MEDICAL AND SURGICAL AFFILIATES INC has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan MEDICAL AND SURGICAL AFFILIATES INC WELFARE BENEFIT PLAN
401k plan membership statisitcs for MEDICAL AND SURGICAL AFFILIATES INC WELFARE BENEFIT PLAN
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
Policy contract number | 0006781362 |
Policy instance | 7 |
Insurance contract or identification number | 0006781362 | Number of Individuals Covered | 0 | Insurance policy start date | 2015-10-01 | Insurance policy end date | 2015-12-01 | Total amount of commissions paid to insurance broker | USD $32 | Total amount of fees paid to insurance company | USD $0 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $476 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $32 | Insurance broker organization code? | 3 | Insurance broker name | COMPASS CONSULTING GROUP |
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AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
Policy contract number | 010-013103 |
Policy instance | 1 |
Insurance contract or identification number | 010-013103 | Number of Individuals Covered | 0 | Insurance policy start date | 2015-10-01 | Insurance policy end date | 2015-11-30 | Total amount of commissions paid to insurance broker | USD $646 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $11,605 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $646 | Insurance broker organization code? | 3 | Insurance broker name | COMPASS CONSULTING GROUP |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 024750 |
Policy instance | 2 |
Insurance contract or identification number | 024750 | Number of Individuals Covered | 0 | Insurance policy start date | 2015-10-01 | Insurance policy end date | 2015-12-01 | Total amount of commissions paid to insurance broker | USD $197 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $2,439 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $197 | Insurance broker organization code? | 3 | Insurance broker name | COMPASS CONSULTING GROUP |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 066577 |
Policy instance | 3 |
Insurance contract or identification number | 066577 | Number of Individuals Covered | 0 | Insurance policy start date | 2015-10-01 | Insurance policy end date | 2015-12-01 | Total amount of commissions paid to insurance broker | USD $961 | Total amount of fees paid to insurance company | USD $0 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $10,277 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $961 | Insurance broker organization code? | 3 | Insurance broker name | COMPASS CONSULTING GROUP |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 066578 |
Policy instance | 4 |
Insurance contract or identification number | 066578 | Number of Individuals Covered | 0 | Insurance policy start date | 2015-10-01 | Insurance policy end date | 2015-12-01 | Total amount of commissions paid to insurance broker | USD $976 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $7,168 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $976 | Insurance broker organization code? | 3 | Insurance broker name | COMPASS CONSULTING GROUP |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 066610 |
Policy instance | 5 |
Insurance contract or identification number | 066610 | Number of Individuals Covered | 0 | Insurance policy start date | 2015-10-01 | Insurance policy end date | 2015-12-01 | Total amount of commissions paid to insurance broker | USD $774 | Total amount of fees paid to insurance company | USD $0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $10,323 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $774 | Insurance broker organization code? | 3 | Insurance broker name | COMPASS CONSULTING GROUP |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 087275 |
Policy instance | 6 |
Insurance contract or identification number | 087275 | Number of Individuals Covered | 0 | Insurance policy start date | 2015-10-01 | Insurance policy end date | 2015-12-01 | Total amount of commissions paid to insurance broker | USD $432 | Total amount of fees paid to insurance company | USD $0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $5,171 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $432 | Insurance broker organization code? | 3 | Insurance broker name | COMPASS CONSULTING GROUP |
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AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
Policy contract number | 010-013103 |
Policy instance | 1 |
Insurance contract or identification number | 010-013103 | Number of Individuals Covered | 178 | Insurance policy start date | 2014-10-01 | Insurance policy end date | 2015-09-30 | Total amount of commissions paid to insurance broker | USD $4,294 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $77,087 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,294 | Insurance broker organization code? | 3 | Insurance broker name | COMPASS CONSULTING GROUP |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 024750 |
Policy instance | 2 |
Insurance contract or identification number | 024750 | Number of Individuals Covered | 307 | Insurance policy start date | 2014-10-01 | Insurance policy end date | 2015-10-01 | Total amount of commissions paid to insurance broker | USD $1,299 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $9,855 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,299 | Insurance broker organization code? | 3 | Insurance broker name | COMPASS CONSULTING GROUP |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 066577 |
Policy instance | 3 |
