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GUADALUPE VALLEY TELEPHONE COOPERATIVE, INC. INSURANCE PLAN 401k Plan overview

Plan NameGUADALUPE VALLEY TELEPHONE COOPERATIVE, INC. INSURANCE PLAN
Plan identification number 505

GUADALUPE VALLEY TELEPHONE COOPERATIVE, INC. INSURANCE 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
  • Other welfare benefit cover

401k Sponsoring company profile

GUADALUPE VALLEY TELEPHONE COOPERATIVE, INC. has sponsored the creation of one or more 401k plans.

Company Name:GUADALUPE VALLEY TELEPHONE COOPERATIVE, INC.
Employer identification number (EIN):741194662
NAIC Classification:517000

Additional information about GUADALUPE VALLEY TELEPHONE COOPERATIVE, INC.

Jurisdiction of Incorporation: Texas Secretary of State
Incorporation Date: 1951-09-21
Company Identification Number: 0010800601
Legal Registered Office Address: 36101 FM 3159

NEW BRAUNFELS
United States of America (USA)
78132

More information about GUADALUPE VALLEY TELEPHONE COOPERATIVE, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GUADALUPE VALLEY TELEPHONE COOPERATIVE, INC. INSURANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5052022-01-01MARK GITTER2023-09-05
5052021-01-01
5052020-01-01
5052019-01-01
5052019-01-01
5052018-01-01MARK GITTER
5052018-01-01MARK GITTER2020-01-21
5052017-01-01MARK GITTER
5052017-01-01MARK GITTER2020-01-21
5052016-01-01MARK GITTER
5052016-01-01MARK GITTER2020-01-22
5052016-01-01MARK GITTER2020-01-22
5052015-01-01MARK GITTER
5052015-01-01MARK GITTER
5052015-01-01MARK GITTER2020-01-21
5052015-01-01 MARK GITTER2016-08-12
5052014-01-01MARK GITTER
5052014-01-01MARK GITTER2020-01-21
5052013-01-01MARK GITTER
5052013-01-01MARK GITTER2020-01-21
5052012-01-01MARK GITTER
5052012-01-01MARK GITTER2020-01-21
5052011-01-01MARK GITTER
5052011-01-01MARK GITTER2020-01-21
5052010-01-01MARK GITTER2020-01-21
5052009-01-01MARK GITTER
5052009-01-01MARK GITTER2020-01-21

Plan Statistics for GUADALUPE VALLEY TELEPHONE COOPERATIVE, INC. INSURANCE PLAN

401k plan membership statisitcs for GUADALUPE VALLEY TELEPHONE COOPERATIVE, INC. INSURANCE PLAN

Measure Date Value
2022: GUADALUPE VALLEY TELEPHONE COOPERATIVE, INC. INSURANCE PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01340
Total number of active participants reported on line 7a of the Form 55002022-01-01208
Number of retired or separated participants receiving benefits2022-01-01138
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-01346
2021: GUADALUPE VALLEY TELEPHONE COOPERATIVE, INC. INSURANCE PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01348
Total number of active participants reported on line 7a of the Form 55002021-01-01205
Number of retired or separated participants receiving benefits2021-01-01135
Total of all active and inactive participants2021-01-01340
Total participants2021-01-01340
2020: GUADALUPE VALLEY TELEPHONE COOPERATIVE, INC. INSURANCE PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01349
Total number of active participants reported on line 7a of the Form 55002020-01-01213
Number of retired or separated participants receiving benefits2020-01-01135
Total of all active and inactive participants2020-01-01348
Total participants2020-01-01348
2019: GUADALUPE VALLEY TELEPHONE COOPERATIVE, INC. INSURANCE PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01330
Total number of active participants reported on line 7a of the Form 55002019-01-01209
Number of retired or separated participants receiving benefits2019-01-01140
Total of all active and inactive participants2019-01-01349
Total participants2019-01-01349
Number of participants with account balances2019-01-010
2018: GUADALUPE VALLEY TELEPHONE COOPERATIVE, INC. INSURANCE PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01328
Total number of active participants reported on line 7a of the Form 55002018-01-01195
Number of retired or separated participants receiving benefits2018-01-01135
Total of all active and inactive participants2018-01-01330
Number of other retired or separated participants entitled to future benefits2018-01-010
2017: GUADALUPE VALLEY TELEPHONE COOPERATIVE, INC. INSURANCE PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01334
Total number of active participants reported on line 7a of the Form 55002017-01-01195
Number of retired or separated participants receiving benefits2017-01-01133
Total of all active and inactive participants2017-01-01328
Number of other retired or separated participants entitled to future benefits2017-01-010
2016: GUADALUPE VALLEY TELEPHONE COOPERATIVE, INC. INSURANCE PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01320
Total number of active participants reported on line 7a of the Form 55002016-01-01205
Number of retired or separated participants receiving benefits2016-01-01129
Total of all active and inactive participants2016-01-01334
2015: GUADALUPE VALLEY TELEPHONE COOPERATIVE, INC. INSURANCE PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01316
Total number of active participants reported on line 7a of the Form 55002015-01-01195
Number of retired or separated participants receiving benefits2015-01-01125
Number of other retired or separated participants entitled to future benefits2015-01-010
Total of all active and inactive participants2015-01-01320
2014: GUADALUPE VALLEY TELEPHONE COOPERATIVE, INC. INSURANCE PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01314
Total number of active participants reported on line 7a of the Form 55002014-01-01199
Number of retired or separated participants receiving benefits2014-01-01117
Number of other retired or separated participants entitled to future benefits2014-01-010
Total of all active and inactive participants2014-01-01316
2013: GUADALUPE VALLEY TELEPHONE COOPERATIVE, INC. INSURANCE PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01304
