ROGERS & BROWN CUSTOM BROKERS has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan ROGERS & BROWN CUSTOM BROKERS, INC. HEALTH CARE PLAN
401k plan membership statisitcs for ROGERS & BROWN CUSTOM BROKERS, INC. HEALTH CARE PLAN
Measure | Date | Value |
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2017: ROGERS & BROWN CUSTOM BROKERS, INC. HEALTH CARE PLAN 2017 401k membership |
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Total participants, beginning-of-year | 2017-09-01 | 124 |
Total number of active participants reported on line 7a of the Form 5500 | 2017-09-01 | 107 |
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 | 4 |
Total of all active and inactive participants | 2017-09-01 | 111 |
2016: ROGERS & BROWN CUSTOM BROKERS, INC. HEALTH CARE PLAN 2016 401k membership |
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Total participants, beginning-of-year | 2016-09-01 | 135 |
Total number of active participants reported on line 7a of the Form 5500 | 2016-09-01 | 120 |
Number of retired or separated participants receiving benefits | 2016-09-01 | 1 |
Number of other retired or separated participants entitled to future benefits | 2016-09-01 | 3 |
Total of all active and inactive participants | 2016-09-01 | 124 |
2015: ROGERS & BROWN CUSTOM BROKERS, INC. HEALTH CARE PLAN 2015 401k membership |
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Total participants, beginning-of-year | 2015-09-01 | 109 |
Total number of active participants reported on line 7a of the Form 5500 | 2015-09-01 | 113 |
Number of retired or separated participants receiving benefits | 2015-09-01 | 1 |
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 | 114 |
2014: ROGERS & BROWN CUSTOM BROKERS, INC. HEALTH CARE PLAN 2014 401k membership |
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Total participants, beginning-of-year | 2014-09-01 | 112 |
Total number of active participants reported on line 7a of the Form 5500 | 2014-09-01 | 109 |
Number of retired or separated participants receiving benefits | 2014-09-01 | 1 |
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 | 110 |
2013: ROGERS & BROWN CUSTOM BROKERS, INC. HEALTH CARE PLAN 2013 401k membership |
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Total participants, beginning-of-year | 2013-09-01 | 110 |
Total number of active participants reported on line 7a of the Form 5500 | 2013-09-01 | 112 |
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 | 112 |
2012: ROGERS & BROWN CUSTOM BROKERS, INC. HEALTH CARE PLAN 2012 401k membership |
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Total participants, beginning-of-year | 2012-09-01 | 121 |
Total number of active participants reported on line 7a of the Form 5500 | 2012-09-01 | 110 |
Number of retired or separated participants receiving benefits | 2012-09-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2012-09-01 | 0 |
Total of all active and inactive participants | 2012-09-01 | 110 |
2011: ROGERS & BROWN CUSTOM BROKERS, INC. HEALTH CARE PLAN 2011 401k membership |
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Total participants, beginning-of-year | 2011-09-01 | 130 |
Total number of active participants reported on line 7a of the Form 5500 | 2011-09-01 | 121 |
Total of all active and inactive participants | 2011-09-01 | 121 |
2010: ROGERS & BROWN CUSTOM BROKERS, INC. HEALTH CARE PLAN 2010 401k membership |
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Total participants, beginning-of-year | 2010-09-01 | 134 |
Total number of active participants reported on line 7a of the Form 5500 | 2010-09-01 | 130 |
Total of all active and inactive participants | 2010-09-01 | 130 |
2009: ROGERS & BROWN CUSTOM BROKERS, INC. HEALTH CARE PLAN 2009 401k membership |
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Total participants, beginning-of-year | 2009-09-01 | 152 |
Total number of active participants reported on line 7a of the Form 5500 | 2009-09-01 | 134 |
Total of all active and inactive participants | 2009-09-01 | 134 |
2003: ROGERS & BROWN CUSTOM BROKERS, INC. HEALTH CARE PLAN 2003 401k membership |
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Total participants, beginning-of-year | 2003-09-01 | 166 |
Total number of active participants reported on line 7a of the Form 5500 | 2003-09-01 | 163 |
Total of all active and inactive participants | 2003-09-01 | 163 |
2002: ROGERS & BROWN CUSTOM BROKERS, INC. HEALTH CARE PLAN 2002 401k membership |
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Total participants, beginning-of-year | 2002-09-01 | 155 |
Total number of active participants reported on line 7a of the Form 5500 | 2002-09-01 | 166 |
Total of all active and inactive participants | 2002-09-01 | 166 |
2017: ROGERS & BROWN CUSTOM BROKERS, INC. HEALTH CARE PLAN 2017 form 5500 responses |
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2017-09-01 | Type of plan entity | Single employer plan |
