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PRESTONWOOD COUNTRY CLUB, INC. 401k Plan overview

Plan NamePRESTONWOOD COUNTRY CLUB, INC.
Plan identification number 501

PRESTONWOOD COUNTRY CLUB, INC. 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
  • Other welfare benefit cover

401k Sponsoring company profile

SAS INSTITUTE INC. has sponsored the creation of one or more 401k plans.

Company Name:SAS INSTITUTE INC.
Employer identification number (EIN):561750016
NAIC Classification:713900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PRESTONWOOD COUNTRY CLUB, INC.

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-02-01JIM W GRAY2023-08-15
5012020-02-01JIM W GRAY2021-08-25
5012019-02-01JIM W GRAY2020-11-12
5012018-02-01JIM W GRAY2019-08-26
5012017-02-01
5012017-02-01
5012016-02-01
5012015-02-01
5012014-02-01
5012013-02-01
5012012-02-01JIM GRAY
5012011-02-15JIM GRAY
5012009-02-14JIM GRAY
5012009-02-14JIM GRAY

Plan Statistics for PRESTONWOOD COUNTRY CLUB, INC.

401k plan membership statisitcs for PRESTONWOOD COUNTRY CLUB, INC.

Measure Date Value
2022: PRESTONWOOD COUNTRY CLUB, INC. 2022 401k membership
Total participants, beginning-of-year2022-02-01149
Total number of active participants reported on line 7a of the Form 55002022-02-01149
Total of all active and inactive participants2022-02-01149
2020: PRESTONWOOD COUNTRY CLUB, INC. 2020 401k membership
Total participants, beginning-of-year2020-02-01117
Total number of active participants reported on line 7a of the Form 55002020-02-0184
Number of retired or separated participants receiving benefits2020-02-015
Total of all active and inactive participants2020-02-0189
2019: PRESTONWOOD COUNTRY CLUB, INC. 2019 401k membership
Total participants, beginning-of-year2019-02-01146
Total number of active participants reported on line 7a of the Form 55002019-02-01117
Number of retired or separated participants receiving benefits2019-02-015
Total of all active and inactive participants2019-02-01122
2018: PRESTONWOOD COUNTRY CLUB, INC. 2018 401k membership
Total participants, beginning-of-year2018-02-01132
Total number of active participants reported on line 7a of the Form 55002018-02-01144
Number of retired or separated participants receiving benefits2018-02-012
Total of all active and inactive participants2018-02-01146
2017: PRESTONWOOD COUNTRY CLUB, INC. 2017 401k membership
Total participants, beginning-of-year2017-02-01123
Total number of active participants reported on line 7a of the Form 55002017-02-01131
Number of retired or separated participants receiving benefits2017-02-011
Total of all active and inactive participants2017-02-01132
2016: PRESTONWOOD COUNTRY CLUB, INC. 2016 401k membership
Total participants, beginning-of-year2016-02-01149
Total number of active participants reported on line 7a of the Form 55002016-02-01123
Number of retired or separated participants receiving benefits2016-02-010
Total of all active and inactive participants2016-02-01123
2015: PRESTONWOOD COUNTRY CLUB, INC. 2015 401k membership
Total participants, beginning-of-year2015-02-01139
Total number of active participants reported on line 7a of the Form 55002015-02-01149
Total of all active and inactive participants2015-02-01149
2014: PRESTONWOOD COUNTRY CLUB, INC. 2014 401k membership
Total participants, beginning-of-year2014-02-01130
Total number of active participants reported on line 7a of the Form 55002014-02-01138
Number of retired or separated participants receiving benefits2014-02-011
Total of all active and inactive participants2014-02-01139
2013: PRESTONWOOD COUNTRY CLUB, INC. 2013 401k membership
Total participants, beginning-of-year2013-02-01115
Total number of active participants reported on line 7a of the Form 55002013-02-01127
Number of retired or separated participants receiving benefits2013-02-013
Total of all active and inactive participants2013-02-01130
2012: PRESTONWOOD COUNTRY CLUB, INC. 2012 401k membership
Total participants, beginning-of-year2012-02-01123
Total number of active participants reported on line 7a of the Form 55002012-02-01115
Number of retired or separated participants receiving benefits2012-02-010
Total of all active and inactive participants2012-02-01115
2011: PRESTONWOOD COUNTRY CLUB, INC. 2011 401k membership
Total participants, beginning-of-year2011-02-15121
Total number of active participants reported on line 7a of the Form 55002011-02-15123
Total of all active and inactive participants2011-02-15123
Total participants2011-02-15123
2009: PRESTONWOOD COUNTRY CLUB, INC. 2009 401k membership
Total participants, beginning-of-year2009-02-14140
Total number of active participants reported on line 7a of the Form 55002009-02-14109
Number of retired or separated participants receiving benefits2009-02-142
Number of other retired or separated participants entitled to future benefits2009-02-140
Total of all active and inactive participants2009-02-14111
Total participants2009-02-14111

