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TTCU THE CREDIT UNION EMPLOYEE BENEFIT PLAN 401k Plan overview

Plan NameTTCU THE CREDIT UNION EMPLOYEE BENEFIT PLAN
Plan identification number 501

TTCU THE CREDIT UNION EMPLOYEE BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)
  • Other welfare benefit cover

401k Sponsoring company profile

TTCU FEDERAL CREDIT UNION has sponsored the creation of one or more 401k plans.

Company Name:TTCU FEDERAL CREDIT UNION
Employer identification number (EIN):730489468
NAIC Classification:522130
NAIC Description:Credit Unions

Form 5500 Filing Information

Submission information for form 5500 for 401k plan TTCU THE CREDIT UNION EMPLOYEE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01SHELBY BELL2023-07-26
5012021-01-01
5012020-01-01
5012019-01-01
5012018-01-01
5012017-01-01
5012016-01-01SHELBY BEIL
5012015-01-01SHELBY BEIL
5012015-01-01SHELBY BEIL
5012014-01-01SHELBY BEIL
5012013-01-01SHELBY BEIL
5012012-01-01SHELBY BEIL
5012011-01-01SHELBY BEIL
5012010-01-01SHELBY BEIL
5012009-01-01TIMOTHY L LYONS
5012009-01-01TIMOTHY L LYONS
5012009-01-01TIMOTHY L LYONS

Plan Statistics for TTCU THE CREDIT UNION EMPLOYEE BENEFIT PLAN

401k plan membership statisitcs for TTCU THE CREDIT UNION EMPLOYEE BENEFIT PLAN

Measure Date Value
2022: TTCU THE CREDIT UNION EMPLOYEE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01406
Total number of active participants reported on line 7a of the Form 55002022-01-01463
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-01463
Number of employers contributing to the scheme2022-01-010
2021: TTCU THE CREDIT UNION EMPLOYEE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01382
Total number of active participants reported on line 7a of the Form 55002021-01-01404
Number of retired or separated participants receiving benefits2021-01-012
Total of all active and inactive participants2021-01-01406
2020: TTCU THE CREDIT UNION EMPLOYEE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01408
Total number of active participants reported on line 7a of the Form 55002020-01-01406
Number of retired or separated participants receiving benefits2020-01-012
Number of other retired or separated participants entitled to future benefits2020-01-011
Total of all active and inactive participants2020-01-01409
2019: TTCU THE CREDIT UNION EMPLOYEE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01266
Total number of active participants reported on line 7a of the Form 55002019-01-01322
Number of retired or separated participants receiving benefits2019-01-011
Total of all active and inactive participants2019-01-01323
2018: TTCU THE CREDIT UNION EMPLOYEE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01234
Total number of active participants reported on line 7a of the Form 55002018-01-01298
Number of retired or separated participants receiving benefits2018-01-015
Total of all active and inactive participants2018-01-01303
2017: TTCU THE CREDIT UNION EMPLOYEE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01222
Total number of active participants reported on line 7a of the Form 55002017-01-01272
Number of retired or separated participants receiving benefits2017-01-014
Total of all active and inactive participants2017-01-01276
Total participants2017-01-01276
2016: TTCU THE CREDIT UNION EMPLOYEE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01251
Total number of active participants reported on line 7a of the Form 55002016-01-01262
Number of retired or separated participants receiving benefits2016-01-012
Total of all active and inactive participants2016-01-01264
Total participants2016-01-010
2015: TTCU THE CREDIT UNION EMPLOYEE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01239
Total number of active participants reported on line 7a of the Form 55002015-01-01251
Total of all active and inactive participants2015-01-01251
Total participants2015-01-010
2014: TTCU THE CREDIT UNION EMPLOYEE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01216
Total number of active participants reported on line 7a of the Form 55002014-01-01237
Number of retired or separated participants receiving benefits2014-01-012
Total of all active and inactive participants2014-01-01239
Total participants2014-01-010
2013: TTCU THE CREDIT UNION EMPLOYEE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01201
Total number of active participants reported on line 7a of the Form 55002013-01-01213
Number of retired or separated participants receiving benefits2013-01-013
Total of all active and inactive participants2013-01-01216
Total participants2013-01-010
2012: TTCU THE CREDIT UNION EMPLOYEE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01208
Total number of active participants reported on line 7a of the Form 55002012-01-01199
Number of retired or separated participants receiving benefits2012-01-012
Total of all active and inactive participants2012-01-01201
Total participants2012-01-010
2011: TTCU THE CREDIT UNION EMPLOYEE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01224
Total number of active participants reported on line 7a of the Form 55002011-01-01206
Number of retired or separated participants receiving benefits2011-01-012
Total of all active and inactive participants2011-01-01208
Total participants2011-01-01208
2010: TTCU THE CREDIT UNION EMPLOYEE BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-01189
Total number of active participants reported on line 7a of the Form 55002010-01-01224
Total of all active and inactive participants2010-01-01224
Total participants2010-01-01224
2009: TTCU THE CREDIT UNION EMPLOYEE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01190
Total number of active participants reported on line 7a of the Form 55002009-01-01188
Number of retired or separated participants receiving benefits2009-01-011
Total of all active and inactive participants2009-01-01189
Total participants2009-01-01189

Form 5500 Responses for TTCU THE CREDIT UNION EMPLOYEE BENEFIT PLAN

