD COOLEY ERICKSON AND ASSOCIATES LLC WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01104
Total number of active participants reported on line 7a of the Form 55002011-01-01106
Number of retired or separated participants receiving benefits2011-01-014
Total of all active and inactive participants2011-01-01110
2010: MICHAUD COOLEY ERICKSON AND ASSOCIATES LLC WELFARE BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-01115
Total number of active participants reported on line 7a of the Form 55002010-01-01102
Number of retired or separated participants receiving benefits2010-01-012
Number of other retired or separated participants entitled to future benefits2010-01-010
Total of all active and inactive participants2010-01-01104
2009: MICHAUD COOLEY ERICKSON AND ASSOCIATES LLC WELFARE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01111
Total number of active participants reported on line 7a of the Form 55002009-01-01109
Number of retired or separated participants receiving benefits2009-01-016
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-01115

Form 5500 Responses for MICHAUD COOLEY ERICKSON AND ASSOCIATES LLC WELFARE BENEFIT PLAN

2023: MICHAUD COOLEY ERICKSON AND ASSOCIATES LLC WELFARE BENEFIT PLAN 2023 form 5500 responses
2023-01-01Type of plan entitySingle employer plan
2023-01-01Plan funding arrangement – InsuranceYes
2023-01-01Plan funding arrangement – General assets of the sponsorYes
2023-01-01Plan benefit arrangement – InsuranceYes
2023-01-01Plan benefit arrangement – General assets of the sponsorYes
2022: MICHAUD COOLEY ERICKSON AND ASSOCIATES LLC WELFARE BENEFIT PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: MICHAUD COOLEY ERICKSON AND ASSOCIATES LLC WELFARE BENEFIT PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: MICHAUD COOLEY ERICKSON AND ASSOCIATES LLC WELFARE BENEFIT PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: MICHAUD COOLEY ERICKSON AND ASSOCIATES LLC WELFARE BENEFIT PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – General assets of the sponsorYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – General assets of the sponsorYes
2018: MICHAUD COOLEY ERICKSON AND ASSOCIATES LLC WELFARE BENEFIT PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: MICHAUD COOLEY ERICKSON AND ASSOCIATES LLC WELFARE BENEFIT PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: MICHAUD COOLEY ERICKSON AND ASSOCIATES LLC WELFARE BENEFIT PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – General assets of the sponsorYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – General assets of the sponsorYes
2015: MICHAUD COOLEY ERICKSON AND ASSOCIATES LLC 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: MICHAUD COOLEY ERICKSON AND ASSOCIATES LLC 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: MICHAUD COOLEY ERICKSON AND ASSOCIATES LLC 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: MICHAUD COOLEY ERICKSON AND ASSOCIATES LLC 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: MICHAUD COOLEY ERICKSON AND ASSOCIATES LLC 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
2010: MICHAUD COOLEY ERICKSON AND ASSOCIATES LLC WELFARE BENEFIT PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedNo
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan funding arrangement – General assets of the sponsorYes
2010-01-01Plan benefit arrangement – InsuranceYes
2010-01-01Plan benefit arrangement – General assets of the sponsorYes
2009: MICHAUD COOLEY ERICKSON AND ASSOCIATES LLC WELFARE BENEFIT PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
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

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0130203
Policy instance 3
Insurance contract or identification number0130203
Number of Individuals Covered1
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedINDIVIDUAL DISABILITY INCOME
Welfare Benefit Premiums Paid to CarrierUSD $606
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 numberSGM0612492
Policy instance 2
Insurance contract or identification numberSGM0612492
Number of Individuals Covered118
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $4,314
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $45,405
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HEALTHPARTNERS INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 44547 )
Policy contract number0172
Policy instance 1
Insurance contract or identification number0172
Number of Individuals Covered222
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $13,892
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,305,710
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0130203
Policy instance 3
Insurance contract or identification number0130203
Number of Individuals Covered1
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedDISABILITY INCOME
Welfare Benefit Premiums Paid to CarrierUSD $606
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: 65675 )
Policy contract number10252835
Policy instance 2
Insurance contract or identification number10252835
Number of Individuals Covered106
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $1,052
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $48,729
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees715
Additional information about fees paid to insurance brokerMARKETING ALLOWANCE
Insurance broker organization code?3
BCBSM, INC. DBA BLUE CROSS AND BLUE SHIELD OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55026 )
Policy contract number265540
Policy instance 1
Insurance contract or identification number265540
Number of Individuals Covered204
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $1,661
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,509,980
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,661
Insurance broker organization code?3
BCBSM, INC. DBA BLUE CROSS AND BLUE SHIELD OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55026 )
Policy contract number265540
Policy instance 1
Insurance contract or identification number265540
Number of Individuals Covered216
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,459,482
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: 65675 )
Policy contract number10252835
Policy instance 2
Insurance contract or identification number10252835
Number of Individuals Covered105
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $913
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $47,135
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees734
Additional information about fees paid to insurance brokerMARKETING ALLOWANCE