Form 5500 Responses for PRESTONWOOD COUNTRY CLUB, INC.

2022: PRESTONWOOD COUNTRY CLUB, INC. 2022 form 5500 responses
2022-02-01Type of plan entitySingle employer plan
2022-02-01Plan funding arrangement – InsuranceYes
2022-02-01Plan benefit arrangement – InsuranceYes
2020: PRESTONWOOD COUNTRY CLUB, INC. 2020 form 5500 responses
2020-02-01Type of plan entitySingle employer plan
2020-02-01Plan funding arrangement – InsuranceYes
2020-02-01Plan benefit arrangement – InsuranceYes
2019: PRESTONWOOD COUNTRY CLUB, INC. 2019 form 5500 responses
2019-02-01Type of plan entitySingle employer plan
2019-02-01Plan funding arrangement – InsuranceYes
2019-02-01Plan benefit arrangement – InsuranceYes
2018: PRESTONWOOD COUNTRY CLUB, INC. 2018 form 5500 responses
2018-02-01Type of plan entitySingle employer plan
2018-02-01Plan funding arrangement – InsuranceYes
2018-02-01Plan benefit arrangement – InsuranceYes
2017: PRESTONWOOD COUNTRY CLUB, INC. 2017 form 5500 responses
2017-02-01Type of plan entitySingle employer plan
2017-02-01Plan funding arrangement – InsuranceYes
2017-02-01Plan benefit arrangement – InsuranceYes
2016: PRESTONWOOD COUNTRY CLUB, INC. 2016 form 5500 responses
2016-02-01Type of plan entitySingle employer plan
2016-02-01Plan funding arrangement – InsuranceYes
2016-02-01Plan benefit arrangement – InsuranceYes
2015: PRESTONWOOD COUNTRY CLUB, INC. 2015 form 5500 responses
2015-02-01Type of plan entitySingle employer plan
2015-02-01Plan funding arrangement – InsuranceYes
2015-02-01Plan benefit arrangement – InsuranceYes
2014: PRESTONWOOD COUNTRY CLUB, INC. 2014 form 5500 responses
2014-02-01Type of plan entitySingle employer plan
2014-02-01Plan funding arrangement – InsuranceYes
2014-02-01Plan benefit arrangement – InsuranceYes
2013: PRESTONWOOD COUNTRY CLUB, INC. 2013 form 5500 responses
2013-02-01Type of plan entitySingle employer plan
2013-02-01Plan funding arrangement – InsuranceYes
2013-02-01Plan benefit arrangement – InsuranceYes
2012: PRESTONWOOD COUNTRY CLUB, INC. 2012 form 5500 responses
2012-02-01Type of plan entitySingle employer plan
2012-02-01Plan funding arrangement – InsuranceYes
2012-02-01Plan benefit arrangement – InsuranceYes
2011: PRESTONWOOD COUNTRY CLUB, INC. 2011 form 5500 responses
2011-02-15Type of plan entitySingle employer plan
2011-02-15Submission has been amendedNo
2011-02-15This submission is the final filingNo
2011-02-15This return/report is a short plan year return/report (less than 12 months)No
2011-02-15Plan is a collectively bargained planNo
2011-02-15Plan funding arrangement – InsuranceYes
2011-02-15Plan funding arrangement – General assets of the sponsorYes
2011-02-15Plan benefit arrangement – InsuranceYes
2011-02-15Plan benefit arrangement – General assets of the sponsorYes
2009: PRESTONWOOD COUNTRY CLUB, INC. 2009 form 5500 responses
2009-02-14Type of plan entitySingle employer plan
2009-02-14Submission has been amendedYes
2009-02-14This submission is the final filingNo
2009-02-14This return/report is a short plan year return/report (less than 12 months)No
2009-02-14Plan is a collectively bargained planNo
2009-02-14Plan funding arrangement – InsuranceYes
2009-02-14Plan funding arrangement – General assets of the sponsorYes
2009-02-14Plan benefit arrangement – InsuranceYes
2009-02-14Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )
Policy contract number14161755-1001
Policy instance 7
Insurance contract or identification number14161755-1001
Number of Individuals Covered135
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $10,240
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Other welfare benefits providedHSA FUND, WELLNESS
Welfare Benefit Premiums Paid to CarrierUSD $972,548
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,240
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGM610040
Policy instance 1
Insurance contract or identification numberSGM610040
Number of Individuals Covered106
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $2,067
Total amount of fees paid to insurance companyUSD $762
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $20,489
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,067
Amount paid for insurance broker fees762
Additional information about fees paid to insurance brokerSERVICE FEES
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSOK607518
Policy instance 2
Insurance contract or identification numberSOK607518
Number of Individuals Covered106
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $98
Total amount of fees paid to insurance companyUSD $37
Other welfare benefits providedACCIDENTAL DEATH
Welfare Benefit Premiums Paid to CarrierUSD $957
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $98
Amount paid for insurance broker fees37
Additional information about fees paid to insurance brokerSERVICE FEES
Insurance broker organization code?3
BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )
Policy contract number14161755-1001
Policy instance 3
Insurance contract or identification number14161755-1001
Number of Individuals Covered147
