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MOUNTAINEER GAS COMPANY BASIC LIFE INSURANCE PLAN 401k Plan overview

Plan NameMOUNTAINEER GAS COMPANY BASIC LIFE INSURANCE PLAN
Plan identification number 503

MOUNTAINEER GAS COMPANY BASIC LIFE INSURANCE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Life insurance

401k Sponsoring company profile

MOUNTAINEER GAS CO. has sponsored the creation of one or more 401k plans.

Company Name:MOUNTAINEER GAS CO.
Employer identification number (EIN):550521087
NAIC Classification:221210
NAIC Description:Natural Gas Distribution

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MOUNTAINEER GAS COMPANY BASIC LIFE INSURANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5032022-01-01MOSES SKAFF2023-07-04
5032022-01-01MOSES SKAFF2024-03-31
5032021-01-01MOSES SKAFF2022-07-21
5032020-01-01MOSES SKAFF2021-07-08
5032019-01-01MOSES SKAFF2020-07-14
5032018-01-01
5032017-01-01
5032016-01-01MOSES SKAFF
5032015-01-01MOSES SKAFF
5032014-01-01MOSES SKAFF
5032013-01-01MOSES SKAFF
5032012-01-01MOSES SKAFF
5032011-01-01MOSES SKAFF
5032009-01-01MOSES SKAFF

Plan Statistics for MOUNTAINEER GAS COMPANY BASIC LIFE INSURANCE PLAN

401k plan membership statisitcs for MOUNTAINEER GAS COMPANY BASIC LIFE INSURANCE PLAN

Measure Date Value
2022: MOUNTAINEER GAS COMPANY BASIC LIFE INSURANCE PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01641
Total number of active participants reported on line 7a of the Form 55002022-01-01484
Number of retired or separated participants receiving benefits2022-01-01173
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-01657
2021: MOUNTAINEER GAS COMPANY BASIC LIFE INSURANCE PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01641
Total number of active participants reported on line 7a of the Form 55002021-01-01466
Number of retired or separated participants receiving benefits2021-01-01175
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-01641
2020: MOUNTAINEER GAS COMPANY BASIC LIFE INSURANCE PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01627
Total number of active participants reported on line 7a of the Form 55002020-01-01482
Number of retired or separated participants receiving benefits2020-01-01144
Total of all active and inactive participants2020-01-01626
2019: MOUNTAINEER GAS COMPANY BASIC LIFE INSURANCE PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01614
Total number of active participants reported on line 7a of the Form 55002019-01-01627
Total of all active and inactive participants2019-01-01627
2018: MOUNTAINEER GAS COMPANY BASIC LIFE INSURANCE PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01575
Total number of active participants reported on line 7a of the Form 55002018-01-01614
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-01614
2017: MOUNTAINEER GAS COMPANY BASIC LIFE INSURANCE PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01566
Total number of active participants reported on line 7a of the Form 55002017-01-01575
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-01575
2016: MOUNTAINEER GAS COMPANY BASIC LIFE INSURANCE PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01552
Total number of active participants reported on line 7a of the Form 55002016-01-01566
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-01566
2015: MOUNTAINEER GAS COMPANY BASIC LIFE INSURANCE PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01538
Total number of active participants reported on line 7a of the Form 55002015-01-01552
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-010
Total of all active and inactive participants2015-01-01552
2014: MOUNTAINEER GAS COMPANY BASIC LIFE INSURANCE PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01517
Total number of active participants reported on line 7a of the Form 55002014-01-01538
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-010
Total of all active and inactive participants2014-01-01538
2013: MOUNTAINEER GAS COMPANY BASIC LIFE INSURANCE PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01519
Total number of active participants reported on line 7a of the Form 55002013-01-01517
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-010
Total of all active and inactive participants2013-01-01517
2012: MOUNTAINEER GAS COMPANY BASIC LIFE INSURANCE PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01523
Total number of active participants reported on line 7a of the Form 55002012-01-01519
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-010
Total of all active and inactive participants2012-01-01519
2011: MOUNTAINEER GAS COMPANY BASIC LIFE INSURANCE PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01507
Total number of active participants reported on line 7a of the Form 55002011-01-01523
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-010
Total of all active and inactive participants2011-01-01523
2009: MOUNTAINEER GAS COMPANY BASIC LIFE INSURANCE PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01466
Total number of active participants reported on line 7a of the Form 55002009-01-01480
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-01480

