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FORRESTER CONSTRUCTION COMPANY HEALTH AND WELFARE BENEFIT PLAN 401k Plan overview

Plan NameFORRESTER CONSTRUCTION COMPANY HEALTH AND WELFARE BENEFIT PLAN
Plan identification number 501

FORRESTER CONSTRUCTION COMPANY HEALTH AND WELFARE BENEFIT PLAN Benefits

401k Plan Type
Plan Features/Benefits

    401k Sponsoring company profile

    FORRESTER CONSTRUCTION COMPANY has sponsored the creation of one or more 401k plans.

    Company Name:FORRESTER CONSTRUCTION COMPANY
    Employer identification number (EIN):521587647
    NAIC Classification:236200

    Additional information about FORRESTER CONSTRUCTION COMPANY

    Jurisdiction of Incorporation: California Department of State
    Incorporation Date:
    Company Identification Number: C2417173

    More information about FORRESTER CONSTRUCTION COMPANY

    Form 5500 Filing Information

    Submission information for form 5500 for 401k plan FORRESTER CONSTRUCTION COMPANY HEALTH AND WELFARE BENEFIT PLAN

    Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
    5012018-10-01WAYNE CABOT2020-02-27
    5012017-10-01WAYNE CABOT2019-04-25
    5012016-10-01
    5012015-10-01
    5012014-10-01
    5012013-10-01WAYNE CABOT
    5012012-10-01WAYNE CABOT
    5012011-10-01WAYNE CABOT
    5012009-10-01WAYNE CABOT

    Plan Statistics for FORRESTER CONSTRUCTION COMPANY HEALTH AND WELFARE BENEFIT PLAN

    401k plan membership statisitcs for FORRESTER CONSTRUCTION COMPANY HEALTH AND WELFARE BENEFIT PLAN

    Measure Date Value
    2018
    Total participants, beginning-of-year2018-10-01103
    Total number of active participants reported on line 7a of the Form 55002018-10-01103
    Number of retired or separated participants receiving benefits2018-10-010
    Number of other retired or separated participants entitled to future benefits2018-10-014
    Total of all active and inactive participants2018-10-01107
    2017
    Total participants, beginning-of-year2017-10-01107
    Total number of active participants reported on line 7a of the Form 55002017-10-01103
    Number of retired or separated participants receiving benefits2017-10-010
    Number of other retired or separated participants entitled to future benefits2017-10-010
    Total of all active and inactive participants2017-10-01103
    2016
    Total participants, beginning-of-year2016-10-01106
    Total number of active participants reported on line 7a of the Form 55002016-10-01104
    Number of retired or separated participants receiving benefits2016-10-011
    Number of other retired or separated participants entitled to future benefits2016-10-012
    Total of all active and inactive participants2016-10-01107
    2015
    Total participants, beginning-of-year2015-10-01122
    Total number of active participants reported on line 7a of the Form 55002015-10-01106
    Number of retired or separated participants receiving benefits2015-10-010
    Number of other retired or separated participants entitled to future benefits2015-10-010
    Total of all active and inactive participants2015-10-01106
    2014
    Total participants, beginning-of-year2014-10-01139
    Total number of active participants reported on line 7a of the Form 55002014-10-01113
    Number of retired or separated participants receiving benefits2014-10-013
    Number of other retired or separated participants entitled to future benefits2014-10-016
    Total of all active and inactive participants2014-10-01122
    2013
    Total participants, beginning-of-year2013-10-01144
    Total number of active participants reported on line 7a of the Form 55002013-10-01132
    Number of retired or separated participants receiving benefits2013-10-013
    Number of other retired or separated participants entitled to future benefits2013-10-014
    Total of all active and inactive participants2013-10-01139
    2012
    Total participants, beginning-of-year2012-10-01236
    Total number of active participants reported on line 7a of the Form 55002012-10-01143
    Number of retired or separated participants receiving benefits2012-10-015
    Number of other retired or separated participants entitled to future benefits2012-10-0116
    Total of all active and inactive participants2012-10-01164
    2011
    Total participants, beginning-of-year2011-10-01248
    Total number of active participants reported on line 7a of the Form 55002011-10-01239
    Number of retired or separated participants receiving benefits2011-10-015
    Number of other retired or separated participants entitled to future benefits2011-10-010
    Total of all active and inactive participants2011-10-01244
    2009
    Total participants, beginning-of-year2009-10-01205
    Total number of active participants reported on line 7a of the Form 55002009-10-01218
    Number of retired or separated participants receiving benefits2009-10-012
    Number of other retired or separated participants entitled to future benefits2009-10-010
    Total of all active and inactive participants2009-10-01220

