INSERSO CORPORATION has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan INSERSO CORPORATION WELFARE BENEFITS PLAN
Measure | Date | Value |
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2021: INSERSO CORPORATION WELFARE BENEFITS PLAN 2021 401k membership |
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Total participants, beginning-of-year | 2021-09-01 | 314 |
Total number of active participants reported on line 7a of the Form 5500 | 2021-09-01 | 326 |
Number of retired or separated participants receiving benefits | 2021-09-01 | 3 |
Number of other retired or separated participants entitled to future benefits | 2021-09-01 | 0 |
Total of all active and inactive participants | 2021-09-01 | 329 |
Number of employers contributing to the scheme | 2021-09-01 | 0 |
2020: INSERSO CORPORATION WELFARE BENEFITS PLAN 2020 401k membership |
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Total participants, beginning-of-year | 2020-09-01 | 325 |
Total number of active participants reported on line 7a of the Form 5500 | 2020-09-01 | 312 |
Number of retired or separated participants receiving benefits | 2020-09-01 | 2 |
Number of other retired or separated participants entitled to future benefits | 2020-09-01 | 0 |
Total of all active and inactive participants | 2020-09-01 | 314 |
2019: INSERSO CORPORATION WELFARE BENEFITS PLAN 2019 401k membership |
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Total participants, beginning-of-year | 2019-09-01 | 319 |
Total number of active participants reported on line 7a of the Form 5500 | 2019-09-01 | 324 |
Number of retired or separated participants receiving benefits | 2019-09-01 | 1 |
Number of other retired or separated participants entitled to future benefits | 2019-09-01 | 0 |
Total of all active and inactive participants | 2019-09-01 | 325 |
2018: INSERSO CORPORATION WELFARE BENEFITS PLAN 2018 401k membership |
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Total participants, beginning-of-year | 2018-09-01 | 223 |
Total number of active participants reported on line 7a of the Form 5500 | 2018-09-01 | 318 |
Number of retired or separated participants receiving benefits | 2018-09-01 | 1 |
Number of other retired or separated participants entitled to future benefits | 2018-09-01 | 0 |
Total of all active and inactive participants | 2018-09-01 | 319 |
2017: INSERSO CORPORATION WELFARE BENEFITS PLAN 2017 401k membership |
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Total participants, beginning-of-year | 2017-09-01 | 248 |
Total number of active participants reported on line 7a of the Form 5500 | 2017-09-01 | 217 |
Number of retired or separated participants receiving benefits | 2017-09-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2017-09-01 | 0 |
Total of all active and inactive participants | 2017-09-01 | 217 |
Number of employers contributing to the scheme | 2017-09-01 | 0 |
2016: INSERSO CORPORATION WELFARE BENEFITS PLAN 2016 401k membership |
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Total participants, beginning-of-year | 2016-09-01 | 248 |
Total number of active participants reported on line 7a of the Form 5500 | 2016-09-01 | 265 |
Number of retired or separated participants receiving benefits | 2016-09-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2016-09-01 | 0 |
Total of all active and inactive participants | 2016-09-01 | 265 |
2015: INSERSO CORPORATION WELFARE BENEFITS PLAN 2015 401k membership |
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Total participants, beginning-of-year | 2015-09-01 | 210 |
Total number of active participants reported on line 7a of the Form 5500 | 2015-09-01 | 334 |
Number of retired or separated participants receiving benefits | 2015-09-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2015-09-01 | 0 |
Total of all active and inactive participants | 2015-09-01 | 334 |
2014: INSERSO CORPORATION WELFARE BENEFITS PLAN 2014 401k membership |
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Total participants, beginning-of-year | 2014-09-01 | 144 |
Total number of active participants reported on line 7a of the Form 5500 | 2014-09-01 | 140 |
Number of retired or separated participants receiving benefits | 2014-09-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2014-09-01 | 0 |
Total of all active and inactive participants | 2014-09-01 | 140 |
2013: INSERSO CORPORATION WELFARE BENEFITS PLAN 2013 401k membership |
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Total participants, beginning-of-year | 2013-09-01 | 123 |
Total number of active participants reported on line 7a of the Form 5500 | 2013-09-01 | 144 |
Number of retired or separated participants receiving benefits | 2013-09-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2013-09-01 | 0 |
Total of all active and inactive participants | 2013-09-01 | 144 |
2021: INSERSO CORPORATION WELFARE BENEFITS PLAN 2021 form 5500 responses |
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2021-09-01 | Type of plan entity | Single employer plan |
2021-09-01 | Plan funding arrangement – Insurance | Yes |
2021-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2021-09-01 | Plan benefit arrangement – Insurance | Yes |
2021-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2020: INSERSO CORPORATION WELFARE BENEFITS PLAN 2020 form 5500 responses |
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2020-09-01 | Type of plan entity | Single employer plan |
2020-09-01 | Submission has been amended | No |
2020-09-01 | This submission is the final filing | No |
2020-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2020-09-01 | Plan is a collectively bargained plan | No |
2020-09-01 | Plan funding arrangement – Insurance | Yes |
2020-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2020-09-01 | Plan benefit arrangement – Insurance | Yes |
2020-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2019: INSERSO CORPORATION WELFARE BENEFITS PLAN 2019 form 5500 responses |
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2019-09-01 | Type of plan entity | Single employer plan |
2019-09-01 | Submission has been amended | No |
2019-09-01 | This submission is the final filing | No |
2019-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2019-09-01 | Plan is a collectively bargained plan | No |
2019-09-01 | Plan funding arrangement – Insurance | Yes |