Form 5500 Responses for MOUNTAINEER GAS COMPANY BASIC LIFE INSURANCE PLAN

2022: MOUNTAINEER GAS COMPANY BASIC LIFE INSURANCE PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – InsuranceYes
2021: MOUNTAINEER GAS COMPANY BASIC LIFE INSURANCE PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – InsuranceYes
2020: MOUNTAINEER GAS COMPANY BASIC LIFE INSURANCE PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – InsuranceYes
2019: MOUNTAINEER GAS COMPANY BASIC LIFE INSURANCE PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – InsuranceYes
2018: MOUNTAINEER GAS COMPANY BASIC LIFE INSURANCE PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – InsuranceYes
2017: MOUNTAINEER GAS COMPANY BASIC LIFE INSURANCE PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – InsuranceYes
2016: MOUNTAINEER GAS COMPANY BASIC LIFE INSURANCE PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – InsuranceYes
2015: MOUNTAINEER GAS COMPANY BASIC LIFE INSURANCE PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: MOUNTAINEER GAS COMPANY BASIC LIFE INSURANCE PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: MOUNTAINEER GAS COMPANY BASIC LIFE INSURANCE PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: MOUNTAINEER GAS COMPANY BASIC LIFE INSURANCE PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: MOUNTAINEER GAS COMPANY BASIC LIFE INSURANCE PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – InsuranceYes
2009: MOUNTAINEER GAS COMPANY BASIC LIFE INSURANCE PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number675565GL
Policy instance 1
Insurance contract or identification number675565GL
Number of Individuals Covered657
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $13,507
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 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
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 $338,443
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,507
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number675565GL
Policy instance 1
Insurance contract or identification number675565GL
Number of Individuals Covered639
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $13,351
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 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
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 $306,219
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,351
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number675565GL
Policy instance 1
Insurance contract or identification number675565GL
Number of Individuals Covered626
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $12,903
Total amount of fees paid to insurance companyUSD $953
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
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 $348,857
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,903
Amount paid for insurance broker fees953
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number675565GL
Policy instance 1
Insurance contract or identification number675565GL
Number of Individuals Covered627
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $13,764
Total amount of fees paid to insurance companyUSD $3,429
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
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 $317,901
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,764
Amount paid for insurance broker fees1587
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number675565OGL
Policy instance 1
Insurance contract or identification number675565OGL
Number of Individuals Covered614
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $5,992
Total amount of fees paid to insurance companyUSD $756
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
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 $317,620
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,992
Insurance broker organization code?3
Amount paid for insurance broker fees756
Additional information about fees paid to insurance brokerFEES
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number675565OGL
Policy instance 1
Insurance contract or identification number675565OGL
Number of Individuals Covered575
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $6,477
Total amount of fees paid to insurance companyUSD $955
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
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 $316,678
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,430
Insurance broker organization code?3
Amount paid for insurance broker fees955
Additional information about fees paid to insurance brokerBONUS
Insurance broker nameHUNTINGTON INSURANCE, INC.
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number675565OGL
Policy instance 1
Insurance contract or identification number675565OGL
Number of Individuals Covered552
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $6,091
Total amount of fees paid to insurance companyUSD $1,682
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $296,993
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees1682
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $6,091
Insurance broker nameHUNTINGTON INSURANCE, INC.
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number675565OGL
Policy instance 1
Insurance contract or identification number675565OGL
Number of Individuals Covered538
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $5,969
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $291,159
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,990
Insurance broker organization code?3
Insurance broker nameHUNTINGTON INSURANCE, INC.
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number675565OGL
Policy instance 1
Insurance contract or identification number675565OGL
Number of Individuals Covered517
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $6,329
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $309,388
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,329
Insurance broker organization code?3
Insurance broker nameWELLS FARGO INS SVCS OF WV INC
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number675565OGL
Policy instance 1
Insurance contract or identification number675565OGL
Number of Individuals Covered519
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $5,565
Total amount of fees paid to insurance companyUSD $3,013
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $295,611
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,565
Insurance broker organization code?3
Amount paid for insurance broker fees3013
Additional information about fees paid to insurance brokerBONUS
Insurance broker nameWELLS FARGO INS SVCS OF WV INC
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number675565OGL
Policy instance 1
Insurance contract or identification number675565OGL
Number of Individuals Covered523
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $5,782
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $258,654
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number675565OGL
Policy instance 1
Insurance contract or identification number675565OGL
Number of Individuals Covered507
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $7,171
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $289,761
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,934
Insurance broker organization code?3
Additional information about fees paid to insurance brokerBONUS PAID
Insurance broker nameWELLS FARGO INS SVCS OF WV INC

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