CARROLL DISTRIBUTING COMPANY has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan CARROLL DISTRIBUTING COMPANY EMPLOYEE INSURANCE BENEFIT PLAN
401k plan membership statisitcs for CARROLL DISTRIBUTING COMPANY EMPLOYEE INSURANCE BENEFIT PLAN
| Measure | Date | Value |
|---|
| 2022: CARROLL DISTRIBUTING COMPANY EMPLOYEE INSURANCE BENEFIT PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-06-01 | 123 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-06-01 | 129 |
| Number of retired or separated participants receiving benefits | 2022-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2022-06-01 | 0 |
| Total of all active and inactive participants | 2022-06-01 | 129 |
| 2021: CARROLL DISTRIBUTING COMPANY EMPLOYEE INSURANCE BENEFIT PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-06-01 | 129 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-06-01 | 123 |
| Number of retired or separated participants receiving benefits | 2021-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-06-01 | 0 |
| Total of all active and inactive participants | 2021-06-01 | 123 |
| 2020: CARROLL DISTRIBUTING COMPANY EMPLOYEE INSURANCE BENEFIT PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-06-01 | 128 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-06-01 | 129 |
| Number of retired or separated participants receiving benefits | 2020-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2020-06-01 | 0 |
| Total of all active and inactive participants | 2020-06-01 | 129 |
| 2019: CARROLL DISTRIBUTING COMPANY EMPLOYEE INSURANCE BENEFIT PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-06-01 | 169 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-06-01 | 128 |
| Number of retired or separated participants receiving benefits | 2019-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-06-01 | 0 |
| Total of all active and inactive participants | 2019-06-01 | 128 |
| 2018: CARROLL DISTRIBUTING COMPANY EMPLOYEE INSURANCE BENEFIT PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-06-01 | 169 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-06-01 | 169 |
| Number of retired or separated participants receiving benefits | 2018-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-06-01 | 0 |
| Total of all active and inactive participants | 2018-06-01 | 169 |
| 2017: CARROLL DISTRIBUTING COMPANY EMPLOYEE INSURANCE BENEFIT PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-06-01 | 163 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-06-01 | 169 |
| Number of retired or separated participants receiving benefits | 2017-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-06-01 | 0 |
| Total of all active and inactive participants | 2017-06-01 | 169 |
| 2016: CARROLL DISTRIBUTING COMPANY EMPLOYEE INSURANCE BENEFIT PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-06-01 | 147 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-06-01 | 163 |
| Number of retired or separated participants receiving benefits | 2016-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2016-06-01 | 0 |
| Total of all active and inactive participants | 2016-06-01 | 163 |
| 2015: CARROLL DISTRIBUTING COMPANY EMPLOYEE INSURANCE BENEFIT PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-06-01 | 125 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-06-01 | 147 |
| Number of retired or separated participants receiving benefits | 2015-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2015-06-01 | 0 |
| Total of all active and inactive participants | 2015-06-01 | 147 |
| 2014: CARROLL DISTRIBUTING COMPANY EMPLOYEE INSURANCE BENEFIT PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-06-01 | 117 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-06-01 | 125 |
| Number of retired or separated participants receiving benefits | 2014-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2014-06-01 | 0 |
| Total of all active and inactive participants | 2014-06-01 | 125 |
| 2013: CARROLL DISTRIBUTING COMPANY EMPLOYEE INSURANCE BENEFIT PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-06-01 | 115 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-06-01 | 117 |
| Total of all active and inactive participants | 2013-06-01 | 117 |
| 2012: CARROLL DISTRIBUTING COMPANY EMPLOYEE INSURANCE BENEFIT PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-06-01 | 112 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-06-01 | 115 |
| Total of all active and inactive participants | 2012-06-01 | 115 |
| 2011: CARROLL DISTRIBUTING COMPANY EMPLOYEE INSURANCE BENEFIT PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-06-01 | 111 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-06-01 | 112 |
| Total of all active and inactive participants | 2011-06-01 | 112 |
| 2009: CARROLL DISTRIBUTING COMPANY EMPLOYEE INSURANCE BENEFIT PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-06-01 | 137 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-06-01 | 140 |
| Number of retired or separated participants receiving benefits | 2009-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2009-06-01 | 0 |
| Total of all active and inactive participants | 2009-06-01 | 140 |
| 2008: CARROLL DISTRIBUTING COMPANY EMPLOYEE INSURANCE BENEFIT PLAN 2008 401k membership |
|---|
| Total participants, beginning-of-year | 2008-06-01 | 149 |
| Total number of active participants reported on line 7a of the Form 5500 | 2008-06-01 | 136 |
| Number of retired or separated participants receiving benefits | 2008-06-01 | 5 |
| Total of all active and inactive participants | 2008-06-01 | 141 |
| Total participants | 2008-06-01 | 141 |
| 2007: CARROLL DISTRIBUTING COMPANY EMPLOYEE INSURANCE BENEFIT PLAN 2007 401k membership |
|---|
| Total participants, beginning-of-year | 2007-06-01 | 152 |
| Total number of active participants reported on line 7a of the Form 5500 | 2007-06-01 | 146 |
| Number of retired or separated participants receiving benefits | 2007-06-01 | 6 |
| Total of all active and inactive participants | 2007-06-01 | 152 |
| Total participants | 2007-06-01 | 152 |
| 2006: CARROLL DISTRIBUTING COMPANY EMPLOYEE INSURANCE BENEFIT PLAN 2006 401k membership |
|---|
| Total participants, beginning-of-year | 2006-06-01 | 150 |
| Total number of active participants reported on line 7a of the Form 5500 | 2006-06-01 | 147 |
| Total of all active and inactive participants | 2006-06-01 | 147 |
| Total participants | 2006-06-01 | 147 |
| 2005: CARROLL DISTRIBUTING COMPANY EMPLOYEE INSURANCE BENEFIT PLAN 2005 401k membership |
|---|
| Total number of active participants reported on line 7a of the Form 5500 | 2005-06-01 | 150 |
| Total of all active and inactive participants | 2005-06-01 | 150 |
| Total participants | 2005-06-01 | 150 |
| 2022: CARROLL DISTRIBUTING COMPANY EMPLOYEE INSURANCE BENEFIT PLAN 2022 form 5500 responses |
|---|
| 2022-06-01 | Type of plan entity | Single employer plan |
| 2022-06-01 | Plan funding arrangement – Insurance | Yes |
| 2022-06-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-06-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: CARROLL DISTRIBUTING COMPANY EMPLOYEE INSURANCE BENEFIT PLAN 2021 form 5500 responses |
|---|
| 2021-06-01 | Type of plan entity | Single employer plan |
| 2021-06-01 | Plan funding arrangement – Insurance | Yes |
| 2021-06-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-06-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: CARROLL DISTRIBUTING COMPANY EMPLOYEE INSURANCE BENEFIT PLAN 2020 form 5500 responses |