2019-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2019-09-01 | Plan benefit arrangement – Insurance | Yes |
2019-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2018: INSERSO CORPORATION WELFARE BENEFITS PLAN 2018 form 5500 responses |
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2018-09-01 | Type of plan entity | Single employer plan |
2018-09-01 | Submission has been amended | No |
2018-09-01 | This submission is the final filing | No |
2018-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2018-09-01 | Plan is a collectively bargained plan | No |
2018-09-01 | Plan funding arrangement – Insurance | Yes |
2018-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2018-09-01 | Plan benefit arrangement – Insurance | Yes |
2018-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2017: INSERSO CORPORATION WELFARE BENEFITS PLAN 2017 form 5500 responses |
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2017-09-01 | Type of plan entity | Single employer plan |
2017-09-01 | Plan funding arrangement – Insurance | Yes |
2017-09-01 | Plan benefit arrangement – Insurance | Yes |
2016: INSERSO CORPORATION WELFARE BENEFITS PLAN 2016 form 5500 responses |
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2016-09-01 | Type of plan entity | Single employer plan |
2016-09-01 | Submission has been amended | No |
2016-09-01 | This submission is the final filing | No |
2016-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2016-09-01 | Plan is a collectively bargained plan | No |
2016-09-01 | Plan funding arrangement – Insurance | Yes |
2016-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2016-09-01 | Plan benefit arrangement – Insurance | Yes |
2016-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2015: INSERSO CORPORATION WELFARE BENEFITS PLAN 2015 form 5500 responses |
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2015-09-01 | Type of plan entity | Single employer plan |
2015-09-01 | Submission has been amended | No |
2015-09-01 | This submission is the final filing | No |
2015-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2015-09-01 | Plan is a collectively bargained plan | No |
2015-09-01 | Plan funding arrangement – Insurance | Yes |
2015-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2015-09-01 | Plan benefit arrangement – Insurance | Yes |
2015-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2014: INSERSO CORPORATION WELFARE BENEFITS PLAN 2014 form 5500 responses |
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2014-09-01 | Type of plan entity | Single employer plan |
2014-09-01 | Submission has been amended | No |
2014-09-01 | This submission is the final filing | No |
2014-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2014-09-01 | Plan is a collectively bargained plan | No |
2014-09-01 | Plan funding arrangement – Insurance | Yes |
2014-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2014-09-01 | Plan benefit arrangement – Insurance | Yes |
2014-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2013: INSERSO CORPORATION WELFARE BENEFITS PLAN 2013 form 5500 responses |
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2013-09-01 | Type of plan entity | Single employer plan |
2013-09-01 | First time form 5500 has been submitted | Yes |
2013-09-01 | Submission has been amended | No |
2013-09-01 | This submission is the final filing | No |
2013-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2013-09-01 | Plan is a collectively bargained plan | No |
2013-09-01 | Plan funding arrangement – Insurance | Yes |
2013-09-01 | Plan benefit arrangement – Insurance | Yes |
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | AI961624 |
Policy instance | 3 |
Insurance contract or identification number | AI961624 | Number of Individuals Covered | 326 | Insurance policy start date | 2021-09-01 | Insurance policy end date | 2022-08-31 | Total amount of commissions paid to insurance broker | USD $13,501 | Total amount of fees paid to insurance company | USD $181 | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENT,CRITICAL ILLNESS,HOSPITAL | Welfare Benefit Premiums Paid to Carrier | USD $67,506 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $10,191 | Amount paid for insurance broker fees | 181 | Additional information about fees paid to insurance broker | OVERRIDES | Insurance broker organization code? | 3 |
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TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 ) |
Policy contract number | ER00041232 |
Policy instance | 2 |
Insurance contract or identification number | ER00041232 | Number of Individuals Covered | 1 | Insurance policy start date | 2021-09-01 | Insurance policy end date | 2022-08-31 | Total amount of commissions paid to insurance broker | USD $8,948 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $89,485 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,594 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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DELTA DENTAL OF VIRGINIA (National Association of Insurance Commissioners NAIC id number: 55611 ) |
Policy contract number | 0686 |
Policy instance | 1 |
Insurance contract or identification number | 0686 | Number of Individuals Covered | 524 | Insurance policy start date | 2021-09-01 | Insurance policy end date | 2022-08-31 | Total amount of commissions paid to insurance broker | USD $6,294 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,125 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
Policy contract number | 3339150 |
Policy instance | 1 |
Insurance contract or identification number | 3339150 | Number of Individuals Covered | 247 | Insurance policy start date | 2020-09-01 | Insurance policy end date | 2021-08-31 | Total amount of commissions paid to insurance broker | USD $7,470 | Total amount of fees paid to insurance company | USD $76 | 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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | 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 Carrier | USD $153,041 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,470 | Amount paid for insurance broker fees | 76 | Additional information about fees paid to insurance broker | GENERAL AGENT PAYMENTS | Insurance broker organization code? | 3 |
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CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
