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INTERSTATE FOAM WELFARE BENEFIT PLAN 401k Plan overview

Plan NameINTERSTATE FOAM WELFARE BENEFIT PLAN
Plan identification number 501

INTERSTATE FOAM WELFARE BENEFIT PLAN Benefits

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

401k Sponsoring company profile

INTERSTATE FOAM & SUPPLY, INC. has sponsored the creation of one or more 401k plans.

Company Name:INTERSTATE FOAM & SUPPLY, INC.
Employer identification number (EIN):561313514
NAIC Classification:337000

Form 5500 Filing Information

Submission information for form 5500 for 401k plan INTERSTATE FOAM WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012021-11-01MARK SMITH2023-08-15 MARK WEBB2023-08-15
5012020-11-01MARK SMITH2022-07-13 MARK WEBB2022-07-13
5012019-11-01MARK SMITH2021-06-24 MARK WEBB2021-06-24
5012018-11-01MARK SMITH2020-05-19 MARK WEBB2020-05-19
5012017-11-01MARK SMITH2019-06-26 MARK WEBB2019-06-26
5012016-11-01
5012015-11-01MARK SMITH
5012014-11-01MARK SMITH
5012013-11-01MARK SMITH
5012012-11-01MARK SMITH
5012011-11-01MARK SMITH
5012010-11-01MARK SMITH
5012009-11-01MARK SMITH

Plan Statistics for INTERSTATE FOAM WELFARE BENEFIT PLAN

401k plan membership statisitcs for INTERSTATE FOAM WELFARE BENEFIT PLAN

Measure Date Value
2021: INTERSTATE FOAM WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-11-01264
Total number of active participants reported on line 7a of the Form 55002021-11-01292
Total of all active and inactive participants2021-11-01292
2020: INTERSTATE FOAM WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-11-01285
Total number of active participants reported on line 7a of the Form 55002020-11-01264
Total of all active and inactive participants2020-11-01264
2019: INTERSTATE FOAM WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-11-01347
Total number of active participants reported on line 7a of the Form 55002019-11-01285
Total of all active and inactive participants2019-11-01285
Total participants2019-11-01285
2018: INTERSTATE FOAM WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-11-01349
Total number of active participants reported on line 7a of the Form 55002018-11-01347
Total of all active and inactive participants2018-11-01347
Total participants2018-11-01347
2017: INTERSTATE FOAM WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-11-01281
Total number of active participants reported on line 7a of the Form 55002017-11-01349
Total of all active and inactive participants2017-11-01349
Total participants2017-11-01349
2016: INTERSTATE FOAM WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-11-01252
Total number of active participants reported on line 7a of the Form 55002016-11-01281
Total of all active and inactive participants2016-11-01281
2015: INTERSTATE FOAM WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-11-01219
Total number of active participants reported on line 7a of the Form 55002015-11-01237
Number of retired or separated participants receiving benefits2015-11-010
Number of other retired or separated participants entitled to future benefits2015-11-0115
Total of all active and inactive participants2015-11-01252
2014: INTERSTATE FOAM WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-11-01187
Total number of active participants reported on line 7a of the Form 55002014-11-01213
Number of retired or separated participants receiving benefits2014-11-010
Number of other retired or separated participants entitled to future benefits2014-11-016
Total of all active and inactive participants2014-11-01219
2013: INTERSTATE FOAM WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-11-01222
Total number of active participants reported on line 7a of the Form 55002013-11-01179
Number of retired or separated participants receiving benefits2013-11-010
Number of other retired or separated participants entitled to future benefits2013-11-018
Total of all active and inactive participants2013-11-01187
2012: INTERSTATE FOAM WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year2012-11-01222
Total number of active participants reported on line 7a of the Form 55002012-11-01218
Number of retired or separated participants receiving benefits2012-11-010
Number of other retired or separated participants entitled to future benefits2012-11-014
Total of all active and inactive participants2012-11-01222
2011: INTERSTATE FOAM WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year2011-11-01216
Total number of active participants reported on line 7a of the Form 55002011-11-01218
Number of retired or separated participants receiving benefits2011-11-010
Number of other retired or separated participants entitled to future benefits2011-11-014
Total of all active and inactive participants2011-11-01222
2010: INTERSTATE FOAM WELFARE BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year2010-11-01211
Total number of active participants reported on line 7a of the Form 55002010-11-01216
Number of retired or separated participants receiving benefits2010-11-010
Number of other retired or separated participants entitled to future benefits2010-11-010
Total of all active and inactive participants2010-11-01216
2009: INTERSTATE FOAM WELFARE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year2009-11-01219
Total number of active participants reported on line 7a of the Form 55002009-11-01208
Number of retired or separated participants receiving benefits2009-11-012
Number of other retired or separated participants entitled to future benefits2009-11-011
Total of all active and inactive participants2009-11-01211