Total number of active participants reported on line 7a of the Form 55002013-01-01230
Number of retired or separated participants receiving benefits2013-01-0184
Number of other retired or separated participants entitled to future benefits2013-01-010
Total of all active and inactive participants2013-01-01314
2012: GUADALUPE VALLEY TELEPHONE COOPERATIVE, INC. INSURANCE PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01280
Total number of active participants reported on line 7a of the Form 55002012-01-01228
Number of retired or separated participants receiving benefits2012-01-0176
Number of other retired or separated participants entitled to future benefits2012-01-010
Total of all active and inactive participants2012-01-01304
2011: GUADALUPE VALLEY TELEPHONE COOPERATIVE, INC. INSURANCE PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01282
Total number of active participants reported on line 7a of the Form 55002011-01-01206
Number of retired or separated participants receiving benefits2011-01-0174
Total of all active and inactive participants2011-01-01280
Number of other retired or separated participants entitled to future benefits2011-01-010
2010: GUADALUPE VALLEY TELEPHONE COOPERATIVE, INC. INSURANCE PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-01284
Total number of active participants reported on line 7a of the Form 55002010-01-01219
Number of retired or separated participants receiving benefits2010-01-0166
Number of other retired or separated participants entitled to future benefits2010-01-010
Total of all active and inactive participants2010-01-01285
2009: GUADALUPE VALLEY TELEPHONE COOPERATIVE, INC. INSURANCE PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01284
Total number of active participants reported on line 7a of the Form 55002009-01-01219
Number of retired or separated participants receiving benefits2009-01-0166
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-01285

Financial Data on GUADALUPE VALLEY TELEPHONE COOPERATIVE, INC. INSURANCE PLAN

Measure Date Value
2022 : GUADALUPE VALLEY TELEPHONE COOPERATIVE, INC. INSURANCE PLAN 2022 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2022-12-31$-403,244
Total unrealized appreciation/depreciation of assets2022-12-31$-403,244
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$849,088
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$740,190
Total income from all sources (including contributions)2022-12-31$1,805,607
Total loss/gain on sale of assets2022-12-31$178,973
Total of all expenses incurred2022-12-31$4,450,853
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$4,176,816
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$3,535,490
Value of total assets at end of year2022-12-31$11,592,548
Value of total assets at beginning of year2022-12-31$14,128,896
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$274,037
Total interest from all sources2022-12-31$50,549
Total dividends received (eg from common stock, registered investment company shares)2022-12-31$157,670
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2022-12-31$142,408
Administrative expenses professional fees incurred2022-12-31$66,971
Was this plan covered by a fidelity bond2022-12-31Yes
Value of fidelity bond cover2022-12-31$500,000
If this is an individual account plan, was there a blackout period2022-12-31No
Were there any nonexempt tranactions with any party-in-interest2022-12-31No
Contributions received from participants2022-12-31$720,256
Assets. Other investments not covered elsewhere at end of year2022-12-31$513,656
Assets. Other investments not covered elsewhere at beginning of year2022-12-31$485,586
Value of other receiveables (less allowance for doubtful accounts) at end of year2022-12-31$57,415
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2022-12-31$465,243
Administrative expenses (other) incurred2022-12-31$1,829
Liabilities. Value of operating payables at end of year2022-12-31$449,088
Liabilities. Value of operating payables at beginning of year2022-12-31$430,190
Total non interest bearing cash at end of year2022-12-31$2,711,218
Total non interest bearing cash at beginning of year2022-12-31$2,663,383
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Value of net income/loss2022-12-31$-2,645,246
Value of net assets at end of year (total assets less liabilities)2022-12-31$10,743,460
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$13,388,706
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2022-12-31No
Were any leases to which the plan was party in default or uncollectible2022-12-31No
Investment advisory and management fees2022-12-31$41,548
Value of interest in registered invesment companies (eg mutual funds) at end of year2022-12-31$5,277,401
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2022-12-31$6,532,129
Value of interest in pooled separate accounts at end of year2022-12-31$0
Value of interest in pooled separate accounts at beginning of year2022-12-31$0
Interest earned on other investments2022-12-31$15,101
Income. Interest from US Government securities2022-12-31$13,708
Income. Interest from corporate debt instruments2022-12-31$21,732
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2022-12-31$75,241
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2022-12-31$238,278
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2022-12-31$238,278
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2022-12-31$8
Expenses. Payments to insurance carriers foe the provision of benefits2022-12-31$775,481
Asset value of US Government securities at end of year2022-12-31$977,803
Asset value of US Government securities at beginning of year2022-12-31$1,291,398
Net investment gain/loss from registered investment companies (e.g. mutual funds)2022-12-31$-1,713,831
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-12-31No
Was there a failure to transmit to the plan any participant contributions2022-12-31No
