QUALITY RESTAURANT CONCEPTS, LLC has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan QUALITY RESTAURANT CONCEPTS, L.L.C. LIFE & DISABILITY INSURANCE PLAN
401k plan membership statisitcs for QUALITY RESTAURANT CONCEPTS, L.L.C. LIFE & DISABILITY INSURANCE PLAN
| Measure | Date | Value |
|---|
| 2022: QUALITY RESTAURANT CONCEPTS, L.L.C. LIFE & DISABILITY INSURANCE PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 332 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 322 |
| Total of all active and inactive participants | 2022-01-01 | 322 |
| Total participants | 2022-01-01 | 322 |
| 2021: QUALITY RESTAURANT CONCEPTS, L.L.C. LIFE & DISABILITY INSURANCE PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 340 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 332 |
| Number of retired or separated participants receiving benefits | 2021-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-01-01 | 0 |
| Total of all active and inactive participants | 2021-01-01 | 332 |
| Total participants | 2021-01-01 | 332 |
| 2020: QUALITY RESTAURANT CONCEPTS, L.L.C. LIFE & DISABILITY INSURANCE PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 346 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 340 |
| Total of all active and inactive participants | 2020-01-01 | 340 |
| 2019: QUALITY RESTAURANT CONCEPTS, L.L.C. LIFE & DISABILITY INSURANCE PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 295 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 346 |
| Total of all active and inactive participants | 2019-01-01 | 346 |
| Total participants | 2019-01-01 | 346 |
| 2018: QUALITY RESTAURANT CONCEPTS, L.L.C. LIFE & DISABILITY INSURANCE PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 281 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 295 |
| Total of all active and inactive participants | 2018-01-01 | 295 |
| Total participants | 2018-01-01 | 295 |
| 2017: QUALITY RESTAURANT CONCEPTS, L.L.C. LIFE & DISABILITY INSURANCE PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 277 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 281 |
| Total of all active and inactive participants | 2017-01-01 | 281 |
| Total participants | 2017-01-01 | 281 |
| 2016: QUALITY RESTAURANT CONCEPTS, L.L.C. LIFE & DISABILITY INSURANCE PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 282 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 277 |
| Total of all active and inactive participants | 2016-01-01 | 277 |
| Total participants | 2016-01-01 | 277 |
| 2015: QUALITY RESTAURANT CONCEPTS, L.L.C. LIFE & DISABILITY INSURANCE PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 291 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 282 |
| Total of all active and inactive participants | 2015-01-01 | 282 |
| 2014: QUALITY RESTAURANT CONCEPTS, L.L.C. LIFE & DISABILITY INSURANCE PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 277 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 291 |
| Total of all active and inactive participants | 2014-01-01 | 291 |
| Total participants | 2014-01-01 | 291 |
| 2013: QUALITY RESTAURANT CONCEPTS, L.L.C. LIFE & DISABILITY INSURANCE PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 310 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 277 |
| Total of all active and inactive participants | 2013-01-01 | 277 |
| Total participants | 2013-01-01 | 277 |
| 2012: QUALITY RESTAURANT CONCEPTS, L.L.C. LIFE & DISABILITY INSURANCE PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 358 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 310 |
| Total of all active and inactive participants | 2012-01-01 | 310 |
| Total participants | 2012-01-01 | 310 |
| 2011: QUALITY RESTAURANT CONCEPTS, L.L.C. LIFE & DISABILITY INSURANCE PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-01-01 | 346 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 358 |
| Total of all active and inactive participants | 2011-01-01 | 358 |
| Total participants | 2011-01-01 | 358 |
| 2010: QUALITY RESTAURANT CONCEPTS, L.L.C. LIFE & DISABILITY INSURANCE PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-01-01 | 275 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-01-01 | 346 |
| Total of all active and inactive participants | 2010-01-01 | 346 |
| Total participants | 2010-01-01 | 346 |
| 2009: QUALITY RESTAURANT CONCEPTS, L.L.C. LIFE & DISABILITY INSURANCE PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-01-01 | 281 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 275 |
| Total of all active and inactive participants | 2009-01-01 | 275 |
| Total participants | 2009-01-01 | 275 |
| 2022: QUALITY RESTAURANT CONCEPTS, L.L.C. LIFE & DISABILITY INSURANCE PLAN 2022 form 5500 responses |
|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021: QUALITY RESTAURANT CONCEPTS, L.L.C. LIFE & DISABILITY INSURANCE PLAN 2021 form 5500 responses |
|---|
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: QUALITY RESTAURANT CONCEPTS, L.L.C. LIFE & DISABILITY INSURANCE PLAN 2020 form 5500 responses |
|---|
