JOHN W. STONE OIL DISTRIBUTOR, L.L.C. has sponsored the creation of one or more 401k plans.
Additional information about JOHN W. STONE OIL DISTRIBUTOR, L.L.C.
Submission information for form 5500 for 401k plan JOHN W. STONE OIL DISTRIBUTOR, L.L.C. LIFE, ADD, AND DENTAL PLAN
401k plan membership statisitcs for JOHN W. STONE OIL DISTRIBUTOR, L.L.C. LIFE, ADD, AND DENTAL PLAN
| Measure | Date | Value |
|---|
| 2018: JOHN W. STONE OIL DISTRIBUTOR, L.L.C. LIFE, ADD, AND DENTAL PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 297 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 0 |
| Number of retired or separated participants receiving benefits | 2018-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-01-01 | 0 |
| Total of all active and inactive participants | 2018-01-01 | 0 |
| 2017: JOHN W. STONE OIL DISTRIBUTOR, L.L.C. LIFE, ADD, AND DENTAL PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 805 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 0 |
| Number of retired or separated participants receiving benefits | 2017-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-01-01 | 0 |
| Total of all active and inactive participants | 2017-01-01 | 0 |
| 2016: JOHN W. STONE OIL DISTRIBUTOR, L.L.C. LIFE, ADD, AND DENTAL PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 1,212 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 1,139 |
| Total of all active and inactive participants | 2016-01-01 | 1,139 |
| 2015: JOHN W. STONE OIL DISTRIBUTOR, L.L.C. LIFE, ADD, AND DENTAL PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 1,197 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 1,212 |
| Total of all active and inactive participants | 2015-01-01 | 1,212 |
| 2014: JOHN W. STONE OIL DISTRIBUTOR, L.L.C. LIFE, ADD, AND DENTAL PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 954 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 1,197 |
| Total of all active and inactive participants | 2014-01-01 | 1,197 |
| 2013: JOHN W. STONE OIL DISTRIBUTOR, L.L.C. LIFE, ADD, AND DENTAL PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 953 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 954 |
| Total of all active and inactive participants | 2013-01-01 | 954 |
| Total participants | 2013-01-01 | 954 |
| 2012: JOHN W. STONE OIL DISTRIBUTOR, L.L.C. LIFE, ADD, AND DENTAL PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-12-01 | 928 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-12-01 | 953 |
| Total of all active and inactive participants | 2012-12-01 | 953 |
| 2011: JOHN W. STONE OIL DISTRIBUTOR, L.L.C. LIFE, ADD, AND DENTAL PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-12-01 | 907 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-12-01 | 928 |
| Total of all active and inactive participants | 2011-12-01 | 928 |
| Total participants | 2011-12-01 | 928 |
| 2010: JOHN W. STONE OIL DISTRIBUTOR, L.L.C. LIFE, ADD, AND DENTAL PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-12-01 | 900 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-12-01 | 907 |
| Total of all active and inactive participants | 2010-12-01 | 907 |
| Total participants | 2010-12-01 | 907 |
| 2009: JOHN W. STONE OIL DISTRIBUTOR, L.L.C. LIFE, ADD, AND DENTAL PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-12-01 | 884 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-12-01 | 900 |
| Total of all active and inactive participants | 2009-12-01 | 900 |
| Total participants | 2009-12-01 | 900 |
| 2008: JOHN W. STONE OIL DISTRIBUTOR, L.L.C. LIFE, ADD, AND DENTAL PLAN 2008 401k membership |
|---|
| Total participants, beginning-of-year | 2008-12-01 | 935 |
| Total number of active participants reported on line 7a of the Form 5500 | 2008-12-01 | 884 |
| Total of all active and inactive participants | 2008-12-01 | 884 |
| Total participants | 2008-12-01 | 884 |
| 2007: JOHN W. STONE OIL DISTRIBUTOR, L.L.C. LIFE, ADD, AND DENTAL PLAN 2007 401k membership |
|---|
| Total participants, beginning-of-year | 2007-12-01 | 308 |
| Total number of active participants reported on line 7a of the Form 5500 | 2007-12-01 | 935 |
| Total of all active and inactive participants | 2007-12-01 | 935 |
| 2006: JOHN W. STONE OIL DISTRIBUTOR, L.L.C. LIFE, ADD, AND DENTAL PLAN 2006 401k membership |
|---|
| Total participants, beginning-of-year | 2006-12-01 | 267 |
| Total number of active participants reported on line 7a of the Form 5500 | 2006-12-01 | 308 |
| Total of all active and inactive participants | 2006-12-01 | 308 |
| Total participants | 2006-12-01 | 308 |
| 2005: JOHN W. STONE OIL DISTRIBUTOR, L.L.C. LIFE, ADD, AND DENTAL PLAN 2005 401k membership |
|---|
| Total participants, beginning-of-year | 2005-12-01 | 207 |
| Total number of active participants reported on line 7a of the Form 5500 | 2005-12-01 | 267 |
| Total of all active and inactive participants | 2005-12-01 | 267 |