2022: TTCU THE CREDIT UNION EMPLOYEE BENEFIT PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: TTCU THE CREDIT UNION EMPLOYEE BENEFIT PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: TTCU THE CREDIT UNION EMPLOYEE BENEFIT PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: TTCU THE CREDIT UNION EMPLOYEE BENEFIT PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – General assets of the sponsorYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – General assets of the sponsorYes
2018: TTCU THE CREDIT UNION EMPLOYEE BENEFIT PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: TTCU THE CREDIT UNION EMPLOYEE BENEFIT PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: TTCU THE CREDIT UNION EMPLOYEE BENEFIT PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – General assets of the sponsorYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – General assets of the sponsorYes
2015: TTCU THE CREDIT UNION EMPLOYEE BENEFIT PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedYes
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – General assets of the sponsorYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – General assets of the sponsorYes
2014: TTCU THE CREDIT UNION EMPLOYEE BENEFIT PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – General assets of the sponsorYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – General assets of the sponsorYes
2013: TTCU THE CREDIT UNION EMPLOYEE BENEFIT PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – General assets of the sponsorYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – General assets of the sponsorYes
2012: TTCU THE CREDIT UNION EMPLOYEE BENEFIT PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – General assets of the sponsorYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – General assets of the sponsorYes
2011: TTCU THE CREDIT UNION EMPLOYEE BENEFIT PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – General assets of the sponsorYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – General assets of the sponsorYes
2010: TTCU THE CREDIT UNION EMPLOYEE BENEFIT PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan funding arrangement – General assets of the sponsorYes
2010-01-01Plan benefit arrangement – InsuranceYes
2010-01-01Plan benefit arrangement – General assets of the sponsorYes
2009: TTCU THE CREDIT UNION EMPLOYEE BENEFIT PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – General assets of the sponsorYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number87591
Policy instance 1
Insurance contract or identification number87591
Number of Individuals Covered67
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $10,330
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedACCIDENT, CRITICAL ILLNESS, CANCER
Welfare Benefit Premiums Paid to CarrierUSD $45,966
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,188
Amount paid for insurance broker fees0
Insurance broker organization code?3
OPTUMHEALTH, A DIVISION OF UNITED HEALTHCARE SERVICES (National Association of Insurance Commissioners NAIC id number: )
Policy contract numberMB8048
Policy instance 2
Insurance contract or identification numberMB8048
Number of Individuals Covered374
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedORGAN TRANSPLANT
Welfare Benefit Premiums Paid to CarrierUSD $34,966
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract numberXB123254
Policy instance 3
Insurance contract or identification numberXB123254
Number of Individuals Covered64
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $6,263
Total amount of fees paid to insurance companyUSD $415
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $22,272
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,596
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerCONTINGENT COMMISSIONS
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number05909
Policy instance 4
Insurance contract or identification number05909
Number of Individuals Covered458
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $34,388
Total amount of fees paid to insurance companyUSD $6,746
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $343,876
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,445
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMMISSIONS
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30085699
Policy instance 5
Insurance contract or identification number30085699
Number of Individuals Covered330
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $6,491
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $65,388
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,285
Amount paid for insurance broker fees0
Insurance broker organization code?3
BANKERS FIDELITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61239 )
Policy contract numberW5293001
Policy instance 6
Insurance contract or identification numberW5293001
Number of Individuals Covered43
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $19,712
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $20,321
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,712
Amount paid for insurance broker fees0
Insurance broker organization code?3
NATIONAL EMPLOYEE ASSISTANCE PROVIDERS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberEAP
Policy instance 7
Insurance contract or identification numberEAP
Number of Individuals Covered463
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedEMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to CarrierUSD $6,945
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
OPTUMHEALTH, A DIVISION OF UNITED HEALTHCARE SERVICES (National Association of Insurance Commissioners NAIC id number: )
Policy contract numberM8048
Policy instance 2
Insurance contract or identification numberM8048
Number of Individuals Covered374
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Other welfare benefits providedORGAN TRANSPLANT
Welfare Benefit Premiums Paid to CarrierUSD $33,633
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number87591
Policy instance 1
Insurance contract or identification number87591