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: QUALITY RESTAURANT CONCEPTS, L.L.C. LIFE & DISABILITY INSURANCE PLAN 2019 form 5500 responses |
|---|
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: QUALITY RESTAURANT CONCEPTS, L.L.C. LIFE & DISABILITY INSURANCE PLAN 2018 form 5500 responses |
|---|
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: QUALITY RESTAURANT CONCEPTS, L.L.C. LIFE & DISABILITY INSURANCE PLAN 2017 form 5500 responses |
|---|
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: QUALITY RESTAURANT CONCEPTS, L.L.C. LIFE & DISABILITY INSURANCE PLAN 2016 form 5500 responses |
|---|
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: QUALITY RESTAURANT CONCEPTS, L.L.C. LIFE & DISABILITY INSURANCE PLAN 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: QUALITY RESTAURANT CONCEPTS, L.L.C. LIFE & DISABILITY INSURANCE PLAN 2014 form 5500 responses |
|---|
| 2014-01-01 | Type of plan entity | Single employer plan |
| 2014-01-01 | Plan funding arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: QUALITY RESTAURANT CONCEPTS, L.L.C. LIFE & DISABILITY INSURANCE PLAN 2013 form 5500 responses |
|---|
| 2013-01-01 | Type of plan entity | Single employer plan |
| 2013-01-01 | Submission has been amended | Yes |
| 2013-01-01 | Plan funding arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: QUALITY RESTAURANT CONCEPTS, L.L.C. LIFE & DISABILITY INSURANCE PLAN 2012 form 5500 responses |
|---|
| 2012-01-01 | Type of plan entity | Single employer plan |
| 2012-01-01 | Plan funding arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: QUALITY RESTAURANT CONCEPTS, L.L.C. LIFE & DISABILITY INSURANCE PLAN 2011 form 5500 responses |
|---|
| 2011-01-01 | Type of plan entity | Single employer plan |
| 2011-01-01 | Plan funding arrangement – Insurance | Yes |
| 2011-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2010: QUALITY RESTAURANT CONCEPTS, L.L.C. LIFE & DISABILITY INSURANCE PLAN 2010 form 5500 responses |
|---|
| 2010-01-01 | Type of plan entity | Single employer plan |
| 2010-01-01 | Plan funding arrangement – Insurance | Yes |
| 2010-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: QUALITY RESTAURANT CONCEPTS, L.L.C. LIFE & DISABILITY INSURANCE PLAN 2009 form 5500 responses |
|---|
| 2009-01-01 | Type of plan entity | Single employer plan |
| 2009-01-01 | This submission is the final filing | No |
| 2009-01-01 | Plan funding arrangement – Insurance | Yes |
| 2009-01-01 | Plan benefit arrangement – Insurance | Yes |
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 560785 |
| Policy instance | 1 |
| Insurance contract or identification number | 560785 | | Number of Individuals Covered | 322 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Total amount of commissions paid to insurance broker | USD $62,160 | | Total amount of fees paid to insurance company | USD $13,146 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | CANCER, AD&D, CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $397,615 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $62,160 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 13146 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 560785 |
| Policy instance | 1 |
| Insurance contract or identification number | 560785 | | Number of Individuals Covered | 332 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | Total amount of commissions paid to insurance broker | USD $67,879 | | Total amount of fees paid to insurance company | USD $14,874 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | CANCER, AD&D, CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $437,699 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $67,879 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 14874 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 560785 |
| Policy instance | 1 |
| Insurance contract or identification number | 560785 | | Number of Individuals Covered | 340 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $59,979 | | Total amount of fees paid to insurance company | USD $7,704 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | CANCER, AD&D, CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $391,229 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $59,979 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 7704 |
|
| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
| Policy contract number | 5466616 |
| Policy instance | 1 |
| Insurance contract or identification number | 5466616 | | Number of Individuals Covered | 274 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-06-30 | | Total amount of commissions paid to insurance broker | USD $16,070 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $109,863 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $16,070 | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 560785 |
| Policy instance | 3 |
| Insurance contract or identification number | 560785 | | Number of Individuals Covered | 346 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $29,836 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | CANCER, ACCIDENTAL DEATH OR DISABIL | | Welfare Benefit Premiums Paid to Carrier | USD $194,930 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $29,836 | | Insurance broker organization code? | 3 |