Has the plan failed to provide any benefit when due under the plan2022-12-31No
Contributions received in cash from employer2022-12-31$2,815,234
Income. Dividends from common stock2022-12-31$15,262
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$3,401,335
Asset. Corporate debt instrument debt (other) at end of year2022-12-31$591,704
Asset. Corporate debt instrument debt (other) at beginning of year2022-12-31$804,157
Contract administrator fees2022-12-31$163,689
Assets. Corporate common stocks other than exployer securities at end of year2022-12-31$1,388,110
Assets. Corporate common stocks other than exployer securities at beginning of year2022-12-31$1,648,722
Liabilities. Value of benefit claims payable at end of year2022-12-31$400,000
Liabilities. Value of benefit claims payable at beginning of year2022-12-31$310,000
Did the plan have assets held for investment2022-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-12-31No
Aggregate proceeds on sale of assets2022-12-31$5,956,597
Aggregate carrying amount (costs) on sale of assets2022-12-31$5,777,624
Opinion of an independent qualified public accountant for this plan2022-12-31Unqualified
Accountancy firm name2022-12-31HEARD, MCELROY & VESTAL LLC
Accountancy firm EIN2022-12-31720398470
2021 : GUADALUPE VALLEY TELEPHONE COOPERATIVE, INC. INSURANCE PLAN 2021 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2021-12-31$-71,047
Total unrealized appreciation/depreciation of assets2021-12-31$-71,047
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$740,190
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$251,750
Total income from all sources (including contributions)2021-12-31$4,819,993
Total loss/gain on sale of assets2021-12-31$536,833
Total of all expenses incurred2021-12-31$3,925,335
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$3,583,976
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$3,560,284
Value of total assets at end of year2021-12-31$14,128,896
Value of total assets at beginning of year2021-12-31$12,745,798
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$341,359
Total interest from all sources2021-12-31$51,612
Total dividends received (eg from common stock, registered investment company shares)2021-12-31$420,332
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2021-12-31$398,402
Administrative expenses professional fees incurred2021-12-31$79,650
Was this plan covered by a fidelity bond2021-12-31Yes
Value of fidelity bond cover2021-12-31$500,000
If this is an individual account plan, was there a blackout period2021-12-31No
Were there any nonexempt tranactions with any party-in-interest2021-12-31No
Contributions received from participants2021-12-31$739,067
Assets. Other investments not covered elsewhere at end of year2021-12-31$485,586
Assets. Other investments not covered elsewhere at beginning of year2021-12-31$531,696
Value of other receiveables (less allowance for doubtful accounts) at end of year2021-12-31$465,243
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2021-12-31$99,484
Administrative expenses (other) incurred2021-12-31$1,713
Liabilities. Value of operating payables at end of year2021-12-31$430,190
Liabilities. Value of operating payables at beginning of year2021-12-31$1,750
Total non interest bearing cash at end of year2021-12-31$2,663,383
Total non interest bearing cash at beginning of year2021-12-31$2,422,143
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Value of net income/loss2021-12-31$894,658
Value of net assets at end of year (total assets less liabilities)2021-12-31$13,388,706
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$12,494,048
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-12-31No
Were any leases to which the plan was party in default or uncollectible2021-12-31No
Investment advisory and management fees2021-12-31$45,120
Value of interest in registered invesment companies (eg mutual funds) at end of year2021-12-31$6,532,129
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2021-12-31$6,045,194
Value of interest in pooled separate accounts at end of year2021-12-31$0
Interest earned on other investments2021-12-31$10,601
Income. Interest from US Government securities2021-12-31$12,438
Income. Interest from corporate debt instruments2021-12-31$28,561
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2021-12-31$238,278
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2021-12-31$214,071
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2021-12-31$214,071
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2021-12-31$12
Expenses. Payments to insurance carriers foe the provision of benefits2021-12-31$737,707
Asset value of US Government securities at end of year2021-12-31$1,291,398
Asset value of US Government securities at beginning of year2021-12-31$1,285,545
Net investment gain/loss from registered investment companies (e.g. mutual funds)2021-12-31$321,979
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-12-31No
Was there a failure to transmit to the plan any participant contributions2021-12-31No
Has the plan failed to provide any benefit when due under the plan2021-12-31No
Contributions received in cash from employer2021-12-31$2,821,217
Income. Dividends from common stock2021-12-31$21,930
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$2,846,269
Asset. Corporate debt instrument debt (other) at end of year2021-12-31$804,157
Asset. Corporate debt instrument debt (other) at beginning of year2021-12-31$622,679
Contract administrator fees2021-12-31$214,876
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32021-12-31No
Assets. Corporate common stocks other than exployer securities at end of year2021-12-31$1,648,722
Assets. Corporate common stocks other than exployer securities at beginning of year2021-12-31$1,524,986
Liabilities. Value of benefit claims payable at end of year2021-12-31$310,000