    Form 5500 Responses

    2018
    2018-10-01Type of plan entitySingle employer plan
    2018-10-01Submission has been amendedNo
    2018-10-01This submission is the final filingNo
    2018-10-01This return/report is a short plan year return/report (less than 12 months)No
    2018-10-01Plan is a collectively bargained planNo
    2018-10-01Plan funding arrangement – InsuranceYes
    2018-10-01Plan funding arrangement – General assets of the sponsorYes
    2018-10-01Plan benefit arrangement – InsuranceYes
    2018-10-01Plan benefit arrangement – General assets of the sponsorYes
    2017
    2017-10-01Type of plan entitySingle employer plan
    2017-10-01Submission has been amendedNo
    2017-10-01This submission is the final filingNo
    2017-10-01This return/report is a short plan year return/report (less than 12 months)No
    2017-10-01Plan is a collectively bargained planNo
    2017-10-01Plan funding arrangement – InsuranceYes
    2017-10-01Plan funding arrangement – General assets of the sponsorYes
    2017-10-01Plan benefit arrangement – InsuranceYes
    2017-10-01Plan benefit arrangement – General assets of the sponsorYes
    2016
    2016-10-01Type of plan entitySingle employer plan
    2016-10-01Submission has been amendedNo
    2016-10-01This submission is the final filingNo
    2016-10-01This return/report is a short plan year return/report (less than 12 months)No
    2016-10-01Plan is a collectively bargained planNo
    2016-10-01Plan funding arrangement – InsuranceYes
    2016-10-01Plan funding arrangement – General assets of the sponsorYes
    2016-10-01Plan benefit arrangement – InsuranceYes
    2016-10-01Plan benefit arrangement – General assets of the sponsorYes
    2015
    2015-10-01Type of plan entitySingle employer plan
    2015-10-01Submission has been amendedNo
    2015-10-01This submission is the final filingNo
    2015-10-01This return/report is a short plan year return/report (less than 12 months)No
    2015-10-01Plan is a collectively bargained planNo
    2015-10-01Plan funding arrangement – InsuranceYes
    2015-10-01Plan funding arrangement – General assets of the sponsorYes
    2015-10-01Plan benefit arrangement – InsuranceYes
    2015-10-01Plan benefit arrangement – General assets of the sponsorYes
    2014
    2014-10-01Type of plan entitySingle employer plan
    2014-10-01Submission has been amendedNo
    2014-10-01This submission is the final filingNo
    2014-10-01This return/report is a short plan year return/report (less than 12 months)No
    2014-10-01Plan is a collectively bargained planNo
    2014-10-01Plan funding arrangement – InsuranceYes
    2014-10-01Plan funding arrangement – General assets of the sponsorYes
    2014-10-01Plan benefit arrangement – InsuranceYes
    2014-10-01Plan benefit arrangement – General assets of the sponsorYes
    2013
    2013-10-01Type of plan entitySingle employer plan
    2013-10-01Submission has been amendedNo
    2013-10-01This submission is the final filingNo
    2013-10-01This return/report is a short plan year return/report (less than 12 months)No
    2013-10-01Plan is a collectively bargained planNo
    2013-10-01Plan funding arrangement – InsuranceYes
    2013-10-01Plan funding arrangement – General assets of the sponsorYes
    2013-10-01Plan benefit arrangement – InsuranceYes
    2013-10-01Plan benefit arrangement – General assets of the sponsorYes
    2012
    2012-10-01Type of plan entitySingle employer plan
    2012-10-01Submission has been amendedNo
    2012-10-01This submission is the final filingNo
    2012-10-01This return/report is a short plan year return/report (less than 12 months)No
    2012-10-01Plan is a collectively bargained planNo
    2012-10-01Plan funding arrangement – InsuranceYes
    2012-10-01Plan funding arrangement – General assets of the sponsorYes
    2012-10-01Plan benefit arrangement – InsuranceYes
    2012-10-01Plan benefit arrangement – General assets of the sponsorYes
    2011
    2011-10-01Type of plan entitySingle employer plan
    2011-10-01Submission has been amendedNo
    2011-10-01This submission is the final filingNo
    2011-10-01This return/report is a short plan year return/report (less than 12 months)No
    2011-10-01Plan is a collectively bargained planNo
    2011-10-01Plan funding arrangement – InsuranceYes
    2011-10-01Plan funding arrangement – General assets of the sponsorYes
    2011-10-01Plan benefit arrangement – InsuranceYes
    2011-10-01Plan benefit arrangement – General assets of the sponsorYes
    2009
    2009-10-01Type of plan entitySingle employer plan
    2009-10-01Submission has been amendedNo
    2009-10-01This submission is the final filingNo
    2009-10-01This return/report is a short plan year return/report (less than 12 months)No
    2009-10-01Plan is a collectively bargained planNo
    2009-10-01Plan funding arrangement – InsuranceYes
    2009-10-01Plan benefit arrangement – InsuranceYes

