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EMPLOYEE GROUP INSURANCE - LONG TERM DISABILITY ST. PETERSBURG KENNEL CLUB 401k Plan overview

Plan NameEMPLOYEE GROUP INSURANCE - LONG TERM DISABILITY ST. PETERSBURG KENNEL CLUB
Plan identification number 504

EMPLOYEE GROUP INSURANCE - LONG TERM DISABILITY ST. PETERSBURG KENNEL CLUB Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Long-term disability cover

401k Sponsoring company profile

ST. PETERSBURG KENNEL CLUB, INC. has sponsored the creation of one or more 401k plans.

Company Name:ST. PETERSBURG KENNEL CLUB, INC.
Employer identification number (EIN):590433065
NAIC Classification:711210
NAIC Description: Spectator Sports

Additional information about ST. PETERSBURG KENNEL CLUB, INC.

Jurisdiction of Incorporation: Florida Department of State Division of Corporations
Incorporation Date: 1924-01-01
Company Identification Number: 159903
Legal Registered Office Address: 10490 GANDY BLVD

ST PETERSBURG

33702

More information about ST. PETERSBURG KENNEL CLUB, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan EMPLOYEE GROUP INSURANCE - LONG TERM DISABILITY ST. PETERSBURG KENNEL CLUB

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5042021-10-01SONDRA HALBERT2023-04-05
5042020-10-01SONDRA HALBERT2022-03-07
5042019-10-01LARRY D. STREUR2020-12-04
5042018-10-01LARRY D. STREUR2019-12-19
5042017-10-01
5042016-10-01
5042015-10-01LARRY D. STREUR
5042014-10-01BEVERLY A SHERMAN
5042013-10-01LARRY D. STREUR
5042012-10-01LARRY D. STREUR
5042011-10-01JONI HYNSON
5042010-10-01JONI HYNSON
5042009-10-01JONI HYNSON

Plan Statistics for EMPLOYEE GROUP INSURANCE - LONG TERM DISABILITY ST. PETERSBURG KENNEL CLUB

401k plan membership statisitcs for EMPLOYEE GROUP INSURANCE - LONG TERM DISABILITY ST. PETERSBURG KENNEL CLUB