Insurance contract or identification number | 066577 | Number of Individuals Covered | 57 | Insurance policy start date | 2014-10-01 | Insurance policy end date | 2015-10-01 | Total amount of commissions paid to insurance broker | USD $3,067 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $40,485 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,067 | Insurance broker organization code? | 3 | Insurance broker name | COMPASS CONSULTING GROUP |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 066578 |
Policy instance | 4 |
Insurance contract or identification number | 066578 | Number of Individuals Covered | 80 | Insurance policy start date | 2014-10-01 | Insurance policy end date | 2015-10-01 | Total amount of commissions paid to insurance broker | USD $4,791 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $28,919 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,791 | Insurance broker organization code? | 3 | Insurance broker name | COMPASS CONSULTING GROUP |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 066610 |
Policy instance | 5 |
Insurance contract or identification number | 066610 | Number of Individuals Covered | 11 | Insurance policy start date | 2014-10-01 | Insurance policy end date | 2015-10-01 | Total amount of commissions paid to insurance broker | USD $4,560 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $57,865 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,560 | Insurance broker organization code? | 3 | Insurance broker name | COMPASS CONSULTING GROUP |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 087275 |
Policy instance | 6 |
Insurance contract or identification number | 087275 | Number of Individuals Covered | 32 | Insurance policy start date | 2014-10-01 | Insurance policy end date | 2015-10-01 | Total amount of commissions paid to insurance broker | USD $2,854 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $20,002 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,854 | Insurance broker organization code? | 3 | Insurance broker name | COMPASS CONSULTING GROUP |
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PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
Policy contract number | 0006781362 |
Policy instance | 7 |
Insurance contract or identification number | 0006781362 | Number of Individuals Covered | 11 | Insurance policy start date | 2014-10-01 | Insurance policy end date | 2015-10-01 | Total amount of commissions paid to insurance broker | USD $144 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $3,163 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $144 | Insurance broker organization code? | 3 | Insurance broker name | COMPASS CONSULTING GROUP |
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PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
Policy contract number | 0006781362 |
Policy instance | 8 |
Insurance contract or identification number | 0006781362 | Number of Individuals Covered | 24 | Insurance policy start date | 2013-10-01 | Insurance policy end date | 2014-10-01 | Total amount of commissions paid to insurance broker | USD $454 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $5,420 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $454 | Insurance broker organization code? | 3 | Insurance broker name | COMPASS CONSULTING GROUP |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 087275 |
Policy instance | 7 |
Insurance contract or identification number | 087275 | Number of Individuals Covered | 35 | Insurance policy start date | 2013-10-01 | Insurance policy end date | 2014-10-01 | Total amount of commissions paid to insurance broker | USD $3,432 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $30,702 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,432 | Insurance broker organization code? | 3 | Insurance broker name | COMPASS CONSULTING GROUP |
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BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 ) |
Policy contract number | M0752 |
Policy instance | 1 |
Insurance contract or identification number | M0752 | Number of Individuals Covered | 239 | Insurance policy start date | 2013-10-01 | Insurance policy end date | 2014-09-30 | Total amount of commissions paid to insurance broker | USD $110,769 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Health 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 $110,769 | Insurance broker organization code? | 3 | Insurance broker name | COMPASS CONSULTING GROUP |
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AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
Policy contract number | 010-013103 |
Policy instance | 2 |
Insurance contract or identification number | 010-013103 | Number of Individuals Covered | 305 | Insurance policy start date | 2013-10-01 | Insurance policy end date | 2014-09-30 | Total amount of commissions paid to insurance broker | USD $7,461 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $133,755 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,461 | Insurance broker organization code? | 3 | Insurance broker name | COMPASS CONSULTING GROUP |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 024750 |
Policy instance | 3 |
Insurance contract or identification number | 024750 | Number of Individuals Covered | 346 | Insurance policy start date | 2013-10-01 | Insurance policy end date | 2014-10-01 | Total amount of commissions paid to insurance broker | USD $1,365 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $13,366 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,365 | Insurance broker organization code? | 3 | Insurance broker name | COMPASS CONSULTING GROUP |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 066577 |
Policy instance | 4 |
Insurance contract or identification number | 066577 | Number of Individuals Covered | 72 | Insurance policy start date | 2013-10-01 | Insurance policy end date | 2014-10-01 | Total amount of commissions paid to insurance broker | USD $2,673 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $62,834 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,673 | Insurance broker organization code? | 3 | Insurance broker name | COMPASS CONSULTING GROUP |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 066578 |