Form 5500 Responses for INTERSTATE FOAM WELFARE BENEFIT PLAN

2021: INTERSTATE FOAM WELFARE BENEFIT PLAN 2021 form 5500 responses
2021-11-01Type of plan entitySingle employer plan
2021-11-01Plan funding arrangement – InsuranceYes
2021-11-01Plan funding arrangement – General assets of the sponsorYes
2021-11-01Plan benefit arrangement – InsuranceYes
2021-11-01Plan benefit arrangement – General assets of the sponsorYes
2020: INTERSTATE FOAM WELFARE BENEFIT PLAN 2020 form 5500 responses
2020-11-01Type of plan entitySingle employer plan
2020-11-01Plan funding arrangement – InsuranceYes
2020-11-01Plan funding arrangement – General assets of the sponsorYes
2020-11-01Plan benefit arrangement – InsuranceYes
2020-11-01Plan benefit arrangement – General assets of the sponsorYes
2019: INTERSTATE FOAM WELFARE BENEFIT PLAN 2019 form 5500 responses
2019-11-01Type of plan entitySingle employer plan
2019-11-01Plan funding arrangement – InsuranceYes
2019-11-01Plan funding arrangement – General assets of the sponsorYes
2019-11-01Plan benefit arrangement – InsuranceYes
2019-11-01Plan benefit arrangement – General assets of the sponsorYes
2018: INTERSTATE FOAM WELFARE BENEFIT PLAN 2018 form 5500 responses
2018-11-01Type of plan entitySingle employer plan
2018-11-01Plan funding arrangement – InsuranceYes
2018-11-01Plan funding arrangement – General assets of the sponsorYes
2018-11-01Plan benefit arrangement – InsuranceYes
2018-11-01Plan benefit arrangement – General assets of the sponsorYes
2017: INTERSTATE FOAM WELFARE BENEFIT PLAN 2017 form 5500 responses
2017-11-01Type of plan entitySingle employer plan
2017-11-01Plan funding arrangement – InsuranceYes
2017-11-01Plan funding arrangement – General assets of the sponsorYes
2017-11-01Plan benefit arrangement – InsuranceYes
2017-11-01Plan benefit arrangement – General assets of the sponsorYes
2016: INTERSTATE FOAM WELFARE BENEFIT PLAN 2016 form 5500 responses
2016-11-01Type of plan entitySingle employer plan
2016-11-01Plan funding arrangement – InsuranceYes
2016-11-01Plan funding arrangement – General assets of the sponsorYes
2016-11-01Plan benefit arrangement – InsuranceYes
2016-11-01Plan benefit arrangement – General assets of the sponsorYes
2015: INTERSTATE FOAM WELFARE BENEFIT PLAN 2015 form 5500 responses
2015-11-01Type of plan entitySingle employer plan
2015-11-01Submission has been amendedNo
2015-11-01This submission is the final filingNo
2015-11-01This return/report is a short plan year return/report (less than 12 months)No
2015-11-01Plan is a collectively bargained planNo
2015-11-01Plan funding arrangement – InsuranceYes
2015-11-01Plan funding arrangement – General assets of the sponsorYes
2015-11-01Plan benefit arrangement – InsuranceYes
2015-11-01Plan benefit arrangement – General assets of the sponsorYes
2014: INTERSTATE FOAM WELFARE BENEFIT PLAN 2014 form 5500 responses
2014-11-01Type of plan entitySingle employer plan
2014-11-01Submission has been amendedNo
2014-11-01This submission is the final filingNo
2014-11-01This return/report is a short plan year return/report (less than 12 months)No
2014-11-01Plan is a collectively bargained planNo
2014-11-01Plan funding arrangement – InsuranceYes
2014-11-01Plan funding arrangement – General assets of the sponsorYes
2014-11-01Plan benefit arrangement – InsuranceYes
2014-11-01Plan benefit arrangement – General assets of the sponsorYes
2013: INTERSTATE FOAM WELFARE BENEFIT PLAN 2013 form 5500 responses
2013-11-01Type of plan entitySingle employer plan
2013-11-01Submission has been amendedNo
2013-11-01This submission is the final filingNo
2013-11-01This return/report is a short plan year return/report (less than 12 months)No
2013-11-01Plan is a collectively bargained planNo
2013-11-01Plan funding arrangement – InsuranceYes
2013-11-01Plan funding arrangement – General assets of the sponsorYes
2013-11-01Plan benefit arrangement – InsuranceYes
2013-11-01Plan benefit arrangement – General assets of the sponsorYes
2012: INTERSTATE FOAM WELFARE BENEFIT PLAN 2012 form 5500 responses
2012-11-01Type of plan entitySingle employer plan
2012-11-01Submission has been amendedNo
2012-11-01This submission is the final filingNo
2012-11-01This return/report is a short plan year return/report (less than 12 months)No
2012-11-01Plan is a collectively bargained planNo
2012-11-01Plan funding arrangement – InsuranceYes
2012-11-01Plan funding arrangement – General assets of the sponsorYes
2012-11-01Plan benefit arrangement – InsuranceYes
2012-11-01Plan benefit arrangement – General assets of the sponsorYes
2011: INTERSTATE FOAM WELFARE BENEFIT PLAN 2011 form 5500 responses
2011-11-01Type of plan entitySingle employer plan
2011-11-01Submission has been amendedNo
2011-11-01This submission is the final filingNo
2011-11-01This return/report is a short plan year return/report (less than 12 months)No
2011-11-01Plan is a collectively bargained planNo
2011-11-01Plan funding arrangement – InsuranceYes
2011-11-01Plan funding arrangement – General assets of the sponsorYes
2011-11-01Plan benefit arrangement – InsuranceYes
2011-11-01Plan benefit arrangement – General assets of the sponsorYes
2010: INTERSTATE FOAM WELFARE BENEFIT PLAN 2010 form 5500 responses
2010-11-01Type of plan entitySingle employer plan
2010-11-01Submission has been amendedNo
2010-11-01This submission is the final filingNo