|---|
| 2020-06-01 | Type of plan entity | Single employer plan |
| 2020-06-01 | Plan funding arrangement – Insurance | Yes |
| 2020-06-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-06-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: CARROLL DISTRIBUTING COMPANY EMPLOYEE INSURANCE BENEFIT PLAN 2019 form 5500 responses |
|---|
| 2019-06-01 | Type of plan entity | Single employer plan |
| 2019-06-01 | Plan funding arrangement – Insurance | Yes |
| 2019-06-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-06-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: CARROLL DISTRIBUTING COMPANY EMPLOYEE INSURANCE BENEFIT PLAN 2018 form 5500 responses |
|---|
| 2018-06-01 | Type of plan entity | Single employer plan |
| 2018-06-01 | Plan funding arrangement – Insurance | Yes |
| 2018-06-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-06-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: CARROLL DISTRIBUTING COMPANY EMPLOYEE INSURANCE BENEFIT PLAN 2017 form 5500 responses |
|---|
| 2017-06-01 | Type of plan entity | Single employer plan |
| 2017-06-01 | Plan funding arrangement – Insurance | Yes |
| 2017-06-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-06-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: CARROLL DISTRIBUTING COMPANY EMPLOYEE INSURANCE BENEFIT PLAN 2016 form 5500 responses |
|---|
| 2016-06-01 | Type of plan entity | Single employer plan |
| 2016-06-01 | Plan funding arrangement – Insurance | Yes |
| 2016-06-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-06-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: CARROLL DISTRIBUTING COMPANY EMPLOYEE INSURANCE BENEFIT PLAN 2015 form 5500 responses |
|---|
| 2015-06-01 | Type of plan entity | Single employer plan |
| 2015-06-01 | Plan funding arrangement – Insurance | Yes |
| 2015-06-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-06-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: CARROLL DISTRIBUTING COMPANY EMPLOYEE INSURANCE BENEFIT PLAN 2014 form 5500 responses |
|---|
| 2014-06-01 | Type of plan entity | Single employer plan |
| 2014-06-01 | Plan funding arrangement – Insurance | Yes |
| 2014-06-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-06-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: CARROLL DISTRIBUTING COMPANY EMPLOYEE INSURANCE BENEFIT PLAN 2013 form 5500 responses |
|---|
| 2013-06-01 | Type of plan entity | Single employer plan |
| 2013-06-01 | Plan funding arrangement – Insurance | Yes |
| 2013-06-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-06-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2012: CARROLL DISTRIBUTING COMPANY EMPLOYEE INSURANCE BENEFIT PLAN 2012 form 5500 responses |
|---|
| 2012-06-01 | Type of plan entity | Single employer plan |
| 2012-06-01 | Plan funding arrangement – Insurance | Yes |
| 2012-06-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2012-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-06-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2011: CARROLL DISTRIBUTING COMPANY EMPLOYEE INSURANCE BENEFIT PLAN 2011 form 5500 responses |
|---|
| 2011-06-01 | Type of plan entity | Single employer plan |
| 2011-06-01 | Plan funding arrangement – Insurance | Yes |
| 2011-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: CARROLL DISTRIBUTING COMPANY EMPLOYEE INSURANCE BENEFIT PLAN 2009 form 5500 responses |
|---|
| 2009-06-01 | Type of plan entity | Single employer plan |
| 2009-06-01 | Plan funding arrangement – Insurance | Yes |
| 2009-06-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2009-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-06-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2008: CARROLL DISTRIBUTING COMPANY EMPLOYEE INSURANCE BENEFIT PLAN 2008 form 5500 responses |
|---|
| 2008-06-01 | Type of plan entity | Single employer plan |
| 2008-06-01 | Submission has been amended | No |
| 2008-06-01 | This submission is the final filing | No |
| 2008-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2008-06-01 | Plan is a collectively bargained plan | No |
| 2008-06-01 | Plan funding arrangement – Insurance | Yes |
| 2008-06-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2008-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2008-06-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2007: CARROLL DISTRIBUTING COMPANY EMPLOYEE INSURANCE BENEFIT PLAN 2007 form 5500 responses |
|---|
| 2007-06-01 | Type of plan entity | Single employer plan |
| 2007-06-01 | Submission has been amended | No |
| 2007-06-01 | This submission is the final filing | No |
| 2007-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2007-06-01 | Plan is a collectively bargained plan | No |
| 2007-06-01 | Plan funding arrangement – Insurance | Yes |
| 2007-06-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2007-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2007-06-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2006: CARROLL DISTRIBUTING COMPANY EMPLOYEE INSURANCE BENEFIT PLAN 2006 form 5500 responses |
|---|
| 2006-06-01 | Type of plan entity | Single employer plan |
| 2006-06-01 | Submission has been amended | No |
| 2006-06-01 | This submission is the final filing | No |
| 2006-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2006-06-01 | Plan is a collectively bargained plan | No |
| 2006-06-01 | Plan funding arrangement – Insurance | Yes |
| 2006-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2005: CARROLL DISTRIBUTING COMPANY EMPLOYEE INSURANCE BENEFIT PLAN 2005 form 5500 responses |
|---|
| 2005-06-01 | Type of plan entity | Single employer plan |
| 2005-06-01 | Submission has been amended | No |
| 2005-06-01 | This submission is the final filing | No |
| 2005-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2005-06-01 | Plan is a collectively bargained plan | No |
| 2005-06-01 | Plan funding arrangement – Insurance | Yes |
| 2005-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2004: CARROLL DISTRIBUTING COMPANY EMPLOYEE INSURANCE BENEFIT PLAN 2004 form 5500 responses |
|---|
| 2004-06-01 | Type of plan entity | Single employer plan |
| 2004-06-01 | Submission has been amended | No |
| 2004-06-01 | This submission is the final filing | No |
| 2004-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2004-06-01 | Plan is a collectively bargained plan | No |
| 2004-06-01 | Plan funding arrangement – Insurance | Yes |
| 2004-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2003: CARROLL DISTRIBUTING COMPANY EMPLOYEE INSURANCE BENEFIT PLAN 2003 form 5500 responses |
|---|
| 2003-06-01 | Type of plan entity | Single employer plan |
| 2003-06-01 | Submission has been amended | No |
| 2003-06-01 | This submission is the final filing | No |
| 2003-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2003-06-01 | Plan is a collectively bargained plan | No |
| 2003-06-01 | Plan funding arrangement – Insurance | Yes |
| 2003-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2002: CARROLL DISTRIBUTING COMPANY EMPLOYEE INSURANCE BENEFIT PLAN 2002 form 5500 responses |
|---|
| 2002-06-01 | Type of plan entity | Single employer plan |
| 2002-06-01 | Submission has been amended | No |
| 2002-06-01 | This submission is the final filing | No |
| 2002-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2002-06-01 | Plan is a collectively bargained plan | No |