2017-09-01 | Submission has been amended | No |
2017-09-01 | This submission is the final filing | No |
2017-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2017-09-01 | Plan is a collectively bargained plan | No |
2017-09-01 | Plan funding arrangement – Insurance | Yes |
2017-09-01 | Plan benefit arrangement – Insurance | Yes |
2016: ROGERS & BROWN CUSTOM BROKERS, INC. HEALTH CARE 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 benefit arrangement – Insurance | Yes |
2015: ROGERS & BROWN CUSTOM BROKERS, INC. HEALTH CARE 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 benefit arrangement – Insurance | Yes |
2014: ROGERS & BROWN CUSTOM BROKERS, INC. HEALTH CARE 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 benefit arrangement – Insurance | Yes |
2013: ROGERS & BROWN CUSTOM BROKERS, INC. HEALTH CARE PLAN 2013 form 5500 responses |
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2013-09-01 | Type of plan entity | Single employer plan |
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 |
2012: ROGERS & BROWN CUSTOM BROKERS, INC. HEALTH CARE PLAN 2012 form 5500 responses |
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2012-09-01 | Type of plan entity | Mulitple employer plan |
2012-09-01 | Submission has been amended | No |
2012-09-01 | This submission is the final filing | No |
2012-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2012-09-01 | Plan is a collectively bargained plan | No |
2012-09-01 | Plan funding arrangement – Insurance | Yes |
2012-09-01 | Plan benefit arrangement – Insurance | Yes |
2011: ROGERS & BROWN CUSTOM BROKERS, INC. HEALTH CARE PLAN 2011 form 5500 responses |
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2011-09-01 | Type of plan entity | Mulitple employer plan |
2011-09-01 | Submission has been amended | No |
2011-09-01 | This submission is the final filing | No |
2011-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2011-09-01 | Plan is a collectively bargained plan | No |
2011-09-01 | Plan funding arrangement – Insurance | Yes |
2011-09-01 | Plan benefit arrangement – Insurance | Yes |
2010: ROGERS & BROWN CUSTOM BROKERS, INC. HEALTH CARE PLAN 2010 form 5500 responses |
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2010-09-01 | Type of plan entity | Mulitple employer plan |
2010-09-01 | Submission has been amended | No |
2010-09-01 | This submission is the final filing | No |
2010-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2010-09-01 | Plan is a collectively bargained plan | No |
2010-09-01 | Plan funding arrangement – Insurance | Yes |
2010-09-01 | Plan benefit arrangement – Insurance | Yes |
2009: ROGERS & BROWN CUSTOM BROKERS, INC. HEALTH CARE PLAN 2009 form 5500 responses |
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2009-09-01 | Type of plan entity | Mulitple employer plan |
2009-09-01 | Submission has been amended | No |
2009-09-01 | This submission is the final filing | No |
2009-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2009-09-01 | Plan is a collectively bargained plan | No |
2009-09-01 | Plan funding arrangement – Insurance | Yes |
2009-09-01 | Plan benefit arrangement – Insurance | Yes |
2003: ROGERS & BROWN CUSTOM BROKERS, INC. HEALTH CARE PLAN 2003 form 5500 responses |
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2003-09-01 | Type of plan entity | Mulitple employer plan |
2003-09-01 | Submission has been amended | No |
2003-09-01 | This submission is the final filing | No |
2003-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2003-09-01 | Plan is a collectively bargained plan | No |
2003-09-01 | Plan funding arrangement – Insurance | Yes |
2003-09-01 | Plan benefit arrangement – Insurance | Yes |
2002: ROGERS & BROWN CUSTOM BROKERS, INC. HEALTH CARE PLAN 2002 form 5500 responses |
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2002-09-01 | Type of plan entity | Mulitple employer plan |
2002-09-01 | Submission has been amended | No |
2002-09-01 | This submission is the final filing | No |
2002-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2002-09-01 | Plan is a collectively bargained plan | No |
2002-09-01 | Plan funding arrangement – Insurance | Yes |
2002-09-01 | Plan benefit arrangement – Insurance | Yes |
PHYSICIANS EYECARE PLAN (National Association of Insurance Commissioners NAIC id number: ) |
Policy contract number | 00206 |
Policy instance | 3 |
Insurance contract or identification number | 00206 | Number of Individuals Covered | 142 | Insurance policy start date | 2017-09-01 | Insurance policy end date | 2018-08-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $963 | 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 | 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 $9,630 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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S & S HEALTHCARE STRATAGIES (National Association of Insurance Commissioners NAIC id number: 52411 ) |