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0130203
Policy instance 3
Insurance contract or identification number0130203
Number of Individuals Covered1
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedDISABILITY INCOME
Welfare Benefit Premiums Paid to CarrierUSD $661
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: 65675 )
Policy contract number10252835
Policy instance 2
Insurance contract or identification number10252835
Number of Individuals Covered111
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $473
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $35,061
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees334
Insurance broker organization code?3
Additional information about fees paid to insurance brokerMARKETING ALLOWANCE
BCBSM, INC. DBA BLUE CROSS AND BLUE SHIELD OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55026 )
Policy contract number265540
Policy instance 1
Insurance contract or identification number265540
Number of Individuals Covered216
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,529,862
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )
Policy contract numberMP0000723493
Policy instance 4
Insurance contract or identification numberMP0000723493
Number of Individuals Covered118
Insurance policy start date2019-01-01
Insurance policy end date2019-05-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $12,946
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: 65675 )
Policy contract number10252835
Policy instance 3
Insurance contract or identification number10252835
Number of Individuals Covered121
Insurance policy start date2019-06-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $1,290
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $25,799
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees1290
Additional information about fees paid to insurance brokerMARKETING ALLOWANCE
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number130203
Policy instance 2
Insurance contract or identification number130203
Number of Individuals Covered3
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedDISABILITY INSURANCE
Welfare Benefit Premiums Paid to CarrierUSD $2,453
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MEDICA (National Association of Insurance Commissioners NAIC id number: 12459 )
Policy contract number122707
Policy instance 1
Insurance contract or identification number122707
Number of Individuals Covered198
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $38,372
Total amount of fees paid to insurance companyUSD $569
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,393,458
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $38,372
Amount paid for insurance broker fees569
Additional information about fees paid to insurance brokerMARKETING ALLOWANCE
Insurance broker organization code?3
LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )
Policy contract numberMP00000723493
Policy instance 3
Insurance contract or identification numberMP00000723493
Number of Individuals Covered118
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $823
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $38,759
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees823
Additional information about fees paid to insurance brokerMARKETING ALLOWANCE
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number130203
Policy instance 2
Insurance contract or identification number130203
Number of Individuals Covered3
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $22
Total amount of fees paid to insurance companyUSD $344
Other welfare benefits providedDISABILITY INSURANCE
Welfare Benefit Premiums Paid to CarrierUSD $1,924
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11
Amount paid for insurance broker fees344
Additional information about fees paid to insurance brokerMARKETING ALLOWANCE
Insurance broker organization code?3
MEDICA (National Association of Insurance Commissioners NAIC id number: 12459 )
Policy contract number122707
Policy instance 1
Insurance contract or identification number122707
Number of Individuals Covered212
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $39,537
Total amount of fees paid to insurance companyUSD $592
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,723,689
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $39,537
Amount paid for insurance broker fees592
Additional information about fees paid to insurance brokerMARKETING ALLOWANCE
Insurance broker organization code?3
LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )
Policy contract numberMP00000727493
Policy instance 3
Insurance contract or identification numberMP00000727493
Number of Individuals Covered125
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $28,717
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number418297
Policy instance 2
Insurance contract or identification number418297
Number of Individuals Covered121
Insurance policy start date2017-01-01
Insurance policy end date2017-04-01
Total amount of commissions paid to insurance brokerUSD $1,954
Total amount of fees paid to insurance companyUSD $-494
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $3,257
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,954
Amount paid for insurance broker fees-494
Additional information about fees paid to insurance brokerMARKETING ALLOWANCE
Insurance broker organization code?3
Insurance broker nameTHE KNW GROUP LLC
MEDICA (National Association of Insurance Commissioners NAIC id number: 12459 )
Policy contract number122707
Policy instance 1
Insurance contract or identification number122707
Number of Individuals Covered239
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $38,110
Total amount of fees paid to insurance companyUSD $2,704
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,524,398
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $38,110
Amount paid for insurance broker fees2704
Additional information about fees paid to insurance brokerMARKETING ALLOWANCE
Insurance broker organization code?3
Insurance broker nameTHE KNW GROUP LLC
MEDICA (National Association of Insurance Commissioners NAIC id number: 12459 )
Policy contract number122707
Policy instance 1
Insurance contract or identification number122707
Number of Individuals Covered95
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $32,256
Total amount of fees paid to insurance companyUSD $529
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,289,787
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $32,256
Amount paid for insurance broker fees529
Additional information about fees paid to insurance brokerMARKETING ALLOWANCE