Number of Individuals Covered87
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $9,227
Total amount of fees paid to insurance companyUSD $284
Other welfare benefits providedACCIDENT, CANCER, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $46,953
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,227
Insurance broker organization code?3
Amount paid for insurance broker fees284
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract numberXB123254
Policy instance 3
Insurance contract or identification numberXB123254
Number of Individuals Covered65
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $6,299
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $26,016
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,187
Insurance broker organization code?3
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number05909
Policy instance 4
Insurance contract or identification number05909
Number of Individuals Covered431
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $38,762
Total amount of fees paid to insurance companyUSD $82
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $325,419
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $32,542
Insurance broker organization code?3
Amount paid for insurance broker fees82
Additional information about fees paid to insurance brokerTHIRD PARTY ADMINISTRATION FEES
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30085699
Policy instance 5
Insurance contract or identification number30085699
Number of Individuals Covered320
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $5,599
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $56,425
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,599
Insurance broker organization code?3
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number87591
Policy instance 2
Insurance contract or identification number87591
Number of Individuals Covered72
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $11,627
Total amount of fees paid to insurance companyUSD $836
Other welfare benefits providedACCIDENT, CANCER, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $37,375
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,627
Insurance broker organization code?3
Amount paid for insurance broker fees836
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number05909
Policy instance 5
Insurance contract or identification number05909
Number of Individuals Covered421
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $43,649
Total amount of fees paid to insurance companyUSD $89
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $312,071
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $31,207
Insurance broker organization code?3
Amount paid for insurance broker fees77
Additional information about fees paid to insurance brokerTHIRD PARTY ADMINISTRATION FEES
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract numberXB123254
Policy instance 1
Insurance contract or identification numberXB123254
Number of Individuals Covered58
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $8,694
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $20,679
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,380
Insurance broker organization code?3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30085699
Policy instance 4
Insurance contract or identification number30085699
Number of Individuals Covered293
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $4,989
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $54,307
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,989
Insurance broker organization code?3
OPTUMHEALTH, A DIVISION OF UNITED HEALTHCARE SERVICES (National Association of Insurance Commissioners NAIC id number: )
Policy contract numberM8048
Policy instance 3
Insurance contract or identification numberM8048
Number of Individuals Covered357
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Other welfare benefits providedORGAN TRANSPLANT
Welfare Benefit Premiums Paid to CarrierUSD $33,219
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract numberXB123254
Policy instance 6
Insurance contract or identification numberXB123254
Number of Individuals Covered53
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $5,022
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $17,390
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,655
Insurance broker organization code?3
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number05909
Policy instance 5
Insurance contract or identification number05909
Number of Individuals Covered397
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $41,405
Total amount of fees paid to insurance companyUSD $139
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $287,384
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $28,738
Insurance broker organization code?3
Amount paid for insurance broker fees139
Additional information about fees paid to insurance brokerTHIRD PARTY ADMINISTRATION FEES
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00482897
Policy instance 4
Insurance contract or identification number00482897
Number of Individuals Covered339
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $7,075
Total amount of fees paid to insurance companyUSD $1,976
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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $30,236
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,075
Insurance broker organization code?3
Amount paid for insurance broker fees1976
Additional information about fees paid to insurance brokerADMINISTRATIVE FEES
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30085699
Policy instance 3
Insurance contract or identification number30085699
Number of Individuals Covered268
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $4,273
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $46,761
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,273
Insurance broker organization code?3
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number87591