Measure Date Value
2021: EMPLOYEE GROUP INSURANCE - LONG TERM DISABILITY ST. PETERSBURG KENNEL CLUB 2021 401k membership
Total participants, beginning-of-year2021-10-01135
Total number of active participants reported on line 7a of the Form 55002021-10-01111
Number of retired or separated participants receiving benefits2021-10-010
Number of other retired or separated participants entitled to future benefits2021-10-010
Total of all active and inactive participants2021-10-01111
Number of employers contributing to the scheme2021-10-010
2020: EMPLOYEE GROUP INSURANCE - LONG TERM DISABILITY ST. PETERSBURG KENNEL CLUB 2020 401k membership
Total participants, beginning-of-year2020-10-01140
Total number of active participants reported on line 7a of the Form 55002020-10-01135
Number of retired or separated participants receiving benefits2020-10-010
Number of other retired or separated participants entitled to future benefits2020-10-010
Total of all active and inactive participants2020-10-01135
Number of employers contributing to the scheme2020-10-010
2019: EMPLOYEE GROUP INSURANCE - LONG TERM DISABILITY ST. PETERSBURG KENNEL CLUB 2019 401k membership
Total participants, beginning-of-year2019-10-01145
Total number of active participants reported on line 7a of the Form 55002019-10-01140
Number of retired or separated participants receiving benefits2019-10-010
Number of other retired or separated participants entitled to future benefits2019-10-010
Total of all active and inactive participants2019-10-01140
Number of employers contributing to the scheme2019-10-010
2018: EMPLOYEE GROUP INSURANCE - LONG TERM DISABILITY ST. PETERSBURG KENNEL CLUB 2018 401k membership
Total participants, beginning-of-year2018-10-01154
Total number of active participants reported on line 7a of the Form 55002018-10-01140
Number of retired or separated participants receiving benefits2018-10-010
Number of other retired or separated participants entitled to future benefits2018-10-010
Total of all active and inactive participants2018-10-01140
Number of employers contributing to the scheme2018-10-010
2017: EMPLOYEE GROUP INSURANCE - LONG TERM DISABILITY ST. PETERSBURG KENNEL CLUB 2017 401k membership
Total participants, beginning-of-year2017-10-01144
Total number of active participants reported on line 7a of the Form 55002017-10-01155
Number of retired or separated participants receiving benefits2017-10-010
Number of other retired or separated participants entitled to future benefits2017-10-010
Total of all active and inactive participants2017-10-01155
Number of employers contributing to the scheme2017-10-010
2016: EMPLOYEE GROUP INSURANCE - LONG TERM DISABILITY ST. PETERSBURG KENNEL CLUB 2016 401k membership
Total participants, beginning-of-year2016-10-01180
Total number of active participants reported on line 7a of the Form 55002016-10-01160
Number of retired or separated participants receiving benefits2016-10-010
Number of other retired or separated participants entitled to future benefits2016-10-010
Total of all active and inactive participants2016-10-01160
2015: EMPLOYEE GROUP INSURANCE - LONG TERM DISABILITY ST. PETERSBURG KENNEL CLUB 2015 401k membership
Total participants, beginning-of-year2015-10-01180
Total number of active participants reported on line 7a of the Form 55002015-10-01180
Number of retired or separated participants receiving benefits2015-10-010
Number of other retired or separated participants entitled to future benefits2015-10-010
Total of all active and inactive participants2015-10-01180
2014: EMPLOYEE GROUP INSURANCE - LONG TERM DISABILITY ST. PETERSBURG KENNEL CLUB 2014 401k membership
Total participants, beginning-of-year2014-10-01188
Total number of active participants reported on line 7a of the Form 55002014-10-01180
Number of retired or separated participants receiving benefits2014-10-010
Number of other retired or separated participants entitled to future benefits2014-10-010
Total of all active and inactive participants2014-10-01180
2013: EMPLOYEE GROUP INSURANCE - LONG TERM DISABILITY ST. PETERSBURG KENNEL CLUB 2013 401k membership
Total participants, beginning-of-year2013-10-01151
Total number of active participants reported on line 7a of the Form 55002013-10-01188
Number of retired or separated participants receiving benefits2013-10-010
Number of other retired or separated participants entitled to future benefits2013-10-010
Total of all active and inactive participants2013-10-01188
2012: EMPLOYEE GROUP INSURANCE - LONG TERM DISABILITY ST. PETERSBURG KENNEL CLUB 2012 401k membership
Total participants, beginning-of-year2012-10-01163
Total number of active participants reported on line 7a of the Form 55002012-10-01151
Number of retired or separated participants receiving benefits2012-10-010
Number of other retired or separated participants entitled to future benefits2012-10-010
Total of all active and inactive participants2012-10-01151
2011: EMPLOYEE GROUP INSURANCE - LONG TERM DISABILITY ST. PETERSBURG KENNEL CLUB 2011 401k membership
Total participants, beginning-of-year2011-10-01158
Total number of active participants reported on line 7a of the Form 55002011-10-01163
Number of retired or separated participants receiving benefits2011-10-010
Number of other retired or separated participants entitled to future benefits2011-10-010
Total of all active and inactive participants2011-10-01163
2010: EMPLOYEE GROUP INSURANCE - LONG TERM DISABILITY ST. PETERSBURG KENNEL CLUB 2010 401k membership
Total participants, beginning-of-year2010-10-01169
Total number of active participants reported on line 7a of the Form 55002010-10-01158
Number of retired or separated participants receiving benefits2010-10-010
Number of other retired or separated participants entitled to future benefits2010-10-010
Total of all active and inactive participants2010-10-01158
2009: EMPLOYEE GROUP INSURANCE - LONG TERM DISABILITY ST. PETERSBURG KENNEL CLUB 2009 401k membership
Total participants, beginning-of-year2009-10-01175
Total number of active participants reported on line 7a of the Form 55002009-10-01158
Number of retired or separated participants receiving benefits2009-10-010
Number of other retired or separated participants entitled to future benefits2009-10-010
Total of all active and inactive participants2009-10-01158