| 2002-06-01 | Plan funding arrangement – Insurance | Yes |
| 2002-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2001: CARROLL DISTRIBUTING COMPANY EMPLOYEE INSURANCE BENEFIT PLAN 2001 form 5500 responses |
|---|
| 2001-06-01 | Type of plan entity | Single employer plan |
| 2001-06-01 | Submission has been amended | Yes |
| 2001-06-01 | This submission is the final filing | No |
| 2001-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2001-06-01 | Plan is a collectively bargained plan | No |
| 2001-06-01 | Plan funding arrangement – Insurance | Yes |
| 2001-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2000: CARROLL DISTRIBUTING COMPANY EMPLOYEE INSURANCE BENEFIT PLAN 2000 form 5500 responses |
|---|
| 2000-06-01 | Type of plan entity | Single employer plan |
| 2000-06-01 | Submission has been amended | No |
| 2000-06-01 | This submission is the final filing | No |
| 2000-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2000-06-01 | Plan is a collectively bargained plan | No |
| 2000-06-01 | Plan funding arrangement – Insurance | Yes |
| 2000-06-01 | Plan benefit arrangement – Insurance | Yes |
| 1999: CARROLL DISTRIBUTING COMPANY EMPLOYEE INSURANCE BENEFIT PLAN 1999 form 5500 responses |
|---|
| 1999-06-01 | Type of plan entity | Single employer plan |
| 1999-06-01 | Submission has been amended | No |
| 1999-06-01 | This submission is the final filing | No |
| 1999-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 1999-06-01 | Plan is a collectively bargained plan | No |
| 1999-06-01 | Plan funding arrangement – Insurance | Yes |
| 1999-06-01 | Plan benefit arrangement – Insurance | Yes |
| 1998: CARROLL DISTRIBUTING COMPANY EMPLOYEE INSURANCE BENEFIT PLAN 1998 form 5500 responses |
|---|
| 1998-06-01 | Type of plan entity | Single employer plan |
| 1998-06-01 | Submission has been amended | No |
| 1998-06-01 | This submission is the final filing | No |
| 1998-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 1998-06-01 | Plan is a collectively bargained plan | No |
| 1998-06-01 | Plan funding arrangement – Insurance | Yes |
| 1998-06-01 | Plan benefit arrangement – Insurance | Yes |
| 1997: CARROLL DISTRIBUTING COMPANY EMPLOYEE INSURANCE BENEFIT PLAN 1997 form 5500 responses |
|---|
| 1997-06-01 | Type of plan entity | Single employer plan |
| 1997-06-01 | Submission has been amended | No |
| 1997-06-01 | This submission is the final filing | No |
| 1997-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 1997-06-01 | Plan is a collectively bargained plan | No |
| 1997-06-01 | Plan funding arrangement – Insurance | Yes |
| 1997-06-01 | Plan benefit arrangement – Insurance | Yes |
| 1996: CARROLL DISTRIBUTING COMPANY EMPLOYEE INSURANCE BENEFIT PLAN 1996 form 5500 responses |
|---|
| 1996-06-01 | Type of plan entity | Single employer plan |
| 1996-06-01 | Submission has been amended | No |
| 1996-06-01 | This submission is the final filing | No |
| 1996-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 1996-06-01 | Plan is a collectively bargained plan | No |
| 1996-06-01 | Plan funding arrangement – Insurance | Yes |
| 1996-06-01 | Plan benefit arrangement – Insurance | Yes |
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00561771 |
| Policy instance | 1 |
| Insurance contract or identification number | 00561771 | | Number of Individuals Covered | 129 | | Insurance policy start date | 2022-06-01 | | Insurance policy end date | 2023-05-31 | | Total amount of commissions paid to insurance broker | USD $18,970 | | Total amount of fees paid to insurance company | USD $5,052 | | 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 | OTHER (CRITICAL ILLNESS) | | Welfare Benefit Premiums Paid to Carrier | USD $144,375 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $18,970 | | Amount paid for insurance broker fees | 5052 | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00561771 |
| Policy instance | 1 |
| Insurance contract or identification number | 00561771 | | Number of Individuals Covered | 123 | | Insurance policy start date | 2021-06-01 | | Insurance policy end date | 2022-05-31 | | Total amount of commissions paid to insurance broker | USD $17,770 | | Total amount of fees paid to insurance company | USD $2,970 | | 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 | OTHER (CRITICAL ILLNESS) | | Welfare Benefit Premiums Paid to Carrier | USD $135,990 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $17,770 | | Amount paid for insurance broker fees | 2970 | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00561771 |
| Policy instance | 1 |
| Insurance contract or identification number | 00561771 | | Number of Individuals Covered | 129 | | Insurance policy start date | 2020-06-01 | | Insurance policy end date | 2021-05-31 | | Total amount of commissions paid to insurance broker | USD $18,606 | | 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 | OTHER (CRITICAL ILLNESS) | | Welfare Benefit Premiums Paid to Carrier | USD $142,070 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $18,606 | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00561771 |
| Policy instance | 1 |
| Insurance contract or identification number | 00561771 | | Number of Individuals Covered | 128 | | Insurance policy start date | 2019-06-01 | | Insurance policy end date | 2020-05-31 | | Total amount of commissions paid to insurance broker | USD $19,088 | | Total amount of fees paid to insurance company | USD $5,379 | | 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 | OTHER (CRITICAL ILLNESS) | | Welfare Benefit Premiums Paid to Carrier | USD $144,090 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $19,088 | | Amount paid for insurance broker fees | 5379 | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TM05945192 |
| Policy instance | 6 |
| Insurance contract or identification number | TM05945192 | | Insurance policy start date | 2018-06-01 | | Insurance policy end date | 2019-05-31 | | Total amount of commissions paid to insurance broker | USD $376 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $376 | | Insurance broker organization code? | 3 |
|
| CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 ) |
| Policy contract number | 0000007773 |
| Policy instance | 2 |
| Insurance contract or identification number | 0000007773 | | Number of Individuals Covered | 169 | | Insurance policy start date | 2018-06-01 | | Insurance policy end date | 2019-05-31 | | Total amount of commissions paid to insurance broker | USD $1,503 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $18,195 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $520 | | Insurance broker organization code? | 3 |
|
| HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 ) |
| Policy contract number | 586380 |
| Policy instance | 3 |
| Insurance contract or identification number | 586380 | | Number of Individuals Covered | 76 | | Insurance policy start date | 2018-06-01 | | Insurance policy end date | 2019-05-31 | | Total amount of commissions paid to insurance broker | USD $1,217 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $12,166 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,217 | | Insurance broker organization code? | 3 |
|
| BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 95089 ) |
| Policy contract number | 81473 |
| Policy instance | 5 |