2010-11-01This return/report is a short plan year return/report (less than 12 months)No
2010-11-01Plan is a collectively bargained planNo
2010-11-01Plan funding arrangement – InsuranceYes
2010-11-01Plan funding arrangement – General assets of the sponsorYes
2010-11-01Plan benefit arrangement – InsuranceYes
2010-11-01Plan benefit arrangement – General assets of the sponsorYes
2009: INTERSTATE FOAM WELFARE BENEFIT PLAN 2009 form 5500 responses
2009-11-01Type of plan entitySingle employer plan
2009-11-01Submission has been amendedNo
2009-11-01This submission is the final filingNo
2009-11-01This return/report is a short plan year return/report (less than 12 months)No
2009-11-01Plan is a collectively bargained planNo
2009-11-01Plan funding arrangement – InsuranceYes
2009-11-01Plan funding arrangement – General assets of the sponsorYes
2009-11-01Plan benefit arrangement – InsuranceYes
2009-11-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010162623
Policy instance 5
Insurance contract or identification number000010162623
Number of Individuals Covered453
Insurance policy start date2021-11-01
Insurance policy end date2022-10-31
Total amount of commissions paid to insurance brokerUSD $2,348
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $15,656
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,348
Insurance broker organization code?3
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE5169412
Policy instance 4
Insurance contract or identification numberE5169412
Number of Individuals Covered131
Insurance policy start date2021-12-01
Insurance policy end date2022-11-30
Total amount of commissions paid to insurance brokerUSD $19,377
Total amount of fees paid to insurance companyUSD $2,024
Life Insurance Welfare BenefitYes
Other welfare benefits providedCANCER INSURANCE
Welfare Benefit Premiums Paid to CarrierUSD $93,302
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,739
Insurance broker organization code?3
Amount paid for insurance broker fees1263
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number000000466583
Policy instance 3
Insurance contract or identification number000000466583
Number of Individuals Covered130
Insurance policy start date2021-12-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $3,646
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $55,631
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,646
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number603226
Policy instance 2
Insurance contract or identification number603226
Number of Individuals Covered15
Insurance policy start date2021-12-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $3,214
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $24,615
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,214
Insurance broker organization code?3
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number4031300010SSLS
Policy instance 1
Insurance contract or identification number4031300010SSLS
Number of Individuals Covered292
Insurance policy start date2021-11-01
Insurance policy end date2022-10-31
Total amount of commissions paid to insurance brokerUSD $38,139
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $762,787
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $38,139
Insurance broker organization code?3
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number4031300010SSLS
Policy instance 1
Insurance contract or identification number4031300010SSLS
Number of Individuals Covered264
Insurance policy start date2020-11-01
Insurance policy end date2021-10-31
Total amount of commissions paid to insurance brokerUSD $33,038
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $660,758
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $33,038
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number603226
Policy instance 2
Insurance contract or identification number603226
Number of Individuals Covered15
Insurance policy start date2020-12-01
Insurance policy end date2021-12-01
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number000000466583
Policy instance 3
Insurance contract or identification number000000466583
Number of Individuals Covered95
Insurance policy start date2020-12-01
Insurance policy end date2021-12-01
Total amount of commissions paid to insurance brokerUSD $2,532
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $31,636
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,532
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE5169412
Policy instance 4
Insurance contract or identification numberE5169412
Number of Individuals Covered86
Insurance policy start date2020-12-01
Insurance policy end date2021-11-30
Total amount of commissions paid to insurance brokerUSD $13,092
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedCANCER INSURANCE
Welfare Benefit Premiums Paid to CarrierUSD $81,177
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,134
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010162623
Policy instance 5
Insurance contract or identification number000010162623
Number of Individuals Covered367
Insurance policy start date2020-11-01
Insurance policy end date2021-10-31
Total amount of commissions paid to insurance brokerUSD $2,137
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $14,250
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,137
Insurance broker organization code?3