Policy instance 2
Insurance contract or identification number87591
Number of Individuals Covered75
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $9,884
Total amount of fees paid to insurance companyUSD $813
Other welfare benefits providedCANCER, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $26,325
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,884
Insurance broker organization code?3
Amount paid for insurance broker fees813
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
OPTUMHEALTH, A DIVISION OF UNITED HEALTHCARE SERVICES (National Association of Insurance Commissioners NAIC id number: )
Policy contract numberM8048
Policy instance 1
Insurance contract or identification numberM8048
Number of Individuals Covered334
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Other welfare benefits providedORGAN TRANSPLANT
Welfare Benefit Premiums Paid to CarrierUSD $29,359
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract numberXB123254
Policy instance 1
Insurance contract or identification numberXB123254
Number of Individuals Covered43
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $4,376
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $13,374
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,405
Insurance broker organization code?3
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number05909
Policy instance 4
Insurance contract or identification number05909
Number of Individuals Covered369
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $33,094
Total amount of fees paid to insurance companyUSD $130
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $212,264
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $21,226
Insurance broker organization code?3
Amount paid for insurance broker fees130
Additional information about fees paid to insurance brokerTHIRD PARTY ADMINISTRATION FEES
OPTUMHEALTH, A DIVISION OF UNITED HEALTHCARE SERVICES (National Association of Insurance Commissioners NAIC id number: )
Policy contract numberM8048
Policy instance 3
Insurance contract or identification numberM8048
Number of Individuals Covered312
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Other welfare benefits providedORGAN TRANSPLANT
Welfare Benefit Premiums Paid to CarrierUSD $26,973
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00482897
Policy instance 2
Insurance contract or identification number00482897
Number of Individuals Covered318
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $6,606
Total amount of fees paid to insurance companyUSD $1,064
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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $28,229
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,606
Insurance broker organization code?3
Amount paid for insurance broker fees1064
Additional information about fees paid to insurance brokerADMINISTRATION FEES
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00482897
Policy instance 4
Insurance contract or identification number00482897
Number of Individuals Covered303
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $6,225
Total amount of fees paid to insurance companyUSD $1,227
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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $26,602
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,713
Insurance broker organization code?3
Amount paid for insurance broker fees1227
Additional information about fees paid to insurance brokerADMINISTRATION FEES
OPTUMHEALTH, A DIVISION OF UNITED HEALTHCARE SERVICES (National Association of Insurance Commissioners NAIC id number: )
Policy contract numberM8048
Policy instance 3
Insurance contract or identification numberM8048
Number of Individuals Covered292
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Other welfare benefits providedORGAN TRANSPLANT
Welfare Benefit Premiums Paid to CarrierUSD $25,250
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract numberXB123254
Policy instance 2
Insurance contract or identification numberXB123254
Number of Individuals Covered36
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $2,848
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $13,495
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,423
Insurance broker organization code?3
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number05909
Policy instance 1
Insurance contract or identification number05909
Number of Individuals Covered353
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $31,843
Total amount of fees paid to insurance companyUSD $127
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $462,640
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $23,132
Insurance broker organization code?3
Amount paid for insurance broker fees127
Additional information about fees paid to insurance brokerADMINISTRATION FEES
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract numberXB123254
Policy instance 13
Insurance contract or identification numberXB123254
Number of Individuals Covered37
Total amount of commissions paid to insurance brokerUSD $2,853
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $10,887
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,476
Insurance broker organization code?3
Insurance broker nameGALLAGHER BENEFITS SERVICES INC
OPTUMHEALTH, A DIVISION OF UNITED HEALTHCARE SERVICES (National Association of Insurance Commissioners NAIC id number: )
Policy contract numberM8048
Policy instance 11
Insurance contract or identification numberM8048
Number of Individuals Covered239
Other welfare benefits providedORGAN TRANSPLANT
Welfare Benefit Premiums Paid to CarrierUSD $25,829
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number87591
Policy instance 12
Insurance contract or identification number87591
Number of Individuals Covered26
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $1,458
Other welfare benefits providedHEART, STROKE, CANCER
Welfare Benefit Premiums Paid to CarrierUSD $8,674
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,458