Policy contract number | ROGERS & BROWN |
Policy instance | 2 |
Insurance contract or identification number | ROGERS & BROWN | Number of Individuals Covered | 107 | Insurance policy start date | 2017-09-01 | Insurance policy end date | 2018-08-31 | 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 | 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 $20,190 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 ) |
Policy contract number | ROGERS & BROWN |
Policy instance | 1 |
Insurance contract or identification number | ROGERS & BROWN | Number of Individuals Covered | 107 | Insurance policy start date | 2017-09-01 | Insurance policy end date | 2018-08-31 | Total amount of commissions paid to insurance broker | USD $16,152 | Total amount of fees paid to insurance company | USD $36,943 | 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 | 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 $221,209 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 ) |
Policy contract number | ROGERS & BROWN |
Policy instance | 1 |
Insurance contract or identification number | ROGERS & BROWN | Number of Individuals Covered | 113 | Insurance policy start date | 2015-09-01 | Insurance policy end date | 2016-08-31 | Total amount of commissions paid to insurance broker | USD $15,960 | Total amount of fees paid to insurance company | USD $30,566 | 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 | Yes | 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 $249,694 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 30566 | Additional information about fees paid to insurance broker | ADMINISTRATION FEES | Insurance broker organization code? | 5 | Commission paid to Insurance Broker | USD $15,960 | Insurance broker name | CLARKE & COMPANY BENEFITS, LLC |
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S & S HEALTHCARE STRATAGIES (National Association of Insurance Commissioners NAIC id number: 52411 ) |
Policy contract number | ROGERS & BROWN |
Policy instance | 2 |
Insurance contract or identification number | ROGERS & BROWN | Number of Individuals Covered | 113 | Insurance policy start date | 2015-09-01 | Insurance policy end date | 2016-08-31 | 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 | 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 $19,618 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 ) |
Policy contract number | ROGERS & BROWN |
Policy instance | 1 |
Insurance contract or identification number | ROGERS & BROWN | Number of Individuals Covered | 109 | Insurance policy start date | 2014-09-01 | Insurance policy end date | 2015-08-31 | Total amount of commissions paid to insurance broker | USD $16,056 | Total amount of fees paid to insurance company | USD $30,853 | 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 | Yes | 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 $252,954 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 30853 | Additional information about fees paid to insurance broker | ADMINISTRATION FEES | Insurance broker organization code? | 5 | Commission paid to Insurance Broker | USD $16,056 | Insurance broker name | CLARKE & COMPANY BENEFITS, LLC |
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S & S HEALTHCARE STRATAGIES (National Association of Insurance Commissioners NAIC id number: 52411 ) |
Policy contract number | ROGERS & BROWN |
Policy instance | 2 |
Insurance contract or identification number | ROGERS & BROWN | Number of Individuals Covered | 109 | Insurance policy start date | 2014-09-01 | Insurance policy end date | 2015-08-31 | 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 | 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 $22,412 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 ) |
Policy contract number | ROGERS & BROWN |
Policy instance | 1 |
Insurance contract or identification number | ROGERS & BROWN | Number of Individuals Covered | 112 | Insurance policy start date | 2013-09-01 | Insurance policy end date | 2014-08-31 | Total amount of commissions paid to insurance broker | USD $16,680 | Total amount of fees paid to insurance company | USD $30,494 | 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 | Yes | 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 $263,898 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 30494 | Additional information about fees paid to insurance broker | ADMINISTRATION FEES | Insurance broker organization code? | 5 | Commission paid to Insurance Broker | USD $16,680 | Insurance broker name | CLARKE & COMPANY BENEFITS, LLC |
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TRANSATLANTIC (National Association of Insurance Commissioners NAIC id number: 52429 ) |
Policy contract number | OB10A029A-010 |
Policy instance | 1 |