Liabilities. Value of benefit claims payable at beginning of year2021-12-31$250,000
Did the plan have assets held for investment2021-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-12-31No
Aggregate proceeds on sale of assets2021-12-31$8,364,888
Aggregate carrying amount (costs) on sale of assets2021-12-31$7,828,055
Opinion of an independent qualified public accountant for this plan2021-12-31Unqualified
Accountancy firm name2021-12-31CURTIS BLAKELY AND CO., PC
Accountancy firm EIN2021-12-31751545734
2020 : GUADALUPE VALLEY TELEPHONE COOPERATIVE, INC. INSURANCE PLAN 2020 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2020-12-31$219,701
Total unrealized appreciation/depreciation of assets2020-12-31$219,701
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$251,750
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$715,710
Total income from all sources (including contributions)2020-12-31$5,999,266
Total loss/gain on sale of assets2020-12-31$198,134
Total of all expenses incurred2020-12-31$4,286,686
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$4,015,808
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$4,786,322
Value of total assets at end of year2020-12-31$12,745,798
Value of total assets at beginning of year2020-12-31$11,497,178
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$270,878
Total interest from all sources2020-12-31$50,077
Total dividends received (eg from common stock, registered investment company shares)2020-12-31$224,540
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2020-12-31$203,860
Administrative expenses professional fees incurred2020-12-31$22,966
Was this plan covered by a fidelity bond2020-12-31Yes
Value of fidelity bond cover2020-12-31$500,000
If this is an individual account plan, was there a blackout period2020-12-31No
Were there any nonexempt tranactions with any party-in-interest2020-12-31No
Contributions received from participants2020-12-31$701,666
Assets. Other investments not covered elsewhere at end of year2020-12-31$531,696
Assets. Other investments not covered elsewhere at beginning of year2020-12-31$656,955
Value of other receiveables (less allowance for doubtful accounts) at end of year2020-12-31$99,484
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2020-12-31$213,111
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2020-12-31$245,710
Administrative expenses (other) incurred2020-12-31$1,622
Liabilities. Value of operating payables at end of year2020-12-31$1,750
Total non interest bearing cash at end of year2020-12-31$2,422,143
Total non interest bearing cash at beginning of year2020-12-31$1,979,356
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Value of net income/loss2020-12-31$1,712,580
Value of net assets at end of year (total assets less liabilities)2020-12-31$12,494,048
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$10,781,468
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-12-31No
Were any leases to which the plan was party in default or uncollectible2020-12-31No
Investment advisory and management fees2020-12-31$37,093
Value of interest in registered invesment companies (eg mutual funds) at end of year2020-12-31$6,045,194
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2020-12-31$5,343,888
Value of interest in pooled separate accounts at end of year2020-12-31$0
Interest earned on other investments2020-12-31$16,162
Income. Interest from US Government securities2020-12-31$12,432
Income. Interest from corporate debt instruments2020-12-31$21,469
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2020-12-31$214,071
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2020-12-31$521,826
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2020-12-31$521,826
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2020-12-31$14
Expenses. Payments to insurance carriers foe the provision of benefits2020-12-31$740,750
Asset value of US Government securities at end of year2020-12-31$1,285,545
Asset value of US Government securities at beginning of year2020-12-31$870,630
Net investment gain/loss from registered investment companies (e.g. mutual funds)2020-12-31$520,492
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-12-31No
Was there a failure to transmit to the plan any participant contributions2020-12-31No
Has the plan failed to provide any benefit when due under the plan2020-12-31No
Contributions received in cash from employer2020-12-31$4,084,656
Income. Dividends from common stock2020-12-31$20,680
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-12-31$3,275,058
Asset. Corporate debt instrument debt (other) at end of year2020-12-31$622,679
Asset. Corporate debt instrument debt (other) at beginning of year2020-12-31$599,173
Contract administrator fees2020-12-31$209,197
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32020-12-31No
Assets. Corporate common stocks other than exployer securities at end of year2020-12-31$1,524,986
Assets. Corporate common stocks other than exployer securities at beginning of year2020-12-31$1,312,239
Liabilities. Value of benefit claims payable at end of year2020-12-31$250,000
Liabilities. Value of benefit claims payable at beginning of year2020-12-31$470,000
Did the plan have assets held for investment2020-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-12-31No
Aggregate proceeds on sale of assets2020-12-31$6,422,142
Aggregate carrying amount (costs) on sale of assets2020-12-31$6,224,008
Opinion of an independent qualified public accountant for this plan2020-12-31Unqualified
Accountancy firm name2020-12-31CURTIS BLAKELY AND CO., PC
Accountancy firm EIN2020-12-31751545734
2019 : GUADALUPE VALLEY TELEPHONE COOPERATIVE, INC. INSURANCE PLAN 2019 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2019-12-31$277,288
Total unrealized appreciation/depreciation of assets2019-12-31$277,288
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$715,710