Insurance broker organization code?3
Insurance broker nameHUB INTNL MIDWEST LTD
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number05909
Policy instance 9
Insurance contract or identification number05909
Number of Individuals Covered294
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $60,956
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number05909
Policy instance 2
Insurance contract or identification number05909
Number of Individuals Covered119
Total amount of commissions paid to insurance brokerUSD $17,504
Total amount of fees paid to insurance companyUSD $112
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $25,611
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,504
Insurance broker organization code?3
Amount paid for insurance broker fees112
Additional information about fees paid to insurance brokerTHIRD PARTY ADMIN
Insurance broker nameAXA ASSISTANCE USA
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: )
Policy contract numberM8048
Policy instance 10
Insurance contract or identification numberM8048
Number of Individuals Covered239
Total amount of commissions paid to insurance brokerUSD $58,919
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $335,493
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $39,453
Insurance broker organization code?3
Insurance broker nameHEALTHCARE SOLUTIONS GROUP, INC
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00482897
Policy instance 1
Insurance contract or identification number00482897
Number of Individuals Covered255
Total amount of commissions paid to insurance brokerUSD $5,596
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $23,455
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,596
Insurance broker organization code?3
Insurance broker nameTHE HOLMES ORGANIZATION
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number05909
Policy instance 3
Insurance contract or identification number05909
Number of Individuals Covered119
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $22,387
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number05909
Policy instance 4
Insurance contract or identification number05909
Other welfare benefits providedVOL DEPENDENT LIFE
Welfare Benefit Premiums Paid to CarrierUSD $3,225
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number05909
Policy instance 5
Insurance contract or identification number05909
Number of Individuals Covered295
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $149,428
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number05909
Policy instance 6
Insurance contract or identification number05909
Number of Individuals Covered295
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $29,535
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number05909
Policy instance 7
Insurance contract or identification number05909
Number of Individuals Covered295
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,213
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number05909
Policy instance 8
Insurance contract or identification number05909
Number of Individuals Covered292
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $53,723
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number05909
Policy instance 5
Insurance contract or identification number05909
Number of Individuals Covered267
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $108,551
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number05909
Policy instance 4
Insurance contract or identification number05909
Other welfare benefits providedVOL DEPENDENT LIFE
Welfare Benefit Premiums Paid to CarrierUSD $2,942
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number05909
Policy instance 3
Insurance contract or identification number05909
Number of Individuals Covered116
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $20,776
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number05909
Policy instance 2
Insurance contract or identification number05909
Number of Individuals Covered116
Total amount of commissions paid to insurance brokerUSD $15,651
Total amount of fees paid to insurance companyUSD $87
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $23,718
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,227
Insurance broker organization code?3
Amount paid for insurance broker fees87
Additional information about fees paid to insurance brokerTHIRD PARTY ADMIN
Insurance broker nameAXA ASSISTANCE USA
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number05909
Policy instance 8
Insurance contract or identification number05909
Number of Individuals Covered264
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $44,516
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number05909
Policy instance 6
Insurance contract or identification number05909
Number of Individuals Covered267
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $24,119
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number05909
Policy instance 7
Insurance contract or identification number05909
Number of Individuals Covered267
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $4,257
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number05909
Policy instance 9
Insurance contract or identification number05909
Number of Individuals Covered267
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $35,961
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: )
Policy contract numberM8048
Policy instance 10
Insurance contract or identification numberM8048
Number of Individuals Covered216
Total amount of commissions paid to insurance brokerUSD $49,546
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $280,722
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $33,035
Insurance broker organization code?3
Insurance broker nameHEALTHCARE SOLUTIONS GROUP, INC
AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 )
Policy contract number19792
Policy instance 11
Insurance contract or identification number19792
Number of Individuals Covered18
Total amount of commissions paid to insurance brokerUSD $46