Insurance policy start date2022-07-01
Insurance policy end date2023-01-31
Total amount of commissions paid to insurance brokerUSD $13,597
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Other welfare benefits providedHSA FUND, WELLNESS
Welfare Benefit Premiums Paid to CarrierUSD $608,607
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,597
Insurance broker organization code?3
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3342803
Policy instance 4
Insurance contract or identification number3342803
Number of Individuals Covered76
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $7,483
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $75,509
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,483
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGD610738
Policy instance 5
Insurance contract or identification numberSGD610738
Number of Individuals Covered105
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $1,592
Total amount of fees paid to insurance companyUSD $715
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $16,715
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,592
Amount paid for insurance broker fees715
Additional information about fees paid to insurance brokerSERVICE FEES
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberVDT602613
Policy instance 6
Insurance contract or identification numberVDT602613
Number of Individuals Covered29
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $878
Total amount of fees paid to insurance companyUSD $335
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $8,601
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $878
Amount paid for insurance broker fees335
Additional information about fees paid to insurance brokerSERVICE FEES
Insurance broker organization code?3
BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )
Policy contract number066114
Policy instance 1
Insurance contract or identification number066114
Number of Individuals Covered150
Insurance policy start date2020-02-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $14,192
Total amount of fees paid to insurance companyUSD $357
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,192
Amount paid for insurance broker fees357
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberVDT602613
Policy instance 2
Insurance contract or identification numberVDT602613
Number of Individuals Covered30
Insurance policy start date2019-07-01
Insurance policy end date2020-07-01
Total amount of commissions paid to insurance brokerUSD $697
Total amount of fees paid to insurance companyUSD $209
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $6,969
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $697
Amount paid for insurance broker fees209
Additional information about fees paid to insurance brokerSALES & SERVICE
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGM610040
Policy instance 3
Insurance contract or identification numberSGM610040
Number of Individuals Covered92
Insurance policy start date2019-07-01
Insurance policy end date2020-07-01
Total amount of commissions paid to insurance brokerUSD $1,926
Total amount of fees paid to insurance companyUSD $578
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $19,262
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,926
Amount paid for insurance broker fees578
Additional information about fees paid to insurance brokerSALES & SERVICE
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGD610738
Policy instance 4
Insurance contract or identification numberSGD610738
Number of Individuals Covered92
Insurance policy start date2019-07-01
Insurance policy end date2020-07-01
Total amount of commissions paid to insurance brokerUSD $1,471
Total amount of fees paid to insurance companyUSD $441
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $14,711
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,471
Amount paid for insurance broker fees441
Additional information about fees paid to insurance brokerSALES & SERVICE
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSOK607518
Policy instance 5
Insurance contract or identification numberSOK607518
Number of Individuals Covered92
Insurance policy start date2019-07-01
Insurance policy end date2020-07-01
Total amount of commissions paid to insurance brokerUSD $125
Total amount of fees paid to insurance companyUSD $38
Other welfare benefits providedACCIDENTAL DEATH
Welfare Benefit Premiums Paid to CarrierUSD $1,253
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $125
Amount paid for insurance broker fees38
Insurance broker organization code?3
BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )
Policy contract number14161755-1001
Policy instance 6
Insurance contract or identification number14161755-1001
Number of Individuals Covered140
Insurance policy start date2020-07-01
Insurance policy end date2021-01-31
Total amount of commissions paid to insurance brokerUSD $13,575
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Other welfare benefits providedHSA FUND, WELLNESS
Welfare Benefit Premiums Paid to CarrierUSD $558,501