| Insurance contract or identification number | 81473 | | Number of Individuals Covered | 120 | | Insurance policy start date | 2018-06-01 | | Insurance policy end date | 2019-05-31 | | Total amount of commissions paid to insurance broker | USD $22,330 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $22,330 | | Insurance broker organization code? | 3 |
|
| PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 138698 |
| Policy instance | 4 |
| Insurance contract or identification number | 138698 | | Number of Individuals Covered | 17 | | Insurance policy start date | 2018-06-01 | | Insurance policy end date | 2019-05-31 | | Total amount of commissions paid to insurance broker | USD $481 | | Other welfare benefits provided | OTHER (LEGAL SERVICES PLAN MEMBERSH | | Welfare Benefit Premiums Paid to Carrier | USD $2,791 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $242 | | Insurance broker organization code? | 4 |
|
| SECURITY MUTUAL LIFE INSURANCE COMPANY OF NY (National Association of Insurance Commissioners NAIC id number: 68772 ) |
| Policy contract number | G000104656 |
| Policy instance | 7 |
| Insurance contract or identification number | G000104656 | | Number of Individuals Covered | 134 | | Insurance policy start date | 2018-06-01 | | Insurance policy end date | 2019-05-31 | | Total amount of commissions paid to insurance broker | USD $699 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $5,825 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $699 | | Insurance broker organization code? | 3 |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | 1093965 |
| Policy instance | 8 |
| Insurance contract or identification number | 1093965 | | Number of Individuals Covered | 155 | | Insurance policy start date | 2018-06-01 | | Insurance policy end date | 2019-05-31 | | Total amount of commissions paid to insurance broker | USD $8,589 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $85,886 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,320 | | Insurance broker organization code? | 3 |
|
| SOLSTICE BENEFITS, INC (National Association of Insurance Commissioners NAIC id number: 12341 ) |
| Policy contract number | 13733 |
| Policy instance | 9 |
| Insurance contract or identification number | 13733 | | Number of Individuals Covered | 59 | | Insurance policy start date | 2018-06-01 | | Insurance policy end date | 2019-05-31 | | Total amount of commissions paid to insurance broker | USD $837 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,583 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $837 | | Insurance broker organization code? | 3 |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | DJH61 |
| Policy instance | 1 |
| Insurance contract or identification number | DJH61 | | Number of Individuals Covered | 41 | | Insurance policy start date | 2018-06-01 | | Insurance policy end date | 2019-05-31 | | Total amount of commissions paid to insurance broker | USD $4,245 | | Total amount of fees paid to insurance company | USD $348 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $24,603 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,711 | | Amount paid for insurance broker fees | 149 | | Insurance broker organization code? | 3 |
|
| PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 138698 |
| Policy instance | 5 |
| Insurance contract or identification number | 138698 | | Number of Individuals Covered | 20 | | Insurance policy start date | 2017-06-01 | | Insurance policy end date | 2018-05-31 | | Total amount of commissions paid to insurance broker | USD $565 | | Other welfare benefits provided | OTHER (LEGAL SERVICES PLAN MEMBERSH | | Welfare Benefit Premiums Paid to Carrier | USD $2,967 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $283 | | Insurance broker organization code? | 4 | | Insurance broker name | TWIN RIVERS INSURANCE INC. |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TM05945192 |
| Policy instance | 7 |
| Insurance contract or identification number | TM05945192 | | Number of Individuals Covered | 154 | | Insurance policy start date | 2017-06-01 | | Insurance policy end date | 2018-05-31 | | Total amount of commissions paid to insurance broker | USD $4,115 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $41,164 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,115 | | Insurance broker organization code? | 3 | | Insurance broker name | TWIN RIVERS INSURANCE AGENCY INC |
|
| BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 95089 ) |
| Policy contract number | 81473 |
| Policy instance | 6 |
| Insurance contract or identification number | 81473 | | Number of Individuals Covered | 117 | | Insurance policy start date | 2017-06-01 | | Insurance policy end date | 2018-05-31 | | Total amount of commissions paid to insurance broker | USD $81,208 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $81,208 | | Insurance broker organization code? | 3 | | Insurance broker name | TWIN RIVERS INSURANCE, INC |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00488035 |
| Policy instance | 4 |
| Insurance contract or identification number | 00488035 | | Number of Individuals Covered | 135 | | Insurance policy start date | 2017-06-01 | | Insurance policy end date | 2018-05-31 | | Total amount of commissions paid to insurance broker | USD $3,875 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | OTHER (OPTIONAL LIFE) | | Welfare Benefit Premiums Paid to Carrier | USD $73,683 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,875 | | Insurance broker organization code? | 3 | | Insurance broker name | TWIN RIVERS INS INC |
|
| HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 ) |
| Policy contract number | 586380 |
| Policy instance | 3 |
| Insurance contract or identification number | 586380 | | Number of Individuals Covered | 78 | | Insurance policy start date | 2017-06-01 | | Insurance policy end date | 2018-05-31 | | Total amount of commissions paid to insurance broker | USD $1,322 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $12,213 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,322 | | Insurance broker organization code? | 3 | | Insurance broker name | TWIN RIVERS INSURANCE INC |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | DJH61 |
| Policy instance | 1 |
| Insurance contract or identification number | DJH61 | | Number of Individuals Covered | 42 | | Insurance policy start date | 2017-06-01 | | Insurance policy end date | 2018-05-31 | | Total amount of commissions paid to insurance broker | USD $4,617 | | Total amount of fees paid to insurance company | USD $320 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $20,243 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,921 | | Amount paid for insurance broker fees | 137 | | Insurance broker organization code? | 3 | | Insurance broker name | BRIAN HANLEY |
|
| CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 ) |
| Policy contract number | 0000007773 |
| Policy instance | 2 |
| Insurance contract or identification number | 0000007773 | | Number of Individuals Covered | 169 | | Insurance policy start date | 2017-06-01 | | Insurance policy end date | 2018-05-31 | | Total amount of commissions paid to insurance broker | USD $2,271 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $21,510 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $700 | | Insurance broker organization code? | 3 | | Insurance broker name | DOUGLAS SUCHECKI |
|
| HEALTH FIRST HEALTH PLANS, INC. (National Association of Insurance Commissioners NAIC id number: 95019 ) |