Health Insurance Welfare BenefitYes
Other welfare benefits providedCANCER
Welfare Benefit Premiums Paid to CarrierUSD $2,886
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $46
Insurance broker organization code?3
Insurance broker nameNORTH AMERICA INS OF TULSA
OPTUMHEALTH, A DIVISION OF UNITED HEALTHCARE SERVICES (National Association of Insurance Commissioners NAIC id number: )
Policy contract numberM8048
Policy instance 12
Insurance contract or identification numberM8048
Number of Individuals Covered216
Other welfare benefits providedORGAN TRANSPLANT
Welfare Benefit Premiums Paid to CarrierUSD $23,013
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00482897
Policy instance 1
Insurance contract or identification number00482897
Number of Individuals Covered223
Total amount of commissions paid to insurance brokerUSD $4,276
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $151,709
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,276
Insurance broker organization code?3
Insurance broker nameTHE HOLMES ORGANIZATION
OPTUMHEALTH, A DIVISION OF UNITED HEALTHCARE SERVICES (National Association of Insurance Commissioners NAIC id number: )
Policy contract numberM8048
Policy instance 2
Insurance contract or identification numberM8048
Number of Individuals Covered201
Other welfare benefits providedORGAN TRANSPLANT
Welfare Benefit Premiums Paid to CarrierUSD $22,097
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number05909
Policy instance 1
Insurance contract or identification number05909
Other welfare benefits providedVOL DEP LIFE CHILD
Welfare Benefit Premiums Paid to CarrierUSD $415
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 number615213
Policy instance 14
Insurance contract or identification number615213
Number of Individuals Covered422
Total amount of commissions paid to insurance brokerUSD $6,872
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $137,334
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,872
Insurance broker organization code?3
Insurance broker nameTHE HOLMES ORGANIZATION
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number05909
Policy instance 13
Insurance contract or identification number05909
Number of Individuals Covered110
Total amount of commissions paid to insurance brokerUSD $12,041
Total amount of fees paid to insurance companyUSD $80
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $23,782
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees80
Additional information about fees paid to insurance brokerTHIRD PARTY ADMIN
Insurance broker organization code?5
Commission paid to Insurance BrokerUSD $12,041
Insurance broker nameHOLMES ORGANIZATION INC
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number05909
Policy instance 11
Insurance contract or identification number05909
Other welfare benefits providedVOL DEPENDENT LIFE
Welfare Benefit Premiums Paid to CarrierUSD $2,817
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number05909
Policy instance 10
Insurance contract or identification number05909
Number of Individuals Covered233
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $96,622
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number05909
Policy instance 9
Insurance contract or identification number05909
Number of Individuals Covered233
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $22,986
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number05909
Policy instance 8
Insurance contract or identification number05909
Number of Individuals Covered233
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $4,057
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number05909
Policy instance 7
Insurance contract or identification number05909
Number of Individuals Covered233
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $37,903
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number05909
Policy instance 6
Insurance contract or identification number05909
Number of Individuals Covered233
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $31,677
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: )
Policy contract numberM8048
Policy instance 5
Insurance contract or identification numberM8048
Number of Individuals Covered201
Total amount of commissions paid to insurance brokerUSD $29,084
Total amount of fees paid to insurance companyUSD $14,542
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $247,159
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees14542
Insurance broker organization code?4
Commission paid to Insurance BrokerUSD $29,084
Insurance broker nameTHE HOLMES ORGANISATION
AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 )
Policy contract number19792
Policy instance 4
Insurance contract or identification number19792
Number of Individuals Covered18
Total amount of commissions paid to insurance brokerUSD $46
Health Insurance Welfare BenefitYes
Other welfare benefits providedCANCER
Welfare Benefit Premiums Paid to CarrierUSD $2,886
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $46
Insurance broker organization code?3
Insurance broker nameNORTH AMERICA INS OF TULSA
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract numberXB123254
Policy instance 3
Insurance contract or identification numberXB123254
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
Insurance broker nameNORTH AMERICA INS AGENCY INC
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number05909
Policy instance 12
Insurance contract or identification number05909
Number of Individuals Covered110
Total amount of commissions paid to insurance brokerUSD $1,153
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $20,551
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,153
Insurance broker organization code?3
Insurance broker nameHOLMES ORGANISATION INC
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number05909
Policy instance 8
Insurance contract or identification number05909
Number of Individuals Covered221
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $93,651