| 2004: JOHN W. STONE OIL DISTRIBUTOR, L.L.C. LIFE, ADD, AND DENTAL PLAN 2004 401k membership |
|---|
| Total participants, beginning-of-year | 2004-12-01 | 222 |
| Total number of active participants reported on line 7a of the Form 5500 | 2004-12-01 | 207 |
| Total of all active and inactive participants | 2004-12-01 | 207 |
| Total participants | 2004-12-01 | 207 |
| 2003: JOHN W. STONE OIL DISTRIBUTOR, L.L.C. LIFE, ADD, AND DENTAL PLAN 2003 401k membership |
|---|
| Total participants, beginning-of-year | 2003-12-01 | 222 |
| Total number of active participants reported on line 7a of the Form 5500 | 2003-12-01 | 222 |
| Total of all active and inactive participants | 2003-12-01 | 222 |
| Total participants | 2003-12-01 | 222 |
| 2018: JOHN W. STONE OIL DISTRIBUTOR, L.L.C. LIFE, ADD, AND DENTAL PLAN 2018 form 5500 responses |
|---|
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | Submission has been amended | No |
| 2018-01-01 | This submission is the final filing | Yes |
| 2018-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2018-01-01 | Plan is a collectively bargained plan | No |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: JOHN W. STONE OIL DISTRIBUTOR, L.L.C. LIFE, ADD, AND DENTAL PLAN 2017 form 5500 responses |
|---|
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | Submission has been amended | No |
| 2017-01-01 | This submission is the final filing | Yes |
| 2017-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-01-01 | Plan is a collectively bargained plan | No |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: JOHN W. STONE OIL DISTRIBUTOR, L.L.C. LIFE, ADD, AND DENTAL PLAN 2016 form 5500 responses |
|---|
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: JOHN W. STONE OIL DISTRIBUTOR, L.L.C. LIFE, ADD, AND DENTAL PLAN 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: JOHN W. STONE OIL DISTRIBUTOR, L.L.C. LIFE, ADD, AND DENTAL PLAN 2014 form 5500 responses |
|---|
| 2014-01-01 | Type of plan entity | Single employer plan |
| 2014-01-01 | Plan funding arrangement – Insurance | Yes |
| 2014-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: JOHN W. STONE OIL DISTRIBUTOR, L.L.C. LIFE, ADD, AND DENTAL PLAN 2013 form 5500 responses |
|---|
| 2013-01-01 | Type of plan entity | Single employer plan |
| 2013-01-01 | Submission has been amended | No |
| 2013-01-01 | This submission is the final filing | No |
| 2013-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-01-01 | Plan is a collectively bargained plan | No |
| 2013-01-01 | Plan funding arrangement – Insurance | Yes |
| 2013-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2012: JOHN W. STONE OIL DISTRIBUTOR, L.L.C. LIFE, ADD, AND DENTAL PLAN 2012 form 5500 responses |
|---|
| 2012-12-01 | Type of plan entity | Single employer plan |
| 2012-12-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2012-12-01 | Plan funding arrangement – Insurance | Yes |
| 2012-12-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2012-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-12-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2011: JOHN W. STONE OIL DISTRIBUTOR, L.L.C. LIFE, ADD, AND DENTAL PLAN 2011 form 5500 responses |
|---|
| 2011-12-01 | Type of plan entity | Single employer plan |
| 2011-12-01 | Plan funding arrangement – Insurance | Yes |
| 2011-12-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2011-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-12-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2010: JOHN W. STONE OIL DISTRIBUTOR, L.L.C. LIFE, ADD, AND DENTAL PLAN 2010 form 5500 responses |
|---|
| 2010-12-01 | Type of plan entity | Single employer plan |
| 2010-12-01 | Plan funding arrangement – Insurance | Yes |
| 2010-12-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2010-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2010-12-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2009: JOHN W. STONE OIL DISTRIBUTOR, L.L.C. LIFE, ADD, AND DENTAL PLAN 2009 form 5500 responses |
|---|
| 2009-12-01 | Type of plan entity | Single employer plan |
| 2009-12-01 | Plan funding arrangement – Insurance | Yes |
| 2009-12-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2009-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-12-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2008: JOHN W. STONE OIL DISTRIBUTOR, L.L.C. LIFE, ADD, AND DENTAL PLAN 2008 form 5500 responses |
|---|
| 2008-12-01 | Type of plan entity | Single employer plan |
| 2008-12-01 | Plan funding arrangement – Insurance | Yes |
| 2008-12-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2008-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2008-12-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2007: JOHN W. STONE OIL DISTRIBUTOR, L.L.C. LIFE, ADD, AND DENTAL PLAN 2007 form 5500 responses |
|---|
| 2007-12-01 | Type of plan entity | Single employer plan |
| 2007-12-01 | Plan funding arrangement – Insurance | Yes |