Form 5500 Responses for EMPLOYEE GROUP INSURANCE - LONG TERM DISABILITY ST. PETERSBURG KENNEL CLUB

2021: EMPLOYEE GROUP INSURANCE - LONG TERM DISABILITY ST. PETERSBURG KENNEL CLUB 2021 form 5500 responses
2021-10-01Type of plan entitySingle employer plan
2021-10-01Plan funding arrangement – InsuranceYes
2021-10-01Plan benefit arrangement – InsuranceYes
2020: EMPLOYEE GROUP INSURANCE - LONG TERM DISABILITY ST. PETERSBURG KENNEL CLUB 2020 form 5500 responses
2020-10-01Type of plan entitySingle employer plan
2020-10-01Plan funding arrangement – InsuranceYes
2020-10-01Plan benefit arrangement – InsuranceYes
2019: EMPLOYEE GROUP INSURANCE - LONG TERM DISABILITY ST. PETERSBURG KENNEL CLUB 2019 form 5500 responses
2019-10-01Type of plan entitySingle employer plan
2019-10-01Plan funding arrangement – InsuranceYes
2019-10-01Plan benefit arrangement – InsuranceYes
2018: EMPLOYEE GROUP INSURANCE - LONG TERM DISABILITY ST. PETERSBURG KENNEL CLUB 2018 form 5500 responses
2018-10-01Type of plan entitySingle employer plan
2018-10-01Plan funding arrangement – InsuranceYes
2018-10-01Plan benefit arrangement – InsuranceYes
2017: EMPLOYEE GROUP INSURANCE - LONG TERM DISABILITY ST. PETERSBURG KENNEL CLUB 2017 form 5500 responses
2017-10-01Type of plan entitySingle employer plan
2017-10-01Plan funding arrangement – InsuranceYes
2017-10-01Plan benefit arrangement – InsuranceYes
2016: EMPLOYEE GROUP INSURANCE - LONG TERM DISABILITY ST. PETERSBURG KENNEL CLUB 2016 form 5500 responses
2016-10-01Type of plan entitySingle employer plan
2016-10-01Submission has been amendedNo
2016-10-01This submission is the final filingNo
2016-10-01This return/report is a short plan year return/report (less than 12 months)No
2016-10-01Plan is a collectively bargained planNo
2016-10-01Plan funding arrangement – InsuranceYes
2016-10-01Plan benefit arrangement – InsuranceYes
2015: EMPLOYEE GROUP INSURANCE - LONG TERM DISABILITY ST. PETERSBURG KENNEL CLUB 2015 form 5500 responses
2015-10-01Type of plan entitySingle employer plan
2015-10-01Submission has been amendedNo
2015-10-01This submission is the final filingNo
2015-10-01This return/report is a short plan year return/report (less than 12 months)No
2015-10-01Plan is a collectively bargained planNo
2015-10-01Plan funding arrangement – InsuranceYes
2015-10-01Plan benefit arrangement – InsuranceYes
2014: EMPLOYEE GROUP INSURANCE - LONG TERM DISABILITY ST. PETERSBURG KENNEL CLUB 2014 form 5500 responses
2014-10-01Type of plan entitySingle employer plan
2014-10-01Submission has been amendedNo
2014-10-01This submission is the final filingNo
2014-10-01This return/report is a short plan year return/report (less than 12 months)No
2014-10-01Plan is a collectively bargained planNo
2014-10-01Plan funding arrangement – InsuranceYes
2014-10-01Plan benefit arrangement – InsuranceYes
2013: EMPLOYEE GROUP INSURANCE - LONG TERM DISABILITY ST. PETERSBURG KENNEL CLUB 2013 form 5500 responses
2013-10-01Type of plan entitySingle employer plan
2013-10-01Submission has been amendedNo
2013-10-01This submission is the final filingNo
2013-10-01This return/report is a short plan year return/report (less than 12 months)No
2013-10-01Plan is a collectively bargained planNo
2013-10-01Plan funding arrangement – InsuranceYes
2013-10-01Plan benefit arrangement – InsuranceYes
2012: EMPLOYEE GROUP INSURANCE - LONG TERM DISABILITY ST. PETERSBURG KENNEL CLUB 2012 form 5500 responses
2012-10-01Type of plan entitySingle employer plan
2012-10-01Submission has been amendedNo
2012-10-01This submission is the final filingNo
2012-10-01This return/report is a short plan year return/report (less than 12 months)No
2012-10-01Plan is a collectively bargained planNo
2012-10-01Plan funding arrangement – InsuranceYes
2012-10-01Plan benefit arrangement – InsuranceYes
2011: EMPLOYEE GROUP INSURANCE - LONG TERM DISABILITY ST. PETERSBURG KENNEL CLUB 2011 form 5500 responses
2011-10-01Type of plan entitySingle employer plan
2011-10-01Submission has been amendedNo
2011-10-01This submission is the final filingNo
2011-10-01This return/report is a short plan year return/report (less than 12 months)No
2011-10-01Plan is a collectively bargained planNo
2011-10-01Plan funding arrangement – InsuranceYes
2011-10-01Plan benefit arrangement – InsuranceYes
2010: EMPLOYEE GROUP INSURANCE - LONG TERM DISABILITY ST. PETERSBURG KENNEL CLUB 2010 form 5500 responses
2010-10-01Type of plan entitySingle employer plan
2010-10-01Submission has been amendedNo
2010-10-01This submission is the final filingNo
2010-10-01This return/report is a short plan year return/report (less than 12 months)No
2010-10-01Plan is a collectively bargained planNo
2010-10-01Plan funding arrangement – InsuranceYes
2010-10-01Plan benefit arrangement – InsuranceYes
2009: EMPLOYEE GROUP INSURANCE - LONG TERM DISABILITY ST. PETERSBURG KENNEL CLUB 2009 form 5500 responses
2009-10-01Type of plan entitySingle employer plan
2009-10-01Submission has been amendedNo
2009-10-01This submission is the final filingNo
2009-10-01This return/report is a short plan year return/report (less than 12 months)No
2009-10-01Plan is a collectively bargained planNo
2009-10-01Plan funding arrangement – InsuranceYes
2009-10-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGD607115