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$301,150
Total income from all sources (including contributions)2019-12-31$6,336,520
Total loss/gain on sale of assets2019-12-31$330,717
Total of all expenses incurred2019-12-31$4,971,095
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$4,710,358
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$4,832,149
Value of total assets at end of year2019-12-31$11,497,178
Value of total assets at beginning of year2019-12-31$9,717,193
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$260,737
Total interest from all sources2019-12-31$53,680
Total dividends received (eg from common stock, registered investment company shares)2019-12-31$328,274
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2019-12-31$315,318
Administrative expenses professional fees incurred2019-12-31$37,856
Was this plan covered by a fidelity bond2019-12-31Yes
Value of fidelity bond cover2019-12-31$500,000
If this is an individual account plan, was there a blackout period2019-12-31No
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Contributions received from participants2019-12-31$711,367
Assets. Other investments not covered elsewhere at end of year2019-12-31$656,955
Assets. Other investments not covered elsewhere at beginning of year2019-12-31$583,419
Value of other receiveables (less allowance for doubtful accounts) at end of year2019-12-31$213,111
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2019-12-31$182,309
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2019-12-31$245,710
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2019-12-31$1,150
Administrative expenses (other) incurred2019-12-31$1,386
Total non interest bearing cash at end of year2019-12-31$1,979,356
Total non interest bearing cash at beginning of year2019-12-31$1,943,321
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Value of net income/loss2019-12-31$1,365,425
Value of net assets at end of year (total assets less liabilities)2019-12-31$10,781,468
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$9,416,043
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Investment advisory and management fees2019-12-31$36,132
Value of interest in registered invesment companies (eg mutual funds) at end of year2019-12-31$5,343,888
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2019-12-31$4,455,229
Value of interest in pooled separate accounts at end of year2019-12-31$0
Income. Interest from loans (other than to participants)2019-12-31$18,716
Income. Interest from US Government securities2019-12-31$15,002
Income. Interest from corporate debt instruments2019-12-31$19,808
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2019-12-31$521,826
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2019-12-31$259,397
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2019-12-31$259,397
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2019-12-31$154
Expenses. Payments to insurance carriers foe the provision of benefits2019-12-31$760,251
Asset value of US Government securities at end of year2019-12-31$870,630
Asset value of US Government securities at beginning of year2019-12-31$659,307
Net investment gain/loss from registered investment companies (e.g. mutual funds)2019-12-31$514,412
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-12-31No
Was there a failure to transmit to the plan any participant contributions2019-12-31No
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Contributions received in cash from employer2019-12-31$4,120,782
Income. Dividends from common stock2019-12-31$12,956
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$3,950,107
Asset. Corporate debt instrument debt (other) at end of year2019-12-31$599,173
Asset. Corporate debt instrument debt (other) at beginning of year2019-12-31$544,154
Contract administrator fees2019-12-31$185,363
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32019-12-31No
Assets. Corporate common stocks other than exployer securities at end of year2019-12-31$1,312,239
Assets. Corporate common stocks other than exployer securities at beginning of year2019-12-31$1,090,057
Liabilities. Value of benefit claims payable at end of year2019-12-31$470,000
Liabilities. Value of benefit claims payable at beginning of year2019-12-31$300,000
Did the plan have assets held for investment2019-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
Aggregate proceeds on sale of assets2019-12-31$5,440,086
Aggregate carrying amount (costs) on sale of assets2019-12-31$5,109,369
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31No
Opinion of an independent qualified public accountant for this plan2019-12-31Unqualified
Accountancy firm name2019-12-31CURTIS BLAKELY AND CO., PC
Accountancy firm EIN2019-12-31751545734
2018 : GUADALUPE VALLEY TELEPHONE COOPERATIVE, INC. INSURANCE PLAN 2018 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2018-12-31$-1,139,305
Total unrealized appreciation/depreciation of assets2018-12-31$-1,139,305
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$301,150
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$400,000
Total income from all sources (including contributions)2018-12-31$3,616,669
Total loss/gain on sale of assets2018-12-31$280,223
Total of all expenses incurred2018-12-31$4,508,270
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-12-31$4,301,647
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-12-31$4,177,428
Value of total assets at end of year2018-12-31$9,717,193
Value of total assets at beginning of year2018-12-31$10,707,644
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-12-31$206,623
Total interest from all sources2018-12-31$43,952
Total dividends received (eg from common stock, registered investment company shares)2018-12-31$533,123
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2018-12-31$525,593