| 2007-12-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2007-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2007-12-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2006: JOHN W. STONE OIL DISTRIBUTOR, L.L.C. LIFE, ADD, AND DENTAL PLAN 2006 form 5500 responses |
|---|
| 2006-12-01 | Type of plan entity | Single employer plan |
| 2006-12-01 | Plan funding arrangement – Insurance | Yes |
| 2006-12-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2006-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2006-12-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2005: JOHN W. STONE OIL DISTRIBUTOR, L.L.C. LIFE, ADD, AND DENTAL PLAN 2005 form 5500 responses |
|---|
| 2005-12-01 | Type of plan entity | Single employer plan |
| 2005-12-01 | Plan funding arrangement – Insurance | Yes |
| 2005-12-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2005-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2005-12-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2004: JOHN W. STONE OIL DISTRIBUTOR, L.L.C. LIFE, ADD, AND DENTAL PLAN 2004 form 5500 responses |
|---|
| 2004-12-01 | Type of plan entity | Single employer plan |
| 2004-12-01 | Plan funding arrangement – Insurance | Yes |
| 2004-12-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2004-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2004-12-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2003: JOHN W. STONE OIL DISTRIBUTOR, L.L.C. LIFE, ADD, AND DENTAL PLAN 2003 form 5500 responses |
|---|
| 2003-12-01 | Type of plan entity | Single employer plan |
| 2003-12-01 | First time form 5500 has been submitted | Yes |
| 2003-12-01 | Plan funding arrangement – Insurance | Yes |
| 2003-12-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2003-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2003-12-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010-046196 |
| Policy instance | 4 |
| Insurance contract or identification number | 010-046196 | | Number of Individuals Covered | 574 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $2,676 | | Total amount of fees paid to insurance company | USD $2,592 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $216,761 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,676 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 2592 | | Additional information about fees paid to insurance broker | FEES |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | KM05713836 |
| Policy instance | 1 |
| Insurance contract or identification number | KM05713836 | | Number of Individuals Covered | 454 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $3,382 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $139,324 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,382 | | Insurance broker organization code? | 3 |
|
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | 94407 |
| Policy instance | 2 |
| Insurance contract or identification number | 94407 | | Number of Individuals Covered | 76 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $5,153 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | HOSPITAL INDEMNITY | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $34,416 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,607 | | Insurance broker organization code? | 3 |
|
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | V6977 |
| Policy instance | 3 |
| Insurance contract or identification number | V6977 | | Number of Individuals Covered | 132 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $76,127 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENT, CANCER, CRITICAL ILLNESS | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $139,511 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $51,833 | | Insurance broker organization code? | 3 |
|
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | V6977 |
| Policy instance | 3 |
| Insurance contract or identification number | V6977 | | Number of Individuals Covered | 32 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $2,676 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $27,445 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,676 | | Insurance broker organization code? | 3 | | Insurance broker name | USI SOUTHWEST, INC. |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E4089355 |
| Policy instance | 2 |
| Insurance contract or identification number | E4089355 | | Number of Individuals Covered | 96 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $11,811 | | Total amount of fees paid to insurance company | USD $738 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENT, CANCER, HOSPITAL, CRITICAL ILLNESS | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $112,326 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,618 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 666 | | Additional information about fees paid to insurance broker | FEES PAID | | Insurance broker name | T & L AGENCY LLC |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | KM05713836 |