Insurance broker organization code?3
Insurance broker nameTHE KNW GROUP LLC
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number418297
Policy instance 2
Insurance contract or identification number418297
Number of Individuals Covered106
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $4,928
Total amount of fees paid to insurance companyUSD $657
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $35,601
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,928
Amount paid for insurance broker fees657
Additional information about fees paid to insurance brokerMARKETING ALLOWANCE
Insurance broker organization code?3
Insurance broker nameFINANCIAL CNCPTS-TWIN CITIES
MEDICA (National Association of Insurance Commissioners NAIC id number: 12459 )
Policy contract number122707
Policy instance 1
Insurance contract or identification number122707
Number of Individuals Covered92
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $25,519
Total amount of fees paid to insurance companyUSD $529
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,110,565
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $25,519
Amount paid for insurance broker fees529
Additional information about fees paid to insurance brokerMARKETING ALLOWANCE
Insurance broker organization code?3
Insurance broker nameTHE KNW GROUP LLC
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number10028991
Policy instance 2
Insurance contract or identification number10028991
Number of Individuals Covered103
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $4,952
Total amount of fees paid to insurance companyUSD $1,417
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $33,013
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,952
Insurance broker organization code?3
Amount paid for insurance broker fees1417
Additional information about fees paid to insurance brokerMARKETING ALLOWANCE
Insurance broker nameFINANCIAL CNCPTS-TWIN CITIES
MEDICA (National Association of Insurance Commissioners NAIC id number: 12459 )
Policy contract number122707
Policy instance 1
Insurance contract or identification number122707
Number of Individuals Covered100
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $31,325
Total amount of fees paid to insurance companyUSD $523
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,273,954
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $31,325
Amount paid for insurance broker fees523
Additional information about fees paid to insurance brokerMARKETING ALLOWANCE
Insurance broker organization code?3
Insurance broker nameTHE KNW GROUP LLC
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number10028991
Policy instance 2
Insurance contract or identification number10028991
Number of Individuals Covered101
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $5,315
Total amount of fees paid to insurance companyUSD $955
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $35,430
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,315
Insurance broker organization code?3
Amount paid for insurance broker fees955
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker nameFINANCIAL CNCPTS-TWIN CITIES
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number10028992
Policy instance 2
Insurance contract or identification number10028992
Number of Individuals Covered123
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $4,774
Total amount of fees paid to insurance companyUSD $1,346
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $31,828
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,774
Insurance broker organization code?3
Amount paid for insurance broker fees1346
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker nameFINANCIAL CNCPTS-TWIN CITIES
MEDICA (National Association of Insurance Commissioners NAIC id number: 12459 )
Policy contract number122707
Policy instance 1
Insurance contract or identification number122707
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $33,357
Total amount of fees paid to insurance companyUSD $4,692
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,328,730
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $33,357
Amount paid for insurance broker fees4692
Additional information about fees paid to insurance brokerMARKETING ALLOWANCE
Insurance broker organization code?3
Insurance broker nameTHE KNW GROUP LLC
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number10028992
Policy instance 2
Insurance contract or identification number10028992
Number of Individuals Covered110
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $4,252
Total amount of fees paid to insurance companyUSD $1,328
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $28,345
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MEDICA (National Association of Insurance Commissioners NAIC id number: 12459 )
Policy contract number122707
Policy instance 1
Insurance contract or identification number122707
Number of Individuals Covered107
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $32,692
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
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,140,388
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MEDICA (National Association of Insurance Commissioners NAIC id number: 12459 )
Policy contract number122707
Policy instance 1
Insurance contract or identification number122707
Number of Individuals Covered102
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $25,524
Total amount of fees paid to insurance companyUSD $798
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
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 $1,006,934
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $25,524
Amount paid for insurance broker fees798
Additional information about fees paid to insurance brokerCONTINGENCY FEE
Insurance broker organization code?3
Insurance broker nameTHE KNW GROUP, LLC
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number10028991
Policy instance 2
Insurance contract or identification number10028991
Number of Individuals Covered100
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $4,194
Total amount of fees paid to insurance companyUSD $604
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 BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
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 $27,961
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,194
Amount paid for insurance broker fees604
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
Insurance broker nameTHE KNW GROUP, LLC

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