    Insurance Providers Used on plan

    UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
    Policy contract number905543
    Policy instance 1
    Insurance contract or identification number905543
    Number of Individuals Covered233
    Insurance policy start date2018-10-01
    Insurance policy end date2019-09-30
    Total amount of commissions paid to insurance brokerUSD $40,645
    Total amount of fees paid to insurance companyUSD $1,106
    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 BenefitYes
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitYes
    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 $1,129,406
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
    Policy contract numberGL 141240
    Policy instance 2
    Insurance contract or identification numberGL 141240
    Number of Individuals Covered103
    Insurance policy start date2018-10-01
    Insurance policy end date2019-09-30
    Total amount of commissions paid to insurance brokerUSD $2,435
    Total amount of fees paid to insurance companyUSD $217
    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 providedAD&D
    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 $17,259
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
    Policy contract numberLTD 115205
    Policy instance 3
    Insurance contract or identification numberLTD 115205
    Number of Individuals Covered103
    Insurance policy start date2018-10-01
    Insurance policy end date2019-09-30
    Total amount of commissions paid to insurance brokerUSD $5,242
    Total amount of fees paid to insurance companyUSD $407
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $32,422
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
    Policy contract numberVG 179940
    Policy instance 4
    Insurance contract or identification numberVG 179940
    Number of Individuals Covered17
    Insurance policy start date2018-10-01
    Insurance policy end date2019-09-30
    Total amount of commissions paid to insurance brokerUSD $1,212
    Total amount of fees paid to insurance companyUSD $98
    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 providedVOLUNTARY GROUP LIFE
    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 $8,078
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
    Policy contract numberVG 179940
    Policy instance 4
    Insurance contract or identification numberVG 179940
    Number of Individuals Covered16
    Insurance policy start date2017-10-01
    Insurance policy end date2018-09-30
    Total amount of commissions paid to insurance brokerUSD $1,158
    Total amount of fees paid to insurance companyUSD $90
    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 providedVOLUNTARY GROUP LIFE
    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 $7,723
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
    Policy contract numberLTD 115205
    Policy instance 3
    Insurance contract or identification numberLTD 115205
    Number of Individuals Covered94
    Insurance policy start date2017-10-01
    Insurance policy end date2018-09-30
    Total amount of commissions paid to insurance brokerUSD $5,215
    Total amount of fees paid to insurance companyUSD $398
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $32,146
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
    Policy contract numberGL 141240
    Policy instance 2
    Insurance contract or identification numberGL 141240
    Number of Individuals Covered94
    Insurance policy start date2017-10-01
    Insurance policy end date2018-09-30
    Total amount of commissions paid to insurance brokerUSD $2,412
    Total amount of fees paid to insurance companyUSD $212
    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 providedAD&D
    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 $17,063
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
    Policy contract number905543
    Policy instance 1
    Insurance contract or identification number905543
    Number of Individuals Covered210
    Insurance policy start date2017-10-01
    Insurance policy end date2018-09-30
    Total amount of commissions paid to insurance brokerUSD $41,416
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitYes
    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 $1,149,492
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
    Policy contract number905543
    Policy instance 1
    Insurance contract or identification number905543
    Number of Individuals Covered229
    Insurance policy start date2015-10-01
    Insurance policy end date2016-09-30
    Total amount of commissions paid to insurance brokerUSD $43,136
    Total amount of fees paid to insurance companyUSD $1,161
    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 BenefitYes
    Vision Insurance Welfare BenefitYes
    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 $1,105,872
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $43,136
    Amount paid for insurance broker fees1161
    Additional information about fees paid to insurance brokerCOMMISSIONS AND FEES
    Insurance broker organization code?3
    Insurance broker nameTHE MELTZER GROUP INC
    RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
    Policy contract numberVG 179940
    Policy instance 4
    Insurance contract or identification numberVG 179940
    Number of Individuals Covered22
    Insurance policy start date2015-10-01
    Insurance policy end date2016-09-30
    Total amount of commissions paid to insurance brokerUSD $698
    Total amount of fees paid to insurance companyUSD $69
    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 BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedVOLUNTARY GROUP LIFE