Administrative expenses professional fees incurred2018-12-31$22,290
Was this plan covered by a fidelity bond2018-12-31Yes
Value of fidelity bond cover2018-12-31$500,000
Were there any nonexempt tranactions with any party-in-interest2018-12-31No
Contributions received from participants2018-12-31$742,523
Assets. Other investments not covered elsewhere at end of year2018-12-31$583,419
Assets. Other investments not covered elsewhere at beginning of year2018-12-31$434,916
Value of other receiveables (less allowance for doubtful accounts) at end of year2018-12-31$182,309
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2018-12-31$19,487
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2018-12-31$1,150
Administrative expenses (other) incurred2018-12-31$1,585
Total non interest bearing cash at end of year2018-12-31$1,943,321
Total non interest bearing cash at beginning of year2018-12-31$2,509,903
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Value of net income/loss2018-12-31$-891,601
Value of net assets at end of year (total assets less liabilities)2018-12-31$9,416,043
Value of net assets at beginning of year (total assets less liabilities)2018-12-31$10,307,644
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2018-12-31No
Were any leases to which the plan was party in default or uncollectible2018-12-31No
Investment advisory and management fees2018-12-31$35,443
Value of interest in registered invesment companies (eg mutual funds) at end of year2018-12-31$4,455,229
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2018-12-31$4,882,766
Interest earned on other investments2018-12-31$5,153
Income. Interest from US Government securities2018-12-31$18,513
Income. Interest from corporate debt instruments2018-12-31$19,973
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2018-12-31$259,397
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2018-12-31$533,286
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2018-12-31$533,286
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2018-12-31$313
Expenses. Payments to insurance carriers foe the provision of benefits2018-12-31$884,724
Asset value of US Government securities at end of year2018-12-31$659,307
Asset value of US Government securities at beginning of year2018-12-31$633,390
Net investment gain/loss from registered investment companies (e.g. mutual funds)2018-12-31$-278,752
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-12-31Yes
Was there a failure to transmit to the plan any participant contributions2018-12-31No
Has the plan failed to provide any benefit when due under the plan2018-12-31No
Contributions received in cash from employer2018-12-31$3,434,905
Income. Dividends from common stock2018-12-31$7,530
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-12-31$3,416,923
Asset. Corporate debt instrument preferred debt at beginning of year2018-12-31$605,686
Asset. Corporate debt instrument debt (other) at end of year2018-12-31$544,154
Contract administrator fees2018-12-31$147,305
Assets. Corporate common stocks other than exployer securities at end of year2018-12-31$1,090,057
Assets. Corporate common stocks other than exployer securities at beginning of year2018-12-31$1,088,210
Liabilities. Value of benefit claims payable at end of year2018-12-31$300,000
Liabilities. Value of benefit claims payable at beginning of year2018-12-31$400,000
Did the plan have assets held for investment2018-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-12-31No
Aggregate proceeds on sale of assets2018-12-31$6,300,789
Aggregate carrying amount (costs) on sale of assets2018-12-31$6,020,566
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-12-31No
Opinion of an independent qualified public accountant for this plan2018-12-31Unqualified
Accountancy firm name2018-12-31CURTIS BLAKELY AND CO., PC
Accountancy firm EIN2018-12-31751545734
2017 : GUADALUPE VALLEY TELEPHONE COOPERATIVE, INC. INSURANCE PLAN 2017 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2017-12-31$-30,025
Total unrealized appreciation/depreciation of assets2017-12-31$-30,025
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$400,000
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$360,000
Total income from all sources (including contributions)2017-12-31$5,707,683
Total loss/gain on sale of assets2017-12-31$128,573
Total of all expenses incurred2017-12-31$4,695,361
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-12-31$4,453,502
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-12-31$4,807,907
Value of total assets at end of year2017-12-31$10,707,644
Value of total assets at beginning of year2017-12-31$9,655,322
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-12-31$241,859
Total interest from all sources2017-12-31$38,939
Total dividends received (eg from common stock, registered investment company shares)2017-12-31$548,328
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-12-31No
Administrative expenses professional fees incurred2017-12-31$40,625
Was this plan covered by a fidelity bond2017-12-31Yes
Value of fidelity bond cover2017-12-31$500,000
Were there any nonexempt tranactions with any party-in-interest2017-12-31No
Contributions received from participants2017-12-31$745,175
Assets. Other investments not covered elsewhere at end of year2017-12-31$434,916
Value of other receiveables (less allowance for doubtful accounts) at end of year2017-12-31$19,487
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2017-12-31$38,323
Administrative expenses (other) incurred2017-12-31$1,666
Total non interest bearing cash at end of year2017-12-31$2,509,903
Total non interest bearing cash at beginning of year2017-12-31$2,693,999
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Value of net income/loss2017-12-31$1,012,322
Value of net assets at end of year (total assets less liabilities)2017-12-31$10,307,644