| Policy contract number | 114956 |
| Policy instance | 6 |
| Insurance contract or identification number | 114956 | | Number of Individuals Covered | 104 | | Insurance policy start date | 2015-06-01 | | Insurance policy end date | 2016-05-31 | | Total amount of commissions paid to insurance broker | USD $48,156 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,203,889 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $48,156 | | Insurance broker organization code? | 3 | | Insurance broker name | TWIN RIVERS INSURANCE INC |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00488035 |
| Policy instance | 5 |
| Insurance contract or identification number | 00488035 | | Number of Individuals Covered | 135 | | Insurance policy start date | 2015-06-01 | | Insurance policy end date | 2016-05-31 | | Total amount of commissions paid to insurance broker | USD $7,025 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | OTHER (OPTIONAL LIFE) | | Welfare Benefit Premiums Paid to Carrier | USD $90,740 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,025 | | Insurance broker organization code? | 3 | | Insurance broker name | TWIN RIVERS INS INC |
|
| HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 ) |
| Policy contract number | 586380 |
| Policy instance | 4 |
| Insurance contract or identification number | 586380 | | Number of Individuals Covered | 71 | | Insurance policy start date | 2015-06-01 | | Insurance policy end date | 2016-05-31 | | Total amount of commissions paid to insurance broker | USD $1,117 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $11,174 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,117 | | Insurance broker organization code? | 3 | | Insurance broker name | TWIN RIVERS INSURANCE INC |
|
| CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 ) |
| Policy contract number | 0000007773 |
| Policy instance | 3 |
| Insurance contract or identification number | 0000007773 | | Number of Individuals Covered | 147 | | Insurance policy start date | 2015-06-01 | | Insurance policy end date | 2016-05-31 | | Total amount of commissions paid to insurance broker | USD $2,812 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $21,220 | | 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 | | Insurance broker organization code? | 3 | | Insurance broker name | MKF & ASSOCIATES |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E9585829 |
| Policy instance | 2 |
| Insurance contract or identification number | E9585829 | | Number of Individuals Covered | 11 | | Insurance policy start date | 2015-06-01 | | Insurance policy end date | 2016-05-31 | | Total amount of commissions paid to insurance broker | USD $403 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,285 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $35 | | Insurance broker organization code? | 3 | | Insurance broker name | STEVEN VERMETTE INC |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | DJH61 |
| Policy instance | 1 |
| Insurance contract or identification number | DJH61 | | Number of Individuals Covered | 35 | | Insurance policy start date | 2015-06-01 | | Insurance policy end date | 2016-05-31 | | Total amount of commissions paid to insurance broker | USD $1,970 | | Total amount of fees paid to insurance company | USD $17 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $11,289 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $873 | | Amount paid for insurance broker fees | 7 | | Insurance broker organization code? | 3 | | Insurance broker name | LESLIE K KIMBROUGH |
|
| HEALTH FIRST INSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 14140 ) |
| Policy contract number | P14956 |
| Policy instance | 8 |
| Insurance contract or identification number | P14956 | | Number of Individuals Covered | 9 | | Insurance policy start date | 2015-06-01 | | Insurance policy end date | 2016-05-31 | | Total amount of commissions paid to insurance broker | USD $4,541 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $113,527 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,541 | | Insurance broker organization code? | 3 | | Insurance broker name | TWIN RIVERS INSURANCE INC |
|
| PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 138698 |
| Policy instance | 7 |
| Insurance contract or identification number | 138698 | | Number of Individuals Covered | 29 | | Insurance policy start date | 2015-06-01 | | Insurance policy end date | 2016-05-31 | | Total amount of commissions paid to insurance broker | USD $1,640 | | Other welfare benefits provided | OTHER (LEGAL SERVICES PLAN MEMBERSH | | Welfare Benefit Premiums Paid to Carrier | USD $8,360 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,640 | | Insurance broker organization code? | 4 | | Insurance broker name | TWIN RIVERS INSURANCE INC. |
|
| PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 138698 |
| Policy instance | 7 |
| Insurance contract or identification number | 138698 | | Number of Individuals Covered | 13 | | Insurance policy start date | 2014-06-01 | | Insurance policy end date | 2015-05-31 | | Total amount of commissions paid to insurance broker | USD $389 | | Other welfare benefits provided | OTHER (LEGAL SERVICES PLAN MEMBERSH | | Welfare Benefit Premiums Paid to Carrier | USD $3,024 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $381 | | Insurance broker organization code? | 4 | | Insurance broker name | EDITH L MAXWELL |
|
| HEALTH FIRST HEALTH PLANS, INC. (National Association of Insurance Commissioners NAIC id number: 95019 ) |
| Policy contract number | 114956 |
| Policy instance | 6 |
| Insurance contract or identification number | 114956 | | Number of Individuals Covered | 101 | | Insurance policy start date | 2014-06-01 | | Insurance policy end date | 2015-05-31 | | Total amount of commissions paid to insurance broker | USD $40,101 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,002,518 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $40,101 | | Insurance broker name | TWIN RIVERS INSURANCE INC |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00488035 |
| Policy instance | 5 |
| Insurance contract or identification number | 00488035 | | Number of Individuals Covered | 125 | | Insurance policy start date | 2014-06-01 | | Insurance policy end date | 2015-05-31 | | Total amount of commissions paid to insurance broker | USD $6,569 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | OTHER (OPTIONAL LIFE) | | Welfare Benefit Premiums Paid to Carrier | USD $82,708 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,569 | | Insurance broker organization code? | 3 | | Insurance broker name | TWIN RIVERS INS INC |
|
| HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 ) |
| Policy contract number | 586380 |
| Policy instance | 4 |
| Insurance contract or identification number | 586380 | | Number of Individuals Covered | 63 | | Insurance policy start date | 2014-06-01 | | Insurance policy end date | 2015-05-31 | | Total amount of commissions paid to insurance broker | USD $956 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $9,558 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $956 | | Insurance broker organization code? | 3 | | Insurance broker name | TWIN RIVERS INSURANCE INC |
|
| CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 ) |
| Policy contract number | 0000007773 |
| Policy instance | 3 |