    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 $4,662
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $698
    Amount paid for insurance broker fees0
    Additional information about fees paid to insurance brokerCOMMISSIONS
    Insurance broker organization code?3
    Insurance broker nameNFP INSURANCE SERVICES INC
    RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
    Policy contract numberLTD 115205
    Policy instance 3
    Insurance contract or identification numberLTD 115205
    Number of Individuals Covered106
    Insurance policy start date2015-10-01
    Insurance policy end date2016-09-30
    Total amount of commissions paid to insurance brokerUSD $4,574
    Total amount of fees paid to insurance companyUSD $345
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $25,738
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $4,574
    Amount paid for insurance broker fees0
    Additional information about fees paid to insurance brokerCOMMISSIONS
    Insurance broker organization code?3
    Insurance broker nameNFP INSURANCE SERVICES INC
    RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
    Policy contract numberGL 141240
    Policy instance 2
    Insurance contract or identification numberGL 141240
    Number of Individuals Covered106
    Insurance policy start date2015-10-01
    Insurance policy end date2016-09-30
    Total amount of commissions paid to insurance brokerUSD $2,145
    Total amount of fees paid to insurance companyUSD $198
    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 BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedAD&D
    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 $14,545
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $2,145
    Amount paid for insurance broker fees0
    Additional information about fees paid to insurance brokerCOMMISSIONS
    Insurance broker organization code?3
    Insurance broker nameNFP INSURANCE SERVICES INC
    RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
    Policy contract numberLTD 115205
    Policy instance 3
    Insurance contract or identification numberLTD 115205
    Number of Individuals Covered130
    Insurance policy start date2014-10-01
    Insurance policy end date2015-09-30
    Total amount of commissions paid to insurance brokerUSD $5,419
    Total amount of fees paid to insurance companyUSD $1,103
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $28,656
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $5,419
    Amount paid for insurance broker fees709
    Additional information about fees paid to insurance brokerCOMMISSIONS AND FEES
    Insurance broker organization code?3
    Insurance broker nameNFP INSURANCE SERVICES INC
    RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
    Policy contract numberVG 179940
    Policy instance 4
    Insurance contract or identification numberVG 179940
    Number of Individuals Covered21
    Insurance policy start date2014-10-01
    Insurance policy end date2015-09-30
    Total amount of commissions paid to insurance brokerUSD $854
    Total amount of fees paid to insurance companyUSD $207
    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 BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedVOLUNTARY GROUP LIFE
    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 $5,797
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $854
    Amount paid for insurance broker fees133
    Additional information about fees paid to insurance brokerBROKER FEES
    Insurance broker organization code?3
    Insurance broker nameNFP INSURANCE SERVICES, INC
    CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
    Policy contract number3333693
    Policy instance 1
    Insurance contract or identification number3333693
    Number of Individuals Covered107
    Insurance policy start date2014-10-01
    Insurance policy end date2015-09-30
    Total amount of commissions paid to insurance brokerUSD $4,105
    Total amount of fees paid to insurance companyUSD $39,516
    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 BenefitYes
    Vision Insurance Welfare BenefitYes
    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 $1,289,844
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $4,105
    Amount paid for insurance broker fees39516
    Additional information about fees paid to insurance brokerCOMMISSIONS AND FEES
    Insurance broker organization code?3
    Insurance broker nameTHE MELTZER GROUP INC
    RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
    Policy contract numberGL 141240
    Policy instance 2
    Insurance contract or identification numberGL 141240
    Number of Individuals Covered130
    Insurance policy start date2014-10-01
    Insurance policy end date2015-09-30
    Total amount of commissions paid to insurance brokerUSD $2,529
    Total amount of fees paid to insurance companyUSD $647
    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 BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedAD&D
    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 $16,500
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $2,529
    Amount paid for insurance broker fees416
    Additional information about fees paid to insurance brokerCOMMISSIONS AND FEES
    Insurance broker organization code?3
    Insurance broker nameNFP INSURANCE SERVICES INC
    CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
    Policy contract number3333693
    Policy instance 1
    Insurance contract or identification number3333693
    Number of Individuals Covered123
    Insurance policy start date2013-10-01
    Insurance policy end date2014-09-30
    Total amount of commissions paid to insurance brokerUSD $4,378