| Policy instance | 1 |
| Insurance contract or identification number | KM05713836 | | Number of Individuals Covered | 1055 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $56,035 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ADD | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $370,910 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $56,035 | | Insurance broker organization code? | 3 | | Insurance broker name | MCGRIFF SEIBELS & WILLIAMS OF LA IN |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E4089355 |
| Policy instance | 2 |
| Insurance contract or identification number | E4089355 | | Number of Individuals Covered | 126 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $22,098 | | Total amount of fees paid to insurance company | USD $1,907 | | Other welfare benefits provided | SUPP ACCIDENT,CANCER,HOSPITAL,CI | | Welfare Benefit Premiums Paid to Carrier | USD $130,368 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,929 | | Amount paid for insurance broker fees | 105 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | T & L AGENCY LLC |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | KM05713836 |
| Policy instance | 1 |
| Insurance contract or identification number | KM05713836 | | Number of Individuals Covered | 1212 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $59,680 | | Total amount of fees paid to insurance company | USD $7,898 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $432,278 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $59,680 | | Amount paid for insurance broker fees | 24 | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | USI INS SERVICES LLC |
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| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E4089355 |
| Policy instance | 2 |
| Insurance contract or identification number | E4089355 | | Number of Individuals Covered | 118 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $44,109 | | Total amount of fees paid to insurance company | USD $5,698 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | SUPP ACCIDENT,CANCER,HOSPITAL,CI | | Welfare Benefit Premiums Paid to Carrier | USD $119,751 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $26,834 | | Amount paid for insurance broker fees | 658 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | T & L AGENCY LLC |
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| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | KM05713836 |
| Policy instance | 1 |
| Insurance contract or identification number | KM05713836 | | Number of Individuals Covered | 1197 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $55,542 | | Total amount of fees paid to insurance company | USD $6,495 | | 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 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $379,176 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $55,542 | | Amount paid for insurance broker fees | 16 | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | USI INS SERVICES LLC |
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| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E4089355 |
| Policy instance | 2 |
| Insurance contract or identification number | E4089355 | | Number of Individuals Covered | 106 | | Insurance policy start date | 2013-02-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $33,084 | | Total amount of fees paid to insurance company | USD $5,262 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | SUPP ACCIDENT, CANCER, HOSPITAL, CI | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $61,668 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $345 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 424 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker name | LINDSAY JO ADAMS |
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| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | KM05713836 |
| Policy instance | 1 |
| Insurance contract or identification number | KM05713836 | | Number of Individuals Covered | 954 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $44,764 | | Total amount of fees paid to insurance company | USD $4,869 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ADD | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $322,841 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 4855 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 | | Commission paid to Insurance Broker | USD $44,764 | | Insurance broker name | USI INS SERVICES LLC |
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| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | KM05713836 |
| Policy instance | 1 |