| Insurance contract or identification number | 0000007773 | | Number of Individuals Covered | 125 | | Insurance policy start date | 2014-06-01 | | Insurance policy end date | 2015-05-31 | | Total amount of commissions paid to insurance broker | USD $3,480 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $23,856 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,050 | | Insurance broker organization code? | 3 | | Insurance broker name | TWIN RIVERS INSURANCE INC |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E9585829 |
| Policy instance | 2 |
| Insurance contract or identification number | E9585829 | | Number of Individuals Covered | 11 | | Insurance policy start date | 2014-06-01 | | Insurance policy end date | 2015-05-31 | | Total amount of commissions paid to insurance broker | USD $442 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,289 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $349 | | Insurance broker organization code? | 3 | | Insurance broker name | DEMOS GINAKES |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | DJH61 |
| Policy instance | 1 |
| Insurance contract or identification number | DJH61 | | Number of Individuals Covered | 25 | | Insurance policy start date | 2014-06-01 | | Insurance policy end date | 2015-05-31 | | Total amount of commissions paid to insurance broker | USD $1,554 | | Total amount of fees paid to insurance company | USD $126 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $11,314 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $686 | | Amount paid for insurance broker fees | 39 | | Insurance broker organization code? | 3 | | Insurance broker name | SENIOR INS RESOURCES INC |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E9585829 |
| Policy instance | 2 |
| Insurance contract or identification number | E9585829 | | Number of Individuals Covered | 13 | | Insurance policy start date | 2013-06-01 | | Insurance policy end date | 2014-05-31 | | Total amount of commissions paid to insurance broker | USD $495 | | Total amount of fees paid to insurance company | USD $14 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $11,544 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $359 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 13 | | Insurance broker name | DEMOS GINAKES |
|
| BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 95089 ) |
| Policy contract number | 81473 |
| Policy instance | 4 |
| Insurance contract or identification number | 81473 | | Number of Individuals Covered | 110 | | Insurance policy start date | 2013-06-01 | | Insurance policy end date | 2014-05-31 | | Total amount of commissions paid to insurance broker | USD $60,482 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $60,482 | | Insurance broker organization code? | 3 | | Insurance broker name | TWIN RIVERS INSURANCE INC |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00488035 |
| Policy instance | 6 |
| Insurance contract or identification number | 00488035 | | Number of Individuals Covered | 117 | | Insurance policy start date | 2013-06-01 | | Insurance policy end date | 2014-05-31 | | Total amount of commissions paid to insurance broker | USD $4,429 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $60,435 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,390 | | Insurance broker organization code? | 3 | | Insurance broker name | HARRISON-DAVIS INC |
|
| HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 ) |
| Policy contract number | 586380 |
| Policy instance | 5 |
| Insurance contract or identification number | 586380 | | Number of Individuals Covered | 53 | | Insurance policy start date | 2013-06-01 | | Insurance policy end date | 2014-05-31 | | Total amount of commissions paid to insurance broker | USD $823 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $8,232 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $823 | | Insurance broker organization code? | 3 | | Insurance broker name | TWIN RIVERS INSURANCE INC |
|
| CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 ) |
| Policy contract number | 0000007773 |
| Policy instance | 3 |
| Insurance contract or identification number | 0000007773 | | Number of Individuals Covered | 114 | | Insurance policy start date | 2013-06-01 | | Insurance policy end date | 2014-05-31 | | Total amount of commissions paid to insurance broker | USD $3,072 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $23,799 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,019 | | Insurance broker organization code? | 3 | | Insurance broker name | LESLIE K KIMBROUGH |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | DJH61 |
| Policy instance | 1 |
| Insurance contract or identification number | DJH61 | | Number of Individuals Covered | 31 | | Insurance policy start date | 2013-06-01 | | Insurance policy end date | 2014-05-31 | | Total amount of commissions paid to insurance broker | USD $3,200 | | Total amount of fees paid to insurance company | USD $71 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $15,280 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,396 | | Amount paid for insurance broker fees | 22 | | Insurance broker organization code? | 3 | | Insurance broker name | ALFRED RIETKERK |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | DJH61 |
| Policy instance | 1 |
| Insurance contract or identification number | DJH61 | | Number of Individuals Covered | 30 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2013-06-30 | | Total amount of commissions paid to insurance broker | USD $3,440 | | Total amount of fees paid to insurance company | USD $65 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $14,695 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,797 | | Amount paid for insurance broker fees | 32 | | Insurance broker organization code? | 3 | | Insurance broker name | ROBERT L TRAPNELL JR |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E9585829 |
| Policy instance | 2 |
| Insurance contract or identification number | E9585829 | | Number of Individuals Covered | 15 | | Insurance policy start date | 2012-06-01 | | Insurance policy end date | 2013-05-31 | | Total amount of commissions paid to insurance broker | USD $900 | | Total amount of fees paid to insurance company | USD $84 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $14,451 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $440 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 83 | | Insurance broker name | KENNETH RONALD LENT |
|
| HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 ) |
| Policy contract number | 586380 |
| Policy instance | 8 |
| Insurance contract or identification number | 586380 | | Number of Individuals Covered | 52 | | Insurance policy start date | 2012-06-01 | | Insurance policy end date | 2013-05-31 | | Total amount of commissions paid to insurance broker | USD $854 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $8,543 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $854 | | Insurance broker organization code? | 3 | | Insurance broker name | TWIN RIVERS INSURANCE INC |
|
| CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 ) |
| Policy contract number | 0000007773 |
| Policy instance | 3 |
| Insurance contract or identification number | 0000007773 | | Number of Individuals Covered | 97 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Total amount of commissions paid to insurance broker | USD $5,004 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $26,833 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,907 | | Insurance broker organization code? | 3 | | Insurance broker name | DOUGLAS SUCHECKI |