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,575
Insurance broker organization code?3
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3342803
Policy instance 7
Insurance contract or identification number3342803
Number of Individuals Covered85
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $7,042
Total amount of fees paid to insurance companyUSD $1,642
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $71,063
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,042
Amount paid for insurance broker fees1642
Additional information about fees paid to insurance brokerINCENTIVE
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number410217
Policy instance 7
Insurance contract or identification number410217
Number of Individuals Covered121
Insurance policy start date2019-01-01
Insurance policy end date2020-01-01
Total amount of commissions paid to insurance brokerUSD $1,900
Total amount of fees paid to insurance companyUSD $297
Life Insurance Welfare BenefitYes
Other welfare benefits providedADD, STD
Welfare Benefit Premiums Paid to CarrierUSD $14,857
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,900
Amount paid for insurance broker fees297
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number410216
Policy instance 6
Insurance contract or identification number410216
Number of Individuals Covered32
Insurance policy start date2019-01-01
Insurance policy end date2020-01-01
Total amount of commissions paid to insurance brokerUSD $1,195
Total amount of fees paid to insurance companyUSD $126
Other welfare benefits providedLIFESTYLE ADD, LIFESTYLE LIFE
Welfare Benefit Premiums Paid to CarrierUSD $6,291
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,195
Amount paid for insurance broker fees126
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number410215
Policy instance 5
Insurance contract or identification number410215
Number of Individuals Covered23
Insurance policy start date2019-01-01
Insurance policy end date2020-01-01
Total amount of commissions paid to insurance brokerUSD $534
Total amount of fees paid to insurance companyUSD $56
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,937
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $534
Amount paid for insurance broker fees56
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number5928329
Policy instance 4
Insurance contract or identification number5928329
Number of Individuals Covered0
Insurance policy start date2019-01-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $2,355
Total amount of fees paid to insurance companyUSD $2,079
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $39,175
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,355
Amount paid for insurance broker fees632
Insurance broker organization code?3
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3342803
Policy instance 3
Insurance contract or identification number3342803
Number of Individuals Covered122
Insurance policy start date2019-07-01
Insurance policy end date2020-01-31
Total amount of commissions paid to insurance brokerUSD $6,131
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,131
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number0010653788
Policy instance 2
Insurance contract or identification number0010653788
Number of Individuals Covered22
Insurance policy start date2019-02-01
Insurance policy end date2020-01-31
Total amount of commissions paid to insurance brokerUSD $817
Total amount of fees paid to insurance companyUSD $63
Other welfare benefits providedGCIEE, GRPACCVO
Welfare Benefit Premiums Paid to CarrierUSD $2,323
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $817
Amount paid for insurance broker fees63
Insurance broker organization code?3
BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )
Policy contract number066114
Policy instance 1
Insurance contract or identification number066114
Number of Individuals Covered203
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $30,171
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $30,171
Insurance broker organization code?3
BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )
Policy contract number066114
Policy instance 1
Insurance contract or identification number066114
Number of Individuals Covered209
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $30,836
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $30,836
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number5928329
Policy instance 2
Insurance contract or identification number5928329
Number of Individuals Covered294
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $4,760
Total amount of fees paid to insurance companyUSD $4,392
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $103,136
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,760
Amount paid for insurance broker fees1502
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMP, NON-MONETARY
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number410216
Policy instance 3
Insurance contract or identification number410216