    Total amount of fees paid to insurance companyUSD $45,242
    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 BenefitYes
    Vision Insurance Welfare BenefitYes
    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 $1,327,284
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $4,378
    Amount paid for insurance broker fees45242
    Additional information about fees paid to insurance brokerBENEFIT ADVISOR PAYMENT
    Insurance broker organization code?3
    Insurance broker nameTHE MELTZER GROUP INC
    RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
    Policy contract numberVG 179940
    Policy instance 4
    Insurance contract or identification numberVG 179940
    Number of Individuals Covered18
    Insurance policy start date2013-10-01
    Insurance policy end date2014-09-30
    Total amount of commissions paid to insurance brokerUSD $590
    Total amount of fees paid to insurance companyUSD $246
    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 BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedVOLUNTARY GROUP TERM LIFE
    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 $5,899
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $590
    Amount paid for insurance broker fees134
    Additional information about fees paid to insurance brokerBROKER FEES
    Insurance broker organization code?3
    Insurance broker nameNFP INSURANCE SERVICES, INC
    RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
    Policy contract numberLTD 115205
    Policy instance 3
    Insurance contract or identification numberLTD 115205
    Number of Individuals Covered243
    Insurance policy start date2013-10-01
    Insurance policy end date2014-09-30
    Total amount of commissions paid to insurance brokerUSD $3,611
    Total amount of fees paid to insurance companyUSD $1,065
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $32,215
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $3,611
    Amount paid for insurance broker fees581
    Additional information about fees paid to insurance brokerBROKER FEES
    Insurance broker organization code?3
    Insurance broker nameNFP INSURANCE SERVICES INC
    RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
    Policy contract numberGL 141240
    Policy instance 2
    Insurance contract or identification numberGL 141240
    Number of Individuals Covered141
    Insurance policy start date2013-10-01
    Insurance policy end date2014-09-30
    Total amount of commissions paid to insurance brokerUSD $1,681
    Total amount of fees paid to insurance companyUSD $634
    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 BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENTAL 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 $18,942
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,681
    Amount paid for insurance broker fees346
    Additional information about fees paid to insurance brokerBROKER FEES
    Insurance broker organization code?3
    Insurance broker nameNFP INSURANCE SERVICES INC
    RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
    Policy contract numberGL 141240
    Policy instance 2
    Insurance contract or identification numberGL 141240
    Number of Individuals Covered146
    Insurance policy start date2012-10-01
    Insurance policy end date2013-09-30
    Total amount of commissions paid to insurance brokerUSD $2,046
    Total amount of fees paid to insurance companyUSD $403
    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 BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENTAL 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 $25,924
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $2,046
    Amount paid for insurance broker fees403
    Additional information about fees paid to insurance brokerBROKER FEES
    Insurance broker organization code?3
    Insurance broker nameNFP INSURANCE SERVICES INC
    RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
    Policy contract numberLTD 115205
    Policy instance 3
    Insurance contract or identification numberLTD 115205
    Number of Individuals Covered146
    Insurance policy start date2012-10-01
    Insurance policy end date2013-09-30
    Total amount of commissions paid to insurance brokerUSD $4,156
    Total amount of fees paid to insurance companyUSD $657
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $43,118
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $4,156
    Amount paid for insurance broker fees657
    Additional information about fees paid to insurance brokerBROKER FEES
    Insurance broker organization code?3
    Insurance broker nameNFP INSURANCE SERVICES INC
    RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
    Policy contract numberVG 179940
    Policy instance 4
    Insurance contract or identification numberVG 179940
    Number of Individuals Covered21
    Insurance policy start date2012-10-01
    Insurance policy end date2013-09-30
    Total amount of commissions paid to insurance brokerUSD $1,115
    Total amount of fees paid to insurance companyUSD $136
    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 BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedVOLUNTARY GROUP TERM LIFE
    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 $11,146
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,115
    Amount paid for insurance broker fees136
    Additional information about fees paid to insurance brokerBROKER FEES
    Insurance broker organization code?3
    Insurance broker nameNFP INSURANCE SERVICES INC
    CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
    Policy contract number3333693
    Policy instance 1
    Insurance contract or identification number3333693