Policy contract number | 611793 |
Policy instance | 2 |
Insurance contract or identification number | 611793 | Number of Individuals Covered | 329 | Insurance policy start date | 2020-09-01 | Insurance policy end date | 2021-08-31 | Total amount of commissions paid to insurance broker | USD $79,158 | Total amount of fees paid to insurance company | USD $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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | 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 Carrier | USD $1,231,001 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $79,158 | Insurance broker organization code? | 3 |
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LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | FLX967461 |
Policy instance | 3 |
Insurance contract or identification number | FLX967461 | Number of Individuals Covered | 312 | Insurance policy start date | 2020-09-01 | Insurance policy end date | 2021-05-31 | Total amount of commissions paid to insurance broker | USD $14,779 | Total amount of fees paid to insurance company | USD $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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT EMPLOYEE ASSISTANCE PROGRAM | 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 Carrier | USD $157,637 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $14,779 | Insurance broker organization code? | 3 |
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LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | FLX967461 |
Policy instance | 4 |
Insurance contract or identification number | FLX967461 | Number of Individuals Covered | 312 | Insurance policy start date | 2021-06-01 | Insurance policy end date | 2021-08-31 | Total amount of commissions paid to insurance broker | USD $2,292 | Total amount of fees paid to insurance company | USD $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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT EMPLOYEE ASSISTANCE PROGRAM | 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 Carrier | USD $31,819 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,292 | Insurance broker organization code? | 3 |
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LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | SGM606861 |
Policy instance | 3 |
Insurance contract or identification number | SGM606861 | Number of Individuals Covered | 324 | Insurance policy start date | 2019-09-01 | Insurance policy end date | 2020-08-31 | Total amount of commissions paid to insurance broker | USD $16,642 | Total amount of fees paid to insurance company | USD $2,618 | 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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT EMPLOYEE ASSISTANCE PROGRAM | 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 Carrier | USD $182,132 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $16,642 | Amount paid for insurance broker fees | 2618 | Additional information about fees paid to insurance broker | OVERRIDE | Insurance broker organization code? | 3 |
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CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
Policy contract number | 611793 |
Policy instance | 2 |
Insurance contract or identification number | 611793 | Number of Individuals Covered | 303 | Insurance policy start date | 2019-09-01 | Insurance policy end date | 2020-08-31 | Total amount of commissions paid to insurance broker | USD $75,389 | Total amount of fees paid to insurance company | USD $1,456 | 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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | 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 Carrier | USD $1,179,650 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $75,389 | Amount paid for insurance broker fees | 1456 | Additional information about fees paid to insurance broker | INCENTIVE COMPENSATION PAYMENTS | Insurance broker organization code? | 3 |
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CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
Policy contract number | 3339150 |
Policy instance | 1 |
Insurance contract or identification number | 3339150 | Number of Individuals Covered | 238 | Insurance policy start date | 2019-09-01 | Insurance policy end date | 2020-08-31 | Total amount of commissions paid to insurance broker | USD $6,205 | Total amount of fees paid to insurance company | USD $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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | 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 Carrier | USD $125,699 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,205 | Insurance broker organization code? | 3 |
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LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | SGM606861 |
Policy instance | 3 |
Insurance contract or identification number | SGM606861 | Number of Individuals Covered | 318 | Insurance policy start date | 2018-09-01 | Insurance policy end date | 2019-08-31 | Total amount of commissions paid to insurance broker | USD $9,433 | Total amount of fees paid to insurance company | USD $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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT EMPLOYEE ASSISTANCE PROGRAM | 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 Carrier | USD $89,919 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $9,433 | Insurance broker organization code? | 3 |
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CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
Policy contract number | 611793 |
Policy instance | 2 |
Insurance contract or identification number | 611793 | Number of Individuals Covered | 193 | Insurance policy start date | 2018-09-01 | Insurance policy end date | 2019-08-31 | Total amount of commissions paid to insurance broker | USD $41,988 | Total amount of fees paid to insurance company | USD $2,197 | 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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | 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 Carrier | USD $663,092 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $41,988 | Amount paid for insurance broker fees | 2197 | Additional information about fees paid to insurance broker | INCENTIVE COMPENSATION PAYMENTS | Insurance broker organization code? | 3 |