|
| BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 95089 ) |
| Policy contract number | 81473 |
| Policy instance | 4 |
| Insurance contract or identification number | 81473 | | Number of Individuals Covered | 115 | | Insurance policy start date | 2012-06-01 | | Insurance policy end date | 2013-05-31 | | Total amount of commissions paid to insurance broker | USD $62,339 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $62,339 | | Insurance broker organization code? | 3 | | Insurance broker name | TWIN RIVERS INSURANCE INC |
|
| FLORIDA COMBINED LIFE INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 76031 ) |
| Policy contract number | 81473 |
| Policy instance | 5 |
| Insurance contract or identification number | 81473 | | Number of Individuals Covered | 114 | | Insurance policy start date | 2012-06-01 | | Insurance policy end date | 2013-05-31 | | Total amount of fees paid to insurance company | USD $440 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,720 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 440 | | Insurance broker organization code? | 3 | | Insurance broker name | TWIN RIVERS INSURANCE INC |
|
| FLORIDA COMBINED LIFE INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 76031 ) |
| Policy contract number | 15X0294 |
| Policy instance | 6 |
| Insurance contract or identification number | 15X0294 | | Number of Individuals Covered | 31 | | Insurance policy start date | 2012-06-01 | | Insurance policy end date | 2013-05-31 | | Total amount of fees paid to insurance company | USD $2,145 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $23,679 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 2145 | | Insurance broker name | TWIN RIVERS INSURANCE INC |
|
| FLORIDA COMBINED LIFE INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 76031 ) |
| Policy contract number | 29597 |
| Policy instance | 7 |
| Insurance contract or identification number | 29597 | | Number of Individuals Covered | 53 | | Insurance policy start date | 2012-06-01 | | Insurance policy end date | 2013-05-31 | | Total amount of fees paid to insurance company | USD $1,754 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $17,638 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 1754 | | Insurance broker name | TWIN RIVERS INSURANCE INC |
|
| HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 ) |
| Policy contract number | 586380 |
| Policy instance | 7 |
| Insurance contract or identification number | 586380 | | Number of Individuals Covered | 53 | | Insurance policy start date | 2011-06-01 | | Insurance policy end date | 2012-05-31 | | Total amount of commissions paid to insurance broker | USD $788 | | Total amount of fees paid to insurance company | USD $7 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $7,883 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 080301 |
| Policy instance | 6 |
| Insurance contract or identification number | 080301 | | Number of Individuals Covered | 107 | | Insurance policy start date | 2011-06-01 | | Insurance policy end date | 2012-05-31 | | Total amount of commissions paid to insurance broker | USD $370 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,699 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 ) |
| Policy contract number | 05475 S0678 |
| Policy instance | 5 |
| Insurance contract or identification number | 05475 S0678 | | Number of Individuals Covered | 31 | | Insurance policy start date | 2011-06-01 | | Insurance policy end date | 2012-05-31 | | Total amount of commissions paid to insurance broker | USD $3,542 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $35,420 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 95089 ) |
| Policy contract number | 81473 |
| Policy instance | 4 |
| Insurance contract or identification number | 81473 | | Number of Individuals Covered | 112 | | Insurance policy start date | 2011-06-01 | | Insurance policy end date | 2012-05-31 | | Total amount of commissions paid to insurance broker | USD $58,487 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | DJH61 |
| Policy instance | 3 |
| Insurance contract or identification number | DJH61 | | Number of Individuals Covered | 31 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Total amount of commissions paid to insurance broker | USD $2,328 | | Total amount of fees paid to insurance company | USD $374 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $9,886 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 ) |
| Policy contract number | 7773 |
| Policy instance | 2 |
| Insurance contract or identification number | 7773 | | Number of Individuals Covered | 112 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Total amount of commissions paid to insurance broker | USD $17,294 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $24,107 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E9585829 |
| Policy instance | 1 |
| Insurance contract or identification number | E9585829 | | Number of Individuals Covered | 16 | | Insurance policy start date | 2011-06-01 | | Insurance policy end date | 2012-05-31 | | Total amount of commissions paid to insurance broker | USD $882 | | Total amount of fees paid to insurance company | USD $171 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $14,551 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | DJH61 |
| Policy instance | 2 |
| Insurance contract or identification number | DJH61 | | Insurance policy start date | 2010-06-01 | | Insurance policy end date | 2011-05-31 | | Total amount of commissions paid to insurance broker | USD $10,127 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $20,976 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
| Policy contract number | R721 |
| Policy instance | 3 |
| Insurance contract or identification number | R721 | | Number of Individuals Covered | 149 | | Insurance policy start date | 2010-06-01 | | Insurance policy end date | 2011-05-31 | | Total amount of commissions paid to insurance broker | USD $1,597 | | Other welfare benefits provided | NG PLUS WO SBA3 | | Welfare Benefit Premiums Paid to Carrier | USD $15,974 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E9585829 |
| Policy instance | 4 |
| Insurance contract or identification number | E9585829 | | Number of Individuals Covered | 198 | | Insurance policy start date | 2010-06-01 | | Insurance policy end date | 2011-05-31 | | Total amount of commissions paid to insurance broker | USD $725 | | Total amount of fees paid to insurance company | USD $1 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $15,345 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 080301 |
| Policy instance | 5 |
| Insurance contract or identification number | 080301 | | Number of Individuals Covered | 105 | | Insurance policy start date | 2010-06-01 | | Insurance policy end date | 2011-05-31 | | Total amount of commissions paid to insurance broker | USD $371 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,711 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HEALTH FIRST HEALTH PLANS, INC. (National Association of Insurance Commissioners NAIC id number: 95019 ) |
| Policy contract number | 114545 |
| Policy instance | 1 |