    Number of Individuals Covered144
    Insurance policy start date2012-10-01
    Insurance policy end date2013-09-30
    Total amount of commissions paid to insurance brokerUSD $5,355
    Total amount of fees paid to insurance companyUSD $55,857
    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 BenefitYes
    Vision Insurance Welfare BenefitYes
    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 $1,714,504
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $5,355
    Amount paid for insurance broker fees55857
    Additional information about fees paid to insurance brokerBENEFIT ADVISOR PAYMENT
    Insurance broker organization code?3
    Insurance broker nameTHE MELTZER GROUP INC
    CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )
    Policy contract number3333693
    Policy instance 1
    Insurance contract or identification number3333693
    Number of Individuals Covered236
    Insurance policy start date2011-10-01
    Insurance policy end date2012-09-30
    Total amount of commissions paid to insurance brokerUSD $88,517
    Total amount of fees paid to insurance companyUSD $6,694
    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 BenefitYes
    Vision Insurance Welfare BenefitYes
    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 $2,490,324
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
    Policy contract numberGL 141240
    Policy instance 2
    Insurance contract or identification numberGL 141240
    Number of Individuals Covered241
    Insurance policy start date2011-10-01
    Insurance policy end date2012-09-30
    Total amount of commissions paid to insurance brokerUSD $2,350
    Total amount of fees paid to insurance companyUSD $382
    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 BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENTAL 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 $32,495
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
    Policy contract numberLTD 115205
    Policy instance 3
    Insurance contract or identification numberLTD 115205
    Number of Individuals Covered241
    Insurance policy start date2011-10-01
    Insurance policy end date2012-09-30
    Total amount of commissions paid to insurance brokerUSD $4,528
    Total amount of fees paid to insurance companyUSD $614
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $52,824
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
    Policy contract numberVG 179940
    Policy instance 4
    Insurance contract or identification numberVG 179940
    Number of Individuals Covered30
    Insurance policy start date2011-10-01
    Insurance policy end date2012-09-30
    Total amount of commissions paid to insurance brokerUSD $1,003
    Total amount of fees paid to insurance companyUSD $129
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedVOLUNTARY GROUP TERM LIFE
    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 $1,026
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )
    Policy contract number3333693
    Policy instance 5
    Insurance contract or identification number3333693
    Number of Individuals Covered230
    Insurance policy start date2010-10-01
    Insurance policy end date2011-09-30
    Total amount of commissions paid to insurance brokerUSD $77,766
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitYes
    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 $1,728,121
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
    Policy contract numberGL 141240
    Policy instance 2
    Insurance contract or identification numberGL 141240
    Number of Individuals Covered242
    Insurance policy start date2010-10-01
    Insurance policy end date2011-09-30
    Total amount of commissions paid to insurance brokerUSD $2,192
    Total amount of fees paid to insurance companyUSD $358
    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 BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENTAL 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 $28,838
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
    Policy contract numberLTD 115205
    Policy instance 3
    Insurance contract or identification numberLTD 115205
    Number of Individuals Covered242
    Insurance policy start date2010-10-01
    Insurance policy end date2010-09-30
    Total amount of commissions paid to insurance brokerUSD $4,311
    Total amount of fees paid to insurance companyUSD $558
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $46,224
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
    Policy contract numberVG 179940
    Policy instance 4
    Insurance contract or identification numberVG 179940
    Number of Individuals Covered35
    Insurance policy start date2010-10-01
    Insurance policy end date2011-09-30
    Total amount of commissions paid to insurance brokerUSD $1,029
    Total amount of fees paid to insurance companyUSD $118
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedVOLUNTARY GROUP TERM LIFE
    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 $10,287
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
    Policy contract number704364
    Policy instance 1
    Insurance contract or identification number704364
    Number of Individuals Covered472
    Insurance policy start date2010-10-01
    Insurance policy end date2011-09-30
    Total amount of commissions paid to insurance brokerUSD $4,017
    Total amount of fees paid to insurance companyUSD $5,000
    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 BenefitYes
    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 $104,070
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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