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AMERICAN MULTISPECIALTY GROUP, INC. DBA ESSE HEALTH LIFE INSURANCE & AD&D INSURANCE PLAN 401k Plan overview

Plan NameAMERICAN MULTISPECIALTY GROUP, INC. DBA ESSE HEALTH LIFE INSURANCE & AD&D INSURANCE PLAN
Plan identification number 501

AMERICAN MULTISPECIALTY GROUP, INC. DBA ESSE HEALTH LIFE INSURANCE & AD&D INSURANCE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Life insurance
  • Other welfare benefit cover

401k Sponsoring company profile

AMERICAN MULTISPECIALTY GROUP, INC. DBA ESSE HEALTH has sponsored the creation of one or more 401k plans.

Company Name:AMERICAN MULTISPECIALTY GROUP, INC. DBA ESSE HEALTH
Employer identification number (EIN):431383893
NAIC Classification:621111
NAIC Description:Offices of Physicians (except Mental Health Specialists)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan AMERICAN MULTISPECIALTY GROUP, INC. DBA ESSE HEALTH LIFE INSURANCE & AD&D INSURANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012019-01-01DAVID KEARNEY2020-08-02
5012018-01-01DAVID KEARNEY2019-07-25
5012017-01-01
5012016-01-01
5012015-01-01
5012014-01-01
5012013-01-01
5012012-01-01DAVID KEARNEY
5012011-01-01DAVID KEARNEY
5012009-01-01DAVID KEARNEY

Plan Statistics for AMERICAN MULTISPECIALTY GROUP, INC. DBA ESSE HEALTH LIFE INSURANCE & AD&D INSURANCE PLAN

401k plan membership statisitcs for AMERICAN MULTISPECIALTY GROUP, INC. DBA ESSE HEALTH LIFE INSURANCE & AD&D INSURANCE PLAN

Measure Date Value
2019: AMERICAN MULTISPECIALTY GROUP, INC. DBA ESSE HEALTH LIFE INSURANCE & AD&D INSURANCE PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01755
Total number of active participants reported on line 7a of the Form 55002019-01-010
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-010
2018: AMERICAN MULTISPECIALTY GROUP, INC. DBA ESSE HEALTH LIFE INSURANCE & AD&D INSURANCE PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01600
Total number of active participants reported on line 7a of the Form 55002018-01-01755
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 participants2018-01-01755
2017: AMERICAN MULTISPECIALTY GROUP, INC. DBA ESSE HEALTH LIFE INSURANCE & AD&D INSURANCE PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01602
Total number of active participants reported on line 7a of the Form 55002017-01-01600
Total of all active and inactive participants2017-01-01600
2016: AMERICAN MULTISPECIALTY GROUP, INC. DBA ESSE HEALTH LIFE INSURANCE & AD&D INSURANCE PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01602
Total number of active participants reported on line 7a of the Form 55002016-01-01602
Total of all active and inactive participants2016-01-01602
2015: AMERICAN MULTISPECIALTY GROUP, INC. DBA ESSE HEALTH LIFE INSURANCE & AD&D INSURANCE PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01599
Total number of active participants reported on line 7a of the Form 55002015-01-01602
Total of all active and inactive participants2015-01-01602
2014: AMERICAN MULTISPECIALTY GROUP, INC. DBA ESSE HEALTH LIFE INSURANCE & AD&D INSURANCE PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01538
Total number of active participants reported on line 7a of the Form 55002014-01-01599
Total of all active and inactive participants2014-01-01599
2013: AMERICAN MULTISPECIALTY GROUP, INC. DBA ESSE HEALTH LIFE INSURANCE & AD&D INSURANCE PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01502
Total number of active participants reported on line 7a of the Form 55002013-01-01538
Total of all active and inactive participants2013-01-01538
2012: AMERICAN MULTISPECIALTY GROUP, INC. DBA ESSE HEALTH LIFE INSURANCE & AD&D INSURANCE PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01462
Total number of active participants reported on line 7a of the Form 55002012-01-01502
Total of all active and inactive participants2012-01-01502
2011: AMERICAN MULTISPECIALTY GROUP, INC. DBA ESSE HEALTH LIFE INSURANCE & AD&D INSURANCE PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01441
Total number of active participants reported on line 7a of the Form 55002011-01-01462
Total of all active and inactive participants2011-01-01462
2009: AMERICAN MULTISPECIALTY GROUP, INC. DBA ESSE HEALTH LIFE INSURANCE & AD&D INSURANCE PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01434
Total number of active participants reported on line 7a of the Form 55002009-01-01432
Total of all active and inactive participants2009-01-01432