Policy instance | 5 |
Insurance contract or identification number | 066578 | Number of Individuals Covered | 110 | Insurance policy start date | 2013-10-01 | Insurance policy end date | 2014-10-01 | Total amount of commissions paid to insurance broker | USD $5,972 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $42,833 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,972 | Insurance broker organization code? | 3 | Insurance broker name | COMPASS CONSULTING GROUP |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 066610 |
Policy instance | 6 |
Insurance contract or identification number | 066610 | Number of Individuals Covered | 11 | Insurance policy start date | 2013-10-01 | Insurance policy end date | 2014-10-01 | Total amount of commissions paid to insurance broker | USD $3,298 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $73,459 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,298 | Insurance broker organization code? | 3 | Insurance broker name | COMPASS CONSULTING GROUP |
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AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
Policy contract number | 010-013103 |
Policy instance | 2 |
Insurance contract or identification number | 010-013103 | Number of Individuals Covered | 453 | Insurance policy start date | 2012-10-01 | Insurance policy end date | 2013-09-30 | Total amount of commissions paid to insurance broker | USD $9,150 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $166,115 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,094 | Insurance broker organization code? | 3 | Insurance broker name | SAM N HOLLOWAY & CO., INC |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 024750 |
Policy instance | 3 |
Insurance contract or identification number | 024750 | Number of Individuals Covered | 408 | Insurance policy start date | 2012-10-01 | Insurance policy end date | 2013-10-01 | Total amount of commissions paid to insurance broker | USD $2,099 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $18,514 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,099 | Insurance broker organization code? | 3 | Insurance broker name | SAM N HOLLOWAY & CO., INC |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 066577 |
Policy instance | 4 |
Insurance contract or identification number | 066577 | Number of Individuals Covered | 121 | Insurance policy start date | 2012-10-01 | Insurance policy end date | 2013-10-01 | Total amount of commissions paid to insurance broker | USD $4,251 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $87,015 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,251 | Insurance broker organization code? | 3 | Insurance broker name | SAM N HOLLOWAY & CO., INC |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 066578 |
Policy instance | 5 |
Insurance contract or identification number | 066578 | Number of Individuals Covered | 192 | Insurance policy start date | 2012-10-01 | Insurance policy end date | 2013-10-01 | Total amount of commissions paid to insurance broker | USD $10,414 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $64,258 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $10,414 | Insurance broker organization code? | 3 | Insurance broker name | SAM N HOLLOWAY & CO., INC |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 066610 |
Policy instance | 6 |
Insurance contract or identification number | 066610 | Number of Individuals Covered | 14 | Insurance policy start date | 2012-10-01 | Insurance policy end date | 2013-10-01 | Total amount of commissions paid to insurance broker | USD $6,067 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $101,147 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,067 | Insurance broker organization code? | 3 | Insurance broker name | SAM N HOLLOWAY & CO., INC |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 087275 |
Policy instance | 7 |
Insurance contract or identification number | 087275 | Number of Individuals Covered | 47 | Insurance policy start date | 2012-10-01 | Insurance policy end date | 2013-10-01 | Total amount of commissions paid to insurance broker | USD $4,042 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $37,511 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,042 | Insurance broker organization code? | 3 | Insurance broker name | SAM N HOLLOWAY & CO., INC |
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PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
Policy contract number | 0006781362 |
Policy instance | 8 |
Insurance contract or identification number | 0006781362 | Number of Individuals Covered | 26 | Insurance policy start date | 2012-10-01 | Insurance policy end date | 2013-10-01 | Total amount of commissions paid to insurance broker | USD $1,352 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $8,246 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,352 | Insurance broker organization code? | 3 | Insurance broker name | SAM N HOLLOWAY & CO., INC |
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BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 ) |
Policy contract number | M0752 |
Policy instance | 1 |
Insurance contract or identification number | M0752 | Number of Individuals Covered | 384 | Insurance policy start date | 2012-10-01 | Insurance policy end date | 2013-09-30 | Total amount of commissions paid to insurance broker | USD $149,334 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Health 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 $149,334 | Insurance broker organization code? | 3 | Insurance broker name | COMPASS CONSULTING GROUP |
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