Value of net assets at beginning of year (total assets less liabilities)2017-12-31$9,295,322
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2017-12-31No
Were any leases to which the plan was party in default or uncollectible2017-12-31No
Investment advisory and management fees2017-12-31$34,204
Value of interest in registered invesment companies (eg mutual funds) at end of year2017-12-31$4,882,766
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2017-12-31$4,184,690
Interest earned on other investments2017-12-31$1,457
Income. Interest from US Government securities2017-12-31$8,373
Income. Interest from corporate debt instruments2017-12-31$29,101
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2017-12-31$533,286
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2017-12-31$45,747
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2017-12-31$45,747
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2017-12-31$8
Expenses. Payments to insurance carriers foe the provision of benefits2017-12-31$809,160
Asset value of US Government securities at end of year2017-12-31$633,390
Asset value of US Government securities at beginning of year2017-12-31$646,864
Net investment gain/loss from registered investment companies (e.g. mutual funds)2017-12-31$213,961
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-12-31Yes
Was there a failure to transmit to the plan any participant contributions2017-12-31No
Has the plan failed to provide any benefit when due under the plan2017-12-31No
Contributions received in cash from employer2017-12-31$4,062,732
Income. Dividends from preferred stock2017-12-31$20,846
Income. Dividends from common stock2017-12-31$527,482
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-12-31$3,644,342
Asset. Corporate debt instrument preferred debt at end of year2017-12-31$605,686
Asset. Corporate debt instrument preferred debt at beginning of year2017-12-31$1,022,934
Contract administrator fees2017-12-31$165,364
Assets. Corporate common stocks other than exployer securities at end of year2017-12-31$1,088,210
Assets. Corporate common stocks other than exployer securities at beginning of year2017-12-31$1,022,765
Liabilities. Value of benefit claims payable at end of year2017-12-31$400,000
Liabilities. Value of benefit claims payable at beginning of year2017-12-31$360,000
Did the plan have assets held for investment2017-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-12-31No
Aggregate proceeds on sale of assets2017-12-31$3,217,809
Aggregate carrying amount (costs) on sale of assets2017-12-31$3,089,236
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-12-31No
Opinion of an independent qualified public accountant for this plan2017-12-31Unqualified
Accountancy firm name2017-12-31CURTIS BLAKELY AND CO., INC.
Accountancy firm EIN2017-12-31751545734
2016 : GUADALUPE VALLEY TELEPHONE COOPERATIVE, INC. INSURANCE PLAN 2016 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2016-12-31$-42,947
Total unrealized appreciation/depreciation of assets2016-12-31$-42,947
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$360,000
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$370,000
Total income from all sources (including contributions)2016-12-31$6,076,296
Total loss/gain on sale of assets2016-12-31$151,460
Total of all expenses incurred2016-12-31$4,921,741
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-12-31$4,679,481
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-12-31$5,854,053
Value of total assets at end of year2016-12-31$9,655,322
Value of total assets at beginning of year2016-12-31$8,510,767
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-12-31$242,260
Total interest from all sources2016-12-31$48,868
Total dividends received (eg from common stock, registered investment company shares)2016-12-31$122,343
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2016-12-31$109,300
Administrative expenses professional fees incurred2016-12-31$42,896
Was this plan covered by a fidelity bond2016-12-31Yes
Value of fidelity bond cover2016-12-31$500,000
Were there any nonexempt tranactions with any party-in-interest2016-12-31No
Contributions received from participants2016-12-31$684,217
Value of other receiveables (less allowance for doubtful accounts) at end of year2016-12-31$38,323
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2016-12-31$211,959
Administrative expenses (other) incurred2016-12-31$1,601
Total non interest bearing cash at end of year2016-12-31$2,693,999
Total non interest bearing cash at beginning of year2016-12-31$1,127,411
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Value of net income/loss2016-12-31$1,154,555
Value of net assets at end of year (total assets less liabilities)2016-12-31$9,295,322
Value of net assets at beginning of year (total assets less liabilities)2016-12-31$8,140,767
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2016-12-31No
Were any leases to which the plan was party in default or uncollectible2016-12-31No
Investment advisory and management fees2016-12-31$32,269
Value of interest in registered invesment companies (eg mutual funds) at end of year2016-12-31$4,184,690
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2016-12-31$3,234,987
Interest earned on other investments2016-12-31$1,658
Income. Interest from US Government securities2016-12-31$10,779
Income. Interest from corporate debt instruments2016-12-31$36,426
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2016-12-31$45,747
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2016-12-31$538,360
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2016-12-31$538,360
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2016-12-31$5
Expenses. Payments to insurance carriers foe the provision of benefits2016-12-31$771,314
Asset value of US Government securities at end of year2016-12-31$646,864
Asset value of US Government securities at beginning of year2016-12-31$1,235,565