| Insurance contract or identification number | KM05713836 | | Number of Individuals Covered | 953 | | Insurance policy start date | 2012-12-01 | | Insurance policy end date | 2013-11-30 | | Total amount of commissions paid to insurance broker | USD $3,453 | | Total amount of fees paid to insurance company | USD $92 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,453 | | Amount paid for insurance broker fees | 34 | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES LLC |
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| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | KM05713836 |
| Policy instance | 1 |
| Insurance contract or identification number | KM05713836 | | Number of Individuals Covered | 928 | | Insurance policy start date | 2011-12-01 | | Insurance policy end date | 2012-11-30 | | Total amount of commissions paid to insurance broker | USD $40,061 | | Total amount of fees paid to insurance company | USD $1,433 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $269,113 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $40,061 | | Amount paid for insurance broker fees | 19 | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES LLC |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | KM05713836 |
| Policy instance | 1 |
| Insurance contract or identification number | KM05713836 | | Number of Individuals Covered | 907 | | Insurance policy start date | 2010-12-01 | | Insurance policy end date | 2011-11-30 | | Total amount of commissions paid to insurance broker | USD $36,842 | | Total amount of fees paid to insurance company | USD $4,932 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $247,647 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $36,842 | | Amount paid for insurance broker fees | 20 | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | USI INS SERVICES LLC |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | KM05713836 |
| Policy instance | 1 |
| Insurance contract or identification number | KM05713836 | | Number of Individuals Covered | 900 | | Insurance policy start date | 2009-12-01 | | Insurance policy end date | 2010-11-30 | | Total amount of commissions paid to insurance broker | USD $34,839 | | Total amount of fees paid to insurance company | USD $5,056 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $231,965 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $34,839 | | Amount paid for insurance broker fees | 1551 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL AND NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | USI INS SERVICES LLC |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | KM05713836 |
| Policy instance | 1 |
| Insurance contract or identification number | KM05713836 | | Number of Individuals Covered | 884 | | Insurance policy start date | 2008-12-01 | | Insurance policy end date | 2009-11-30 | | Total amount of commissions paid to insurance broker | USD $35,923 | | Total amount of fees paid to insurance company | USD $4,401 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $239,208 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $30,085 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 779 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker name | USI INSURANCE SERVICES LLC |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | KM05713836 |
| Policy instance | 1 |
| Insurance contract or identification number | KM05713836 | | Number of Individuals Covered | 935 | | Insurance policy start date | 2007-12-01 | | Insurance policy end date | 2008-11-30 | | Total amount of commissions paid to insurance broker | USD $31,357 | | Total amount of fees paid to insurance company | USD $11,718 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $228,569 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $31,357 | | Amount paid for insurance broker fees | 7914 | | Additional information about fees paid to insurance broker | PREFERRED BROKER COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | ANCO INS SERVICES OF HOUSTON INC |
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| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000860048058 |
| Policy instance | 1 |
| Insurance contract or identification number | 000860048058 | | Number of Individuals Covered | 308 | | Insurance policy start date | 2006-12-01 | | Insurance policy end date | 2007-11-30 | | Total amount of commissions paid to insurance broker | USD $10,955 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $73,035 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,955 | | Insurance broker organization code? | 3 | | Insurance broker name | USI GULF COAST, INC. |
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| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 00086D011411 |
| Policy instance | 2 |
| Insurance contract or identification number | 00086D011411 | | Number of Individuals Covered | 209 | | Insurance policy start date | 2006-12-01 | | Insurance policy end date | 2007-11-30 | | Total amount of commissions paid to insurance broker | USD $18,844 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $125,628 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $18,844 | | Insurance broker organization code? | 3 | | Insurance broker name | USI GULF COAST, INC. |