Policy instance 1
Insurance contract or identification numberSGD607115
Number of Individuals Covered111
Insurance policy start date2021-10-01
Insurance policy end date2022-09-30
Total amount of commissions paid to insurance brokerUSD $1,633
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $10,883
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,633
Amount paid for insurance broker fees0
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGD607115
Policy instance 1
Insurance contract or identification numberSGD607115
Number of Individuals Covered135
Insurance policy start date2020-10-01
Insurance policy end date2021-09-30
Total amount of commissions paid to insurance brokerUSD $1,480
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $9,864
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $1,480
Amount paid for insurance broker fees0
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGD607115
Policy instance 1
Insurance contract or identification numberSGD607115
Number of Individuals Covered140
Insurance policy start date2019-10-01
Insurance policy end date2020-09-30
Total amount of commissions paid to insurance brokerUSD $4,581
Total amount of fees paid to insurance companyUSD $352
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $31,590
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $4,581
Amount paid for insurance broker fees352
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGD607115
Policy instance 1
Insurance contract or identification numberSGD607115
Number of Individuals Covered140
Insurance policy start date2018-10-01
Insurance policy end date2019-09-30
Total amount of commissions paid to insurance brokerUSD $3,267
Total amount of fees paid to insurance companyUSD $196
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $21,780
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,267
Amount paid for insurance broker fees196
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGD607115
Policy instance 1
Insurance contract or identification numberSGD607115
Number of Individuals Covered155
Insurance policy start date2017-10-01
Insurance policy end date2018-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $27,660
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGD607115
Policy instance 1
Insurance contract or identification numberSGD607115
Number of Individuals Covered180
Insurance policy start date2015-10-01
Insurance policy end date2016-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $28,040
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLTD0AQLN
Policy instance 1
Insurance contract or identification numberGLTD0AQLN
Number of Individuals Covered180
Insurance policy start date2014-10-01
Insurance policy end date2015-09-30
Total amount of commissions paid to insurance brokerUSD $5,412
Total amount of fees paid to insurance companyUSD $787
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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $36,082
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,412
Amount paid for insurance broker fees787
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
Insurance broker nameGALLAGHER BENEFIT SERVICES, INC.
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLTD0AQLN
Policy instance 1
Insurance contract or identification numberGLTD0AQLN
Number of Individuals Covered188
Insurance policy start date2013-10-01
Insurance policy end date2014-09-30
Total amount of commissions paid to insurance brokerUSD $5,081
Total amount of fees paid to insurance companyUSD $184
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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $33,876
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,081
Amount paid for insurance broker fees184
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
Insurance broker nameGALLAGHER BENEFIT SERVICES, INC.
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number871706G
Policy instance 1
Insurance contract or identification number871706G
Number of Individuals Covered151
Insurance policy start date2012-10-01
Insurance policy end date2013-09-30
Total amount of commissions paid to insurance brokerUSD $6,815
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $45,433
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,815
Insurance broker organization code?3
Insurance broker nameGALLAGHER BENEFIT SERVICES, INC.
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number871706G
Policy instance 1
Insurance contract or identification number871706G
Number of Individuals Covered163
Insurance policy start date2011-10-01
Insurance policy end date2012-09-30
Total amount of commissions paid to insurance brokerUSD $6,440
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $42,931
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 number586369
Policy instance 1
Insurance contract or identification number586369
Number of Individuals Covered156
Insurance policy start date2010-10-01
Insurance policy end date2011-09-30
Total amount of commissions paid to insurance brokerUSD $4,244
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $41,099
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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