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CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
Policy contract number | 3339150 |
Policy instance | 1 |
Insurance contract or identification number | 3339150 | Number of Individuals Covered | 185 | Insurance policy start date | 2018-09-01 | Insurance policy end date | 2019-08-31 | Total amount of commissions paid to insurance broker | USD $3,655 | Total amount of fees paid to insurance company | USD $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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | 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 Carrier | USD $74,138 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,258 | Insurance broker organization code? | 3 |
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LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | SGM606861 |
Policy instance | 3 |
Insurance contract or identification number | SGM606861 | Number of Individuals Covered | 217 | Insurance policy start date | 2017-09-01 | Insurance policy end date | 2018-08-31 | Total amount of commissions paid to insurance broker | USD $10,444 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $102,859 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
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CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
Policy contract number | 3339150 |
Policy instance | 2 |
Insurance contract or identification number | 3339150 | Number of Individuals Covered | 147 | Insurance policy start date | 2017-09-01 | Insurance policy end date | 2018-08-31 | Total amount of commissions paid to insurance broker | USD $4,579 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $92,966 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
Policy contract number | 611793 |
Policy instance | 1 |
Insurance contract or identification number | 611793 | Number of Individuals Covered | 183 | Insurance policy start date | 2017-09-01 | Insurance policy end date | 2018-08-31 | Total amount of commissions paid to insurance broker | USD $47,237 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $731,251 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
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CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
Policy contract number | 3339150 |
Policy instance | 1 |
Insurance contract or identification number | 3339150 | Number of Individuals Covered | 174 | Insurance policy start date | 2015-09-01 | Insurance policy end date | 2016-08-31 | Total amount of commissions paid to insurance broker | USD $4,007 | Total amount of fees paid to insurance company | USD $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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | 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 Carrier | USD $81,552 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,007 | Insurance broker organization code? | 3 | Insurance broker name | CORPORATE SYNERGIES GROUP, LLC |
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LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | SGM606861 |
Policy instance | 2 |
Insurance contract or identification number | SGM606861 | Number of Individuals Covered | 334 | Insurance policy start date | 2015-09-01 | Insurance policy end date | 2016-08-31 | Total amount of commissions paid to insurance broker | USD $7,078 | Total amount of fees paid to insurance company | USD $1,590 | 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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $64,482 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $7,078 | Amount paid for insurance broker fees | 1590 | Additional information about fees paid to insurance broker | OVERRIDE | Insurance broker organization code? | 3 | Insurance broker name | CORPORATE SYNERGIES GROUP, LLC |
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METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
Policy contract number | TS05469516 |
Policy instance | 1 |
Insurance contract or identification number | TS05469516 | Number of Individuals Covered | 500 | Insurance policy start date | 2014-09-01 | Insurance policy end date | 2015-08-31 | Total amount of commissions paid to insurance broker | USD $8,982 | Total amount of fees paid to insurance company | USD $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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $128,701 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,348 | Insurance broker organization code? | 3 | Insurance broker name | CORPORATE SYNERGIES GROUP, INC. |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 639688 |
Policy instance | 2 |
Insurance contract or identification number | 639688 | Number of Individuals Covered | 184 | Insurance policy start date | 2013-09-01 | Insurance policy end date | 2014-08-31 | Total amount of commissions paid to insurance broker | USD $26,583 | Total amount of fees paid to insurance company | USD $299 | 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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | 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 Carrier | USD $715,677 | Commission paid to Insurance Broker | USD $26,583 | Amount paid for insurance broker fees | 299 | Additional information about fees paid to insurance broker | BONUS | Insurance broker organization code? | 3 | Insurance broker name | ADVANCED BENEFIT STRATEGIES INC |
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METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
Policy contract number | TS05469516 |
Policy instance | 1 |
Insurance contract or identification number | TS05469516 | Number of Individuals Covered | 334 | Insurance policy start date | 2013-09-01 | Insurance policy end date | 2014-08-31 | Total amount of commissions paid to insurance broker | USD $8,189 | Total amount of fees paid to insurance company | USD $1,588 | 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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&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 Carrier | USD $115,211 | Commission paid to Insurance Broker | USD $5,771 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 1588 | Additional information about fees paid to insurance broker | ADMINISTRATIVE FEES | Insurance broker name | KELLY & ASSOCIATES INSURANCE GROUP |
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