Form 5500 Responses for AMERICAN MULTISPECIALTY GROUP, INC. DBA ESSE HEALTH LIFE INSURANCE & AD&D INSURANCE PLAN

2019: AMERICAN MULTISPECIALTY GROUP, INC. DBA ESSE HEALTH LIFE INSURANCE & AD&D INSURANCE 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 filingYes
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: AMERICAN MULTISPECIALTY GROUP, INC. DBA ESSE HEALTH LIFE INSURANCE & AD&D INSURANCE 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: AMERICAN MULTISPECIALTY GROUP, INC. DBA ESSE HEALTH LIFE INSURANCE & AD&D INSURANCE PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – InsuranceYes
2016: AMERICAN MULTISPECIALTY GROUP, INC. DBA ESSE HEALTH LIFE INSURANCE & AD&D INSURANCE PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – InsuranceYes
2015: AMERICAN MULTISPECIALTY GROUP, INC. DBA ESSE HEALTH LIFE INSURANCE & AD&D INSURANCE PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: AMERICAN MULTISPECIALTY GROUP, INC. DBA ESSE HEALTH LIFE INSURANCE & AD&D INSURANCE PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: AMERICAN MULTISPECIALTY GROUP, INC. DBA ESSE HEALTH LIFE INSURANCE & AD&D INSURANCE PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: AMERICAN MULTISPECIALTY GROUP, INC. DBA ESSE HEALTH LIFE INSURANCE & AD&D INSURANCE 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: AMERICAN MULTISPECIALTY GROUP, INC. DBA ESSE HEALTH LIFE INSURANCE & AD&D INSURANCE 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: AMERICAN MULTISPECIALTY GROUP, INC. DBA ESSE HEALTH LIFE INSURANCE & AD&D INSURANCE PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01This submission is the final filingNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number701724
Policy instance 1
Insurance contract or identification number701724
Number of Individuals Covered757
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $10,717
Total amount of fees paid to insurance companyUSD $3,628
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
Other welfare benefits providedACCCIDENTAL DEATH & 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 $229,521
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,053
Amount paid for insurance broker fees857
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number701724
Policy instance 1
Insurance contract or identification number701724
Number of Individuals Covered755
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $26,492
Total amount of fees paid to insurance companyUSD $3,532
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
Other welfare benefits providedACCCIDENTAL DEATH & 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 $176,612
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $26,492
Amount paid for insurance broker fees3532
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberG 163719
Policy instance 2
Insurance contract or identification numberG 163719
Number of Individuals Covered186
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $23,818
Total amount of fees paid to insurance companyUSD $372
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $158,786
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $23,818
Amount paid for insurance broker fees372
Additional information about fees paid to insurance brokerADMINISTRATIVE FEES
Insurance broker organization code?3
Insurance broker nameHUNTLEIGH MCGEHEE INC
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL 153185
Policy instance 1
Insurance contract or identification numberGL 153185
Number of Individuals Covered600
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $28,507
Total amount of fees paid to insurance companyUSD $547
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $190,046
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $28,507
Amount paid for insurance broker fees547
Additional information about fees paid to insurance brokerADMINISTRATIVE FEES
Insurance broker organization code?3
Insurance broker nameHUNTLEIGH MCGEHEE INC
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberG 163719
Policy instance 2
Insurance contract or identification numberG 163719
Number of Individuals Covered178
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $16,362
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $99,884
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,362
Insurance broker organization code?3
Insurance broker nameHUNTLEIGH MCGEHEE INC
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL 153185
Policy instance 1
Insurance contract or identification numberGL 153185
Number of Individuals Covered602
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $24,840
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $151,757
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $24,840
Insurance broker organization code?3
Insurance broker nameHUNTLEIGH MCGEHEE INC
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010108335
Policy instance 1
Insurance contract or identification number000010108335
Number of Individuals Covered599
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $18,516
Total amount of fees paid to insurance companyUSD $3,506
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $123,440
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $18,516
Amount paid for insurance broker fees3506
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
Insurance broker nameCLJM LLC
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000400002000
Policy instance 2
Insurance contract or identification number000400002000
Number of Individuals Covered178
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $15,308
Total amount of fees paid to insurance companyUSD $2,428
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $102,056
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,308
Amount paid for insurance broker fees2428
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
Insurance broker nameCLJM LLC
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000400001000
Policy instance 3
Insurance contract or identification number000400001000
Number of Individuals Covered340
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $8,041
Total amount of fees paid to insurance companyUSD $1,274