| Insurance contract or identification number | 114545 | | Number of Individuals Covered | 111 | | Insurance policy start date | 2010-06-01 | | Insurance policy end date | 2011-05-31 | | Total amount of commissions paid to insurance broker | USD $64,198 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,297,226 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 620855(09) |
| Policy instance | 1 |
| Insurance contract or identification number | 620855(09) | | Number of Individuals Covered | 290 | | Insurance policy start date | 2008-06-01 | | Insurance policy end date | 2009-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $220,887 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E9585829 |
| Policy instance | 4 |
| Insurance contract or identification number | E9585829 | | Number of Individuals Covered | 25 | | Insurance policy start date | 2008-06-01 | | Insurance policy end date | 2009-05-31 | | Total amount of commissions paid to insurance broker | USD $2,021 | | Total amount of fees paid to insurance company | USD $350 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $19,622 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 080301 |
| Policy instance | 3 |
| Insurance contract or identification number | 080301 | | Number of Individuals Covered | 131 | | Insurance policy start date | 2008-06-01 | | Insurance policy end date | 2009-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,352 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
| Policy contract number | R721 |
| Policy instance | 2 |
| Insurance contract or identification number | R721 | | Number of Individuals Covered | 142 | | Insurance policy start date | 2008-06-01 | | Insurance policy end date | 2009-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | NG PLUS W/O SBA-3 | | Welfare Benefit Premiums Paid to Carrier | USD $12,683 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E9585829 |
| Policy instance | 4 |
| Insurance contract or identification number | E9585829 | | Number of Individuals Covered | 30 | | Insurance policy start date | 2007-06-01 | | Insurance policy end date | 2008-06-30 | | Total amount of commissions paid to insurance broker | USD $2,432 | | Total amount of fees paid to insurance company | USD $354 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $20,454 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
| Policy contract number | R721 |
| Policy instance | 2 |
| Insurance contract or identification number | R721 | | Number of Individuals Covered | 135 | | Insurance policy start date | 2007-06-01 | | Insurance policy end date | 2008-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | NG PLUS W/O SBA-3 | | Welfare Benefit Premiums Paid to Carrier | USD $13,064 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | HCL15570 |
| Policy instance | 1 |
| Insurance contract or identification number | HCL15570 | | Number of Individuals Covered | 152 | | Insurance policy start date | 2007-06-01 | | Insurance policy end date | 2008-05-31 | | Total amount of commissions paid to insurance broker | USD $29,504 | | Total amount of fees paid to insurance company | USD $3,344 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $196,691 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 080301 |
| Policy instance | 3 |
| Insurance contract or identification number | 080301 | | Number of Individuals Covered | 147 | | Insurance policy start date | 2007-06-01 | | Insurance policy end date | 2008-05-31 | | Total amount of commissions paid to insurance broker | USD $449 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,490 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E9585829 |
| Policy instance | 2 |
| Insurance contract or identification number | E9585829 | | Number of Individuals Covered | 25 | | Insurance policy start date | 2006-06-01 | | Insurance policy end date | 2007-05-31 | | Total amount of commissions paid to insurance broker | USD $2,030 | | Total amount of fees paid to insurance company | USD $95 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $19,597 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 080301 |
| Policy instance | 1 |
| Insurance contract or identification number | 080301 | | Number of Individuals Covered | 147 | | Insurance policy start date | 2006-06-01 | | Insurance policy end date | 2007-05-31 | | Total amount of commissions paid to insurance broker | USD $457 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,567 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 080301 |
| Policy instance | 2 |
| Insurance contract or identification number | 080301 | | Number of Individuals Covered | 150 | | Insurance policy start date | 2005-06-01 | | Insurance policy end date | 2006-05-31 | | Total amount of commissions paid to insurance broker | USD $2,845 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,560 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E9585829 |
| Policy instance | 1 |
| Insurance contract or identification number | E9585829 | | Number of Individuals Covered | 28 | | Insurance policy start date | 2005-06-01 | | Insurance policy end date | 2006-05-31 | | Total amount of commissions paid to insurance broker | USD $1,788 | | Total amount of fees paid to insurance company | USD $80 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $20,482 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E9585829 |
| Policy instance | 1 |
| Insurance contract or identification number | E9585829 | | Number of Individuals Covered | 28 | | Insurance policy start date | 2004-06-01 | | Insurance policy end date | 2005-05-31 | | Total amount of commissions paid to insurance broker | USD $1,645 | | Total amount of fees paid to insurance company | USD $7 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $20,482 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E9585829 |
| Policy instance | 1 |
| Insurance contract or identification number | E9585829 | | Number of Individuals Covered | 28 | | Insurance policy start date | 2003-06-01 | | Insurance policy end date | 2004-05-31 | | Total amount of commissions paid to insurance broker | USD $3,184 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $8,764 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E9585829 |
| Policy instance | 1 |
| Insurance contract or identification number | E9585829 | | Insurance policy start date | 2002-06-01 | | Insurance policy end date | 2003-05-31 | | Total amount of commissions paid to insurance broker | USD $2,419 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E9585829 |
| Policy instance | 1 |
| Insurance contract or identification number | E9585829 | | Insurance policy start date | 2001-06-01 | | Insurance policy end date | 2002-05-31 | | Total amount of commissions paid to insurance broker | USD $3,255 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E9585829 |
| Policy instance | 1 |
| Insurance contract or identification number | E9585829 | | Insurance policy start date | 2000-06-01 | | Insurance policy end date | 2001-05-31 | | Total amount of commissions paid to insurance broker | USD $2,897 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E9585829 |
| Policy instance | 1 |
| Insurance contract or identification number | E9585829 | | Insurance policy start date | 1999-06-01 | | Insurance policy end date | 2000-05-31 | | Total amount of commissions paid to insurance broker | USD $2,764 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