|
| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
| Policy contract number | 5468109 |
| Policy instance | 2 |
| Insurance contract or identification number | 5468109 | | Number of Individuals Covered | 21 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-06-30 | | Total amount of commissions paid to insurance broker | USD $898 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | CANCER INSURANCE | | Welfare Benefit Premiums Paid to Carrier | USD $3,592 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $898 | | Insurance broker organization code? | 3 |
|
| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
| Policy contract number | 5466616 |
| Policy instance | 1 |
| Insurance contract or identification number | 5466616 | | Number of Individuals Covered | 274 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2019-06-30 | | Total amount of commissions paid to insurance broker | USD $29,568 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $201,641 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $29,568 | | Insurance broker organization code? | 3 |
|
| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
| Policy contract number | 5468109 |
| Policy instance | 2 |
| Insurance contract or identification number | 5468109 | | Number of Individuals Covered | 21 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2019-06-30 | | Total amount of commissions paid to insurance broker | USD $1,789 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | CANCER INSURANCE | | Welfare Benefit Premiums Paid to Carrier | USD $7,157 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,789 | | Insurance broker organization code? | 3 |
|
| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
| Policy contract number | 5468109 |
| Policy instance | 2 |
| Insurance contract or identification number | 5468109 | | Number of Individuals Covered | 19 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $1,643 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | CANCER INSURANCE | | Welfare Benefit Premiums Paid to Carrier | USD $6,572 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,643 | | Insurance broker organization code? | 3 | | Insurance broker name | LAKESHORE BENEFIT ALLIANCE, LLC |
|
| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
| Policy contract number | 5466616 |
| Policy instance | 1 |
| Insurance contract or identification number | 5466616 | | Number of Individuals Covered | 281 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $27,164 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $189,650 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $27,164 | | Insurance broker organization code? | 3 | | Insurance broker name | LAKESHORE BENEFIT ALLIANCE, LLC |
|
| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
| Policy contract number | 5471978 |
| Policy instance | 2 |
| Insurance contract or identification number | 5471978 | | Number of Individuals Covered | 275 | | Insurance policy start date | 2015-07-01 | | Insurance policy end date | 2016-06-30 | | Total amount of commissions paid to insurance broker | USD $11,845 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $118,790 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,845 | | Insurance broker name | LAKESHORE BENEFIT ALLIANCE, LLC |
|
| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
| Policy contract number | 5466616 |
| Policy instance | 1 |
| Insurance contract or identification number | 5466616 | | Number of Individuals Covered | 282 | | Insurance policy start date | 2015-07-01 | | Insurance policy end date | 2016-06-30 | | Total amount of commissions paid to insurance broker | USD $33,736 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $168,389 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $33,736 | | Insurance broker organization code? | 3 | | Insurance broker name | LAKESHORE BENEFIT ALLIANCE, LLC |
|
| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
| Policy contract number | 5466616 |
| Policy instance | 1 |
| Insurance contract or identification number | 5466616 | | Number of Individuals Covered | 277 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Total amount of commissions paid to insurance broker | USD $26,532 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $130,884 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $26,532 | | Insurance broker organization code? | 3 | | Insurance broker name | LAKESHORE BENEFIT ALLIANCE, LLC |
|
| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
| Policy contract number | 5471978 |
| Policy instance | 2 |
| Insurance contract or identification number | 5471978 | | Number of Individuals Covered | 291 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Total amount of commissions paid to insurance broker | USD $13,890 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $138,897 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,890 | | Insurance broker organization code? | 3 | | Insurance broker name | LAKESHORE BENEFIT ALLIANCE, LLC |