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $53,607
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,041
Amount paid for insurance broker fees1274
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
Insurance broker nameCLJM LLC
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000400001000
Policy instance 3
Insurance contract or identification number000400001000
Number of Individuals Covered310
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $6,370
Total amount of fees paid to insurance companyUSD $934
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $42,468
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,370
Amount paid for insurance broker fees934
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
Insurance broker nameCLJM LLC
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000400002000
Policy instance 2
Insurance contract or identification number000400002000
Number of Individuals Covered163
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $12,138
Total amount of fees paid to insurance companyUSD $1,520
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $80,918
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,138
Amount paid for insurance broker fees1520
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
Insurance broker nameCLJM LLC
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010108335
Policy instance 1
Insurance contract or identification number000010108335
Number of Individuals Covered538
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $17,532
Total amount of fees paid to insurance companyUSD $2,135
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $116,879
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,532
Amount paid for insurance broker fees2135
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
Insurance broker nameCLJM LLC
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000400002000
Policy instance 2
Insurance contract or identification number000400002000
Number of Individuals Covered144
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $11,400
Total amount of fees paid to insurance companyUSD $2,969
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $76,002
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,400
Amount paid for insurance broker fees2969
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
Insurance broker nameCLJM LLC
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000400001000
Policy instance 3
Insurance contract or identification number000400001000
Number of Individuals Covered302
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $7,004
Total amount of fees paid to insurance companyUSD $1,937
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $46,695
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,004
Amount paid for insurance broker fees1937
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
Insurance broker nameCLJM LLC
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010108335
Policy instance 1
Insurance contract or identification number000010108335
Number of Individuals Covered502
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $16,010
Total amount of fees paid to insurance companyUSD $4,762
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $106,736
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,010
Amount paid for insurance broker fees4762
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
Insurance broker nameCLJM LLC
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010108335
Policy instance 1
Insurance contract or identification number000010108335
Number of Individuals Covered462
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $15,037
Total amount of fees paid to insurance companyUSD $316
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $100,249
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 number000400002000
Policy instance 2
Insurance contract or identification number000400002000
Number of Individuals Covered132
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $9,377
Total amount of fees paid to insurance companyUSD $197
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $62,510
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 number000400001000
Policy instance 3
Insurance contract or identification number000400001000
Number of Individuals Covered282
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $6,117
Total amount of fees paid to insurance companyUSD $123
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $40,782
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 number000400002000
Policy instance 2
Insurance contract or identification number000400002000
Number of Individuals Covered130
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $10,021
Total amount of fees paid to insurance companyUSD $1,279
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $66,805
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,021
Amount paid for insurance broker fees1279
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
Insurance broker nameCLJM LLC DBA HUNTLEIGH MCGHEE
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010108335
Policy instance 1
Insurance contract or identification number000010108335
Number of Individuals Covered441
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $16,070
Total amount of fees paid to insurance companyUSD $1,947
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $107,135
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,070
Amount paid for insurance broker fees1947
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
Insurance broker nameCLJM LLC DBA HUNTLEIGH MCGHEE
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000400001000
Policy instance 3
Insurance contract or identification number000400001000
Number of Individuals Covered291
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $6,260
Total amount of fees paid to insurance companyUSD $828
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $41,732
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,260
Amount paid for insurance broker fees828
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
Insurance broker nameCLJM LLC DBA HUNTLEIGH MCGHEE

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