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| JEFFERSON PILOT FINANCIAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70254 ) |
| Policy contract number | 000860048058 |
| Policy instance | 1 |
| Insurance contract or identification number | 000860048058 | | Number of Individuals Covered | 267 | | Insurance policy start date | 2005-12-01 | | Insurance policy end date | 2006-11-30 | | Total amount of commissions paid to insurance broker | USD $9,600 | | Total amount of fees paid to insurance company | USD $1,793 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $64,001 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,600 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 1793 | | Additional information about fees paid to insurance broker | BROKER BONUS | | Insurance broker name | ANCO INSURANCE SERVICES OF HOUSTON |
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| JEFFERSON PILOT FINANCIAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70254 ) |
| Policy contract number | 00086D011411 |
| Policy instance | 2 |
| Insurance contract or identification number | 00086D011411 | | Number of Individuals Covered | 177 | | Insurance policy start date | 2005-12-01 | | Insurance policy end date | 2006-11-30 | | Total amount of commissions paid to insurance broker | USD $16,178 | | Total amount of fees paid to insurance company | USD $664 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $107,851 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $16,178 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 664 | | Additional information about fees paid to insurance broker | BROKER BONUS | | Insurance broker name | ANCO INSURANCE SERVICES OF HOUSTON |
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| JEFFERSON PILOT FINANCIAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70254 ) |
| Policy contract number | 00086D011411 |
| Policy instance | 2 |
| Insurance contract or identification number | 00086D011411 | | Number of Individuals Covered | 128 | | Insurance policy start date | 2004-12-01 | | Insurance policy end date | 2005-11-30 | | Total amount of commissions paid to insurance broker | USD $13,468 | | Total amount of fees paid to insurance company | USD $675 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $89,785 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,468 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 675 | | Additional information about fees paid to insurance broker | BROKER BONUS | | Insurance broker name | ANCO INSURANCE SERVICES OF HOUSTON |
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| JEFFERSON PILOT FINANCIAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70254 ) |
| Policy contract number | 000860048058 |
| Policy instance | 1 |
| Insurance contract or identification number | 000860048058 | | Number of Individuals Covered | 207 | | Insurance policy start date | 2004-12-01 | | Insurance policy end date | 2005-11-30 | | Total amount of commissions paid to insurance broker | USD $8,986 | | Total amount of fees paid to insurance company | USD $1,741 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $59,908 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,986 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 1741 | | Additional information about fees paid to insurance broker | BROKER BONUS | | Insurance broker name | ANCO INSURANCE SERVICES OF HOUSTON |
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| JEFFERSON PILOT FINANCIAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70254 ) |
| Policy contract number | 00086D011411 |
| Policy instance | 2 |
| Insurance contract or identification number | 00086D011411 | | Number of Individuals Covered | 139 | | Insurance policy start date | 2003-12-01 | | Insurance policy end date | 2004-11-30 | | Total amount of commissions paid to insurance broker | USD $5,464 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $36,428 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,464 | | Insurance broker organization code? | 3 | | Insurance broker name | USI GULF COAST, INC. |
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| JEFFERSON PILOT FINANCIAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70254 ) |
| Policy contract number | 000860048058 |
| Policy instance | 1 |
| Insurance contract or identification number | 000860048058 | | Number of Individuals Covered | 222 | | Insurance policy start date | 2003-12-01 | | Insurance policy end date | 2004-11-30 | | Total amount of commissions paid to insurance broker | USD $3,660 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $24,402 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,660 | | Insurance broker organization code? | 3 | | Insurance broker name | USI GULF COAST, INC. |
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