Insurance contract or identification number | OB10A029A-010 | Number of Individuals Covered | 110 | Insurance policy start date | 2012-09-01 | Insurance policy end date | 2013-08-31 | Total amount of commissions paid to insurance broker | USD $16,236 | Total amount of fees paid to insurance company | USD $24,828 | 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 $223,570 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 24828 | Additional information about fees paid to insurance broker | ADMINISTRATION FEES | Insurance broker organization code? | 5 | Commission paid to Insurance Broker | USD $16,236 | Insurance broker name | CLARKE & COMPANY BENEFITS, LLC |
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TRANSATLANTIC (National Association of Insurance Commissioners NAIC id number: 52429 ) |
Policy contract number | OB10A029A-010 |
Policy instance | 1 |
Insurance contract or identification number | OB10A029A-010 | Number of Individuals Covered | 121 | Insurance policy start date | 2011-09-01 | Insurance policy end date | 2012-08-31 | Total amount of commissions paid to insurance broker | USD $18,379 | Total amount of fees paid to insurance company | USD $28,630 | 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 $199,093 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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TRANSATLANTIC (National Association of Insurance Commissioners NAIC id number: 52429 ) |
Policy contract number | OB10A029A-010 |
Policy instance | 1 |
Insurance contract or identification number | OB10A029A-010 | Number of Individuals Covered | 130 | Insurance policy start date | 2010-09-01 | Insurance policy end date | 2011-08-31 | Total amount of commissions paid to insurance broker | USD $24,211 | Total amount of fees paid to insurance company | USD $29,684 | 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 $168,101 |
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HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
Policy contract number | 521 |
Policy instance | 1 |
Insurance contract or identification number | 521 | Number of Individuals Covered | 134 | Insurance policy start date | 2009-09-01 | Insurance policy end date | 2010-08-31 | Total amount of commissions paid to insurance broker | USD $24,854 | Total amount of fees paid to insurance company | USD $46,645 | 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 | 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 $140,844 | Commission paid to Insurance Broker | USD $12,426 | Amount paid for insurance broker fees | 40293 | Additional information about fees paid to insurance broker | ADMINISTRATIVE FEES | Insurance broker organization code? | 5 | Insurance broker name | DAVID GILSTON INSURANCE AGENCY |
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HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
Policy contract number | 521 |
Policy instance | 1 |
Insurance contract or identification number | 521 | Number of Individuals Covered | 152 | Insurance policy start date | 2008-09-01 | Insurance policy end date | 2009-08-31 | Total amount of commissions paid to insurance broker | USD $32,674 | Total amount of fees paid to insurance company | USD $57,635 | 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 | 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 $142,557 | Commission paid to Insurance Broker | USD $12,583 | Amount paid for insurance broker fees | 57635 | Additional information about fees paid to insurance broker | ADMINISTRATIVE FEES | Insurance broker organization code? | 5 | Insurance broker name | DAVID GILSTON INSURANCE AGENCY |
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HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 ) |
Policy contract number | 521 |
Policy instance | 2 |
Insurance contract or identification number | 521 | Number of Individuals Covered | 0 | Insurance policy start date | 2008-09-01 | Insurance policy end date | 2009-08-31 | Total amount of commissions paid to insurance broker | USD $0 | 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 | Yes | 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 $51 |
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HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 ) |
Policy contract number | 521 |
Policy instance | 1 |
Insurance contract or identification number | 521 | Number of Individuals Covered | 158 | Insurance policy start date | 2007-09-01 | Insurance policy end date | 2008-08-31 | Total amount of commissions paid to insurance broker | USD $32,934 | Total amount of fees paid to insurance company | USD $50,192 | 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 | 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 $143,952 | Commission paid to Insurance Broker | USD $12,700 | Amount paid for insurance broker fees | 50192 | Additional information about fees paid to insurance broker | ADMINISTRATIVE FEES | Insurance broker organization code? | 5 | Insurance broker name | DAVID GILSTON INSURANCE AGENCY |
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HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 ) |