|
| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
| Policy contract number | 5468109 |
| Policy instance | 3 |
| Insurance contract or identification number | 5468109 | | Number of Individuals Covered | 11 | | Insurance policy start date | 2013-08-01 | | Insurance policy end date | 2014-03-31 | | Total amount of commissions paid to insurance broker | USD $668 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | CANCER INSURANCE | | Welfare Benefit Premiums Paid to Carrier | USD $2,344 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $668 | | Insurance broker organization code? | 3 | | Insurance broker name | LAKESHORE BENEFIT ALLIANCE, LLC |
|
| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
| Policy contract number | 5468110 |
| Policy instance | 2 |
| Insurance contract or identification number | 5468110 | | Number of Individuals Covered | 220 | | Insurance policy start date | 2013-08-01 | | Insurance policy end date | 2014-05-31 | | Total amount of commissions paid to insurance broker | USD $5,832 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $35,513 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,832 | | Insurance broker organization code? | 3 | | Insurance broker name | LAKESHORE BENEFIT ALLIANCE, LLC |
|
| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
| Policy contract number | 5466616 |
| Policy instance | 1 |
| Insurance contract or identification number | 5466616 | | Number of Individuals Covered | 277 | | Insurance policy start date | 2013-03-01 | | Insurance policy end date | 2013-10-31 | | Total amount of commissions paid to insurance broker | USD $19,199 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $79,925 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $19,199 | | Insurance broker organization code? | 3 | | Insurance broker name | LAKESHORE BENEFIT ALLIANCE, LLC |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 293930 |
| Policy instance | 1 |
| Insurance contract or identification number | 293930 | | Number of Individuals Covered | 276 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2013-01-01 | | Total amount of commissions paid to insurance broker | USD $17,415 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $83,185 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $17,415 | | Insurance broker organization code? | 3 | | Insurance broker name | RICHARD HOLMES |
|
| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
| Policy contract number | 8359583 |
| Policy instance | 2 |
| Insurance contract or identification number | 8359583 | | Number of Individuals Covered | 34 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2013-01-01 | | Total amount of commissions paid to insurance broker | USD $410 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $8,061 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $382 | | Insurance broker organization code? | 3 | | Insurance broker name | STEVEN GRIFFIN |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 293931 |
| Policy instance | 2 |
| Insurance contract or identification number | 293931 | | Number of Individuals Covered | 73 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2012-01-01 | | Total amount of commissions paid to insurance broker | USD $5,570 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $25,906 | | 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 number | 293930 |
| Policy instance | 1 |
| Insurance contract or identification number | 293930 | | Number of Individuals Covered | 285 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2012-01-01 | | Total amount of commissions paid to insurance broker | USD $13,128 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $61,062 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
| Policy contract number | OOO8359583 |
| Policy instance | 2 |
| Insurance contract or identification number | OOO8359583 | | Number of Individuals Covered | 78 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2011-01-01 | | Total amount of commissions paid to insurance broker | USD $2,738 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $15,691 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,682 | | Insurance broker organization code? | 3 | | Insurance broker name | STEVEN GRIFFIN |
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| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | ROO84475 |
| Policy instance | 1 |
| Insurance contract or identification number | ROO84475 | | Number of Individuals Covered | 346 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2011-01-01 | | Total amount of commissions paid to insurance broker | USD $20,170 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $94,773 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $20,170 | | Insurance broker organization code? | 3 | | Insurance broker name | RICHARD HOLMES |
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