Number of Individuals Covered34
Insurance policy start date2018-01-01
Insurance policy end date2019-01-01
Total amount of commissions paid to insurance brokerUSD $2,355
Total amount of fees paid to insurance companyUSD $248
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $12,396
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,355
Amount paid for insurance broker fees248
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number410217
Policy instance 4
Insurance contract or identification number410217
Number of Individuals Covered144
Insurance policy start date2018-01-01
Insurance policy end date2019-01-01
Total amount of commissions paid to insurance brokerUSD $4,095
Total amount of fees paid to insurance companyUSD $897
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $30,773
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,095
Amount paid for insurance broker fees897
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number410215
Policy instance 5
Insurance contract or identification number410215
Number of Individuals Covered28
Insurance policy start date2018-01-01
Insurance policy end date2019-01-01
Total amount of commissions paid to insurance brokerUSD $1,164
Total amount of fees paid to insurance companyUSD $123
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $6,125
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,164
Amount paid for insurance broker fees123
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number410215
Policy instance 6
Insurance contract or identification number410215
Number of Individuals Covered26
Insurance policy start date2017-02-01
Insurance policy end date2018-02-01
Total amount of commissions paid to insurance brokerUSD $1,774
Total amount of fees paid to insurance companyUSD $206
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $9,810
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,774
Amount paid for insurance broker fees206
Insurance broker organization code?3
Insurance broker nameMARSH & MCLENNAN AGENCY LLC
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number410217
Policy instance 5
Insurance contract or identification number410217
Number of Individuals Covered146
Insurance policy start date2017-02-01
Insurance policy end date2018-02-01
Total amount of commissions paid to insurance brokerUSD $2,846
Total amount of fees paid to insurance companyUSD $644
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $21,975
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,846
Amount paid for insurance broker fees644
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
Insurance broker nameMARSH & MCLENNAN
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number410216
Policy instance 4
Insurance contract or identification number410216
Number of Individuals Covered32
Insurance policy start date2017-02-01
Insurance policy end date2018-02-01
Total amount of commissions paid to insurance brokerUSD $2,013
Total amount of fees paid to insurance companyUSD $227
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $11,608
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,013
Amount paid for insurance broker fees227
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
Insurance broker nameMARSH & MCLENNAN AGENCY LLC
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberTM05928329
Policy instance 3
Insurance contract or identification numberTM05928329
Number of Individuals Covered353
Insurance policy start date2017-02-01
Insurance policy end date2018-01-31
Total amount of commissions paid to insurance brokerUSD $7,858
Total amount of fees paid to insurance companyUSD $1,531
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $98,167
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,911
Amount paid for insurance broker fees1531
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
Insurance broker namePLANSOURCE BENEFITS ADMIN INC
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract numberR0594036
Policy instance 2
Insurance contract or identification numberR0594036
Number of Individuals Covered14
Insurance policy start date2017-02-01
Insurance policy end date2018-02-01
Total amount of commissions paid to insurance brokerUSD $331
Total amount of fees paid to insurance companyUSD $19
Other welfare benefits providedGROUP CRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $2,426
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $331
Amount paid for insurance broker fees19
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
Insurance broker nameMARSH & MCLENNAN AGENCY LLC
BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )
Policy contract number066114
Policy instance 1
Insurance contract or identification number066114
Number of Individuals Covered235
Insurance policy start date2017-02-01
Insurance policy end date2018-01-31
Total amount of commissions paid to insurance brokerUSD $33,222
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $33,222
Insurance broker organization code?3
Insurance broker nameMCDONNELL, JOHN N

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