Policy contract number | 521 |
Policy instance | 1 |
Insurance contract or identification number | 521 | Number of Individuals Covered | 154 | Insurance policy start date | 2006-09-01 | Insurance policy end date | 2007-08-31 | Total amount of commissions paid to insurance broker | USD $34,184 | Total amount of fees paid to insurance company | USD $42,598 | 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 | 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 $150,468 | Commission paid to Insurance Broker | USD $13,275 | Amount paid for insurance broker fees | 42598 | Additional information about fees paid to insurance broker | ADMINISTRATIVE FEES | Insurance broker organization code? | 5 | Insurance broker name | DAVID GILSTON INSURANCE AGENCY |
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HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 ) |
Policy contract number | 521 |
Policy instance | 1 |
Insurance contract or identification number | 521 | Number of Individuals Covered | 144 | Insurance policy start date | 2005-09-01 | Insurance policy end date | 2006-08-31 | Total amount of commissions paid to insurance broker | USD $31,722 | Total amount of fees paid to insurance company | USD $41,022 | 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 | 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 $139,050 | Commission paid to Insurance Broker | USD $12,269 | Amount paid for insurance broker fees | 41022 | Additional information about fees paid to insurance broker | ADMINISTRATIVE FEES | Insurance broker organization code? | 5 | Insurance broker name | DAVID GILSTON INSURANCE AGENCY |
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HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 ) |
Policy contract number | 521 |
Policy instance | 1 |
Insurance contract or identification number | 521 | Number of Individuals Covered | 160 | Insurance policy start date | 2004-09-01 | Insurance policy end date | 2005-08-31 | Total amount of commissions paid to insurance broker | USD $30,327 | Total amount of fees paid to insurance company | USD $43,056 | 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 | 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 $127,588 | Commission paid to Insurance Broker | USD $11,258 | Amount paid for insurance broker fees | 43056 | Additional information about fees paid to insurance broker | ADMINISTRATIVE FEES | Insurance broker organization code? | 5 | Insurance broker name | DAVID GILSTON INSURANCE AGENCY |
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STANDARD SECURITY LIFE (National Association of Insurance Commissioners NAIC id number: 69078 ) |
Policy contract number | 521 |
Policy instance | 2 |
Insurance contract or identification number | 521 | Number of Individuals Covered | 0 | Insurance policy start date | 2003-09-01 | Insurance policy end date | 2004-08-31 | Total amount of commissions paid to insurance broker | USD $0 | 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 | Yes | 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 $225 |
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HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 ) |
Policy contract number | 521 |
Policy instance | 1 |
Insurance contract or identification number | 521 | Number of Individuals Covered | 163 | Insurance policy start date | 2003-09-01 | Insurance policy end date | 2004-08-31 | Total amount of commissions paid to insurance broker | USD $25,180 | Total amount of fees paid to insurance company | USD $42,784 | 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 | 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 $98,215 | Commission paid to Insurance Broker | USD $8,672 | Amount paid for insurance broker fees | 42784 | Additional information about fees paid to insurance broker | ADMINISTRATIVE FEES | Insurance broker organization code? | 5 | Insurance broker name | DAVID GILSTON INSURANCE AGENCY |
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STANDARD SECURITY LIFE (National Association of Insurance Commissioners NAIC id number: 69078 ) |
Policy contract number | 521 |
Policy instance | 1 |
Insurance contract or identification number | 521 | Number of Individuals Covered | 166 | Insurance policy start date | 2002-09-01 | Insurance policy end date | 2003-08-31 | Total amount of commissions paid to insurance broker | USD $18,211 | Total amount of fees paid to insurance company | USD $34,474 | 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 | 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 $97,402 | Commission paid to Insurance Broker | USD $2,706 | Amount paid for insurance broker fees | 34474 | Additional information about fees paid to insurance broker | ADMINISTRATIVE FEES | Insurance broker organization code? | 5 | Insurance broker name | DAVID GILSTON INSURANCE AGENCY |
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