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE5169412
Policy instance 4
Insurance contract or identification numberE5169412
Number of Individuals Covered83
Insurance policy start date2019-12-01
Insurance policy end date2020-11-30
Total amount of commissions paid to insurance brokerUSD $11,722
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedCANCER INSURANCE
Welfare Benefit Premiums Paid to CarrierUSD $37,309
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,805
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number000000466583
Policy instance 3
Insurance contract or identification number000000466583
Number of Individuals Covered90
Insurance policy start date2019-12-01
Insurance policy end date2020-12-01
Total amount of commissions paid to insurance brokerUSD $2,310
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $27,194
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,310
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number603226
Policy instance 2
Insurance contract or identification number603226
Number of Individuals Covered15
Insurance policy start date2019-12-01
Insurance policy end date2020-12-01
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number4031300010SSLS
Policy instance 1
Insurance contract or identification number4031300010SSLS
Number of Individuals Covered285
Insurance policy start date2019-11-01
Insurance policy end date2020-10-31
Total amount of commissions paid to insurance brokerUSD $67,061
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $670,611
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $67,061
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010162623
Policy instance 1
Insurance contract or identification number000010162623
Number of Individuals Covered347
Insurance policy start date2018-11-01
Insurance policy end date2019-10-31
Total amount of commissions paid to insurance brokerUSD $1,958
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $13,055
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,958
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number466583
Policy instance 3
Insurance contract or identification number466583
Number of Individuals Covered86
Insurance policy start date2018-12-01
Insurance policy end date2019-12-01
Total amount of commissions paid to insurance brokerUSD $2,102
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $23,600
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,102
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE5169412
Policy instance 4
Insurance contract or identification numberE5169412
Number of Individuals Covered85
Insurance policy start date2018-12-01
Insurance policy end date2019-11-30
Total amount of commissions paid to insurance brokerUSD $29,425
Total amount of fees paid to insurance companyUSD $5,767
Life Insurance Welfare BenefitYes
Other welfare benefits providedCANCER INSURANCE
Welfare Benefit Premiums Paid to CarrierUSD $32,654
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,692
Amount paid for insurance broker fees3602
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number603226
Policy instance 2
Insurance contract or identification number603226
Number of Individuals Covered15
Insurance policy start date2018-12-01
Insurance policy end date2019-12-01
Total amount of commissions paid to insurance brokerUSD $2,446
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $17,544
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,446
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010162623
Policy instance 1
Insurance contract or identification number000010162623
Number of Individuals Covered349
Insurance policy start date2017-11-01
Insurance policy end date2018-10-31
Total amount of commissions paid to insurance brokerUSD $1,830
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $12,202
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number466583
Policy instance 3
Insurance contract or identification number466583
Number of Individuals Covered75
Insurance policy start date2016-12-01
Insurance policy end date2017-12-01
Total amount of commissions paid to insurance brokerUSD $1,719
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $18,124
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number466584
Policy instance 4
Insurance contract or identification number466584
Number of Individuals Covered54
Insurance policy start date2016-12-01
Insurance policy end date2017-12-01
Total amount of commissions paid to insurance brokerUSD $4,254
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $26,034
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE7029580
Policy instance 5
Insurance contract or identification numberE7029580
Number of Individuals Covered5
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $371
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedCANCER INSURANCE
Welfare Benefit Premiums Paid to CarrierUSD $4,468
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number603226
Policy instance 2
Insurance contract or identification number603226
Number of Individuals Covered15
Insurance policy start date2016-12-01
Insurance policy end date2017-12-01
Total amount of commissions paid to insurance brokerUSD $1,593
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $11,427
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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