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number05909
Policy instance 7
Insurance contract or identification number05909
Number of Individuals Covered221
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $22,238
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 )
Policy contract numberCANCER
Policy instance 2
Insurance contract or identification numberCANCER
Number of Individuals Covered18
Total amount of commissions paid to insurance brokerUSD $45
Other welfare benefits providedCANCER
Welfare Benefit Premiums Paid to CarrierUSD $2,798
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract numberXB123254
Policy instance 1
Insurance contract or identification numberXB123254
Number of Individuals Covered29
Total amount of commissions paid to insurance brokerUSD $1,798
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $8,725
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number05909
Policy instance 4
Insurance contract or identification number05909
Number of Individuals Covered221
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $30,901
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number05909
Policy instance 5
Insurance contract or identification number05909
Number of Individuals Covered221
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $36,589
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number05909
Policy instance 6
Insurance contract or identification number05909
Number of Individuals Covered221
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,924
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 number615213
Policy instance 12
Insurance contract or identification number615213
Number of Individuals Covered405
Total amount of commissions paid to insurance brokerUSD $6,248
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $122,097
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number05909
Policy instance 11
Insurance contract or identification number05909
Number of Individuals Covered113
Total amount of commissions paid to insurance brokerUSD $11,689
Total amount of fees paid to insurance companyUSD $81
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $23,242
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number05909
Policy instance 10
Insurance contract or identification number05909
Number of Individuals Covered113
Total amount of commissions paid to insurance brokerUSD $1,729
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $20,010
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number05909
Policy instance 9
Insurance contract or identification number05909
Other welfare benefits providedVOL DEPENDENT LIFE
Welfare Benefit Premiums Paid to CarrierUSD $3,233
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: )
Policy contract numberM8048
Policy instance 3
Insurance contract or identification numberM8048
Number of Individuals Covered189
Total amount of commissions paid to insurance brokerUSD $39,277
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $222,496
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number05909
Policy instance 8
Insurance contract or identification number05909
Other welfare benefits providedVOL DEPENDENT LIFE
Welfare Benefit Premiums Paid to CarrierUSD $3,117
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number05909
Policy instance 7
Insurance contract or identification number05909
Number of Individuals Covered224
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $88,793
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number05909
Policy instance 6
Insurance contract or identification number05909
Number of Individuals Covered224
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $21,439
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number05909
Policy instance 9
Insurance contract or identification number05909
Number of Individuals Covered113
Total amount of commissions paid to insurance brokerUSD $1,635
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $17,431
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number05909
Policy instance 4
Insurance contract or identification number05909
Number of Individuals Covered224
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $35,346
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number05909
Policy instance 3
Insurance contract or identification number05909
Number of Individuals Covered224
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $28,224
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: )
Policy contract numberM8048
Policy instance 2
Insurance contract or identification numberM8048
Number of Individuals Covered196
Total amount of commissions paid to insurance brokerUSD $35,840
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $203,143
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 )
Policy contract numberCANCER
Policy instance 1
Insurance contract or identification numberCANCER
Number of Individuals Covered10
Total amount of commissions paid to insurance brokerUSD $53
Other welfare benefits providedCANCER
Welfare Benefit Premiums Paid to CarrierUSD $3,315
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number05909
Policy instance 10
Insurance contract or identification number05909
Number of Individuals Covered113
Total amount of commissions paid to insurance brokerUSD $10,934
Total amount of fees paid to insurance companyUSD $73
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $20,548
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 number615213
Policy instance 11
Insurance contract or identification number615213
Number of Individuals Covered409
Total amount of commissions paid to insurance brokerUSD $6,000
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $117,733
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number05909
Policy instance 5
Insurance contract or identification number05909
Number of Individuals Covered224
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,783
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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