Net investment gain/loss from registered investment companies (e.g. mutual funds)2016-12-31$-57,481
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-12-31No
Was there a failure to transmit to the plan any participant contributions2016-12-31No
Has the plan failed to provide any benefit when due under the plan2016-12-31No
Contributions received in cash from employer2016-12-31$5,169,836
Income. Dividends from common stock2016-12-31$13,043
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-12-31$3,908,167
Asset. Corporate debt instrument preferred debt at end of year2016-12-31$1,022,934
Asset. Corporate debt instrument preferred debt at beginning of year2016-12-31$1,493,500
Contract administrator fees2016-12-31$165,494
Assets. Corporate common stocks other than exployer securities at end of year2016-12-31$1,022,765
Assets. Corporate common stocks other than exployer securities at beginning of year2016-12-31$668,985
Liabilities. Value of benefit claims payable at end of year2016-12-31$360,000
Liabilities. Value of benefit claims payable at beginning of year2016-12-31$370,000
Did the plan have assets held for investment2016-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-12-31No
Aggregate proceeds on sale of assets2016-12-31$4,239,887
Aggregate carrying amount (costs) on sale of assets2016-12-31$4,088,427
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-12-31No
Opinion of an independent qualified public accountant for this plan2016-12-31Unqualified
Accountancy firm name2016-12-31CURTIS BLAKELY AND CO., INC.
Accountancy firm EIN2016-12-31751545734
2015 : GUADALUPE VALLEY TELEPHONE COOPERATIVE, INC. INSURANCE PLAN 2015 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2015-12-31$-812,296
Total unrealized appreciation/depreciation of assets2015-12-31$-812,296
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$370,000
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$496,782
Total income from all sources (including contributions)2015-12-31$4,732,874
Total loss/gain on sale of assets2015-12-31$319,561
Total of all expenses incurred2015-12-31$5,280,057
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-12-31$5,050,993
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-12-31$4,921,126
Value of total assets at end of year2015-12-31$8,510,767
Value of total assets at beginning of year2015-12-31$9,184,732
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-12-31$229,064
Total interest from all sources2015-12-31$64,963
Total dividends received (eg from common stock, registered investment company shares)2015-12-31$239,520
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2015-12-31$224,007
Administrative expenses professional fees incurred2015-12-31$38,029
Was this plan covered by a fidelity bond2015-12-31Yes
Value of fidelity bond cover2015-12-31$500,000
Were there any nonexempt tranactions with any party-in-interest2015-12-31No
Contributions received from participants2015-12-31$541,066
Value of other receiveables (less allowance for doubtful accounts) at end of year2015-12-31$211,959
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2015-12-31$131,742
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2015-12-31$76,782
Administrative expenses (other) incurred2015-12-31$20,028
Total non interest bearing cash at end of year2015-12-31$1,127,411
Total non interest bearing cash at beginning of year2015-12-31$1,181,183
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Value of net income/loss2015-12-31$-547,183
Value of net assets at end of year (total assets less liabilities)2015-12-31$8,140,767
Value of net assets at beginning of year (total assets less liabilities)2015-12-31$8,687,950
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2015-12-31No
Were any leases to which the plan was party in default or uncollectible2015-12-31No
Investment advisory and management fees2015-12-31$32,065
Value of interest in registered invesment companies (eg mutual funds) at end of year2015-12-31$3,234,987
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2015-12-31$3,531,162
Income. Interest from US Government securities2015-12-31$13,243
Income. Interest from corporate debt instruments2015-12-31$51,679
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2015-12-31$538,360
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2015-12-31$701,487
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2015-12-31$701,487
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2015-12-31$41
Expenses. Payments to insurance carriers foe the provision of benefits2015-12-31$682,082
Asset value of US Government securities at end of year2015-12-31$1,235,565
Asset value of US Government securities at beginning of year2015-12-31$1,042,578
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-12-31No
Was there a failure to transmit to the plan any participant contributions2015-12-31No
Has the plan failed to provide any benefit when due under the plan2015-12-31No
Contributions received in cash from employer2015-12-31$4,380,060
Income. Dividends from common stock2015-12-31$15,513
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-12-31$4,368,911
Asset. Corporate debt instrument preferred debt at end of year2015-12-31$1,493,500
Asset. Corporate debt instrument preferred debt at beginning of year2015-12-31$1,986,758
Contract administrator fees2015-12-31$138,942
Assets. Corporate common stocks other than exployer securities at end of year2015-12-31$668,985
Assets. Corporate common stocks other than exployer securities at beginning of year2015-12-31$609,822
Liabilities. Value of benefit claims payable at end of year2015-12-31$370,000
Liabilities. Value of benefit claims payable at beginning of year2015-12-31$420,000
Did the plan have assets held for investment2015-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-12-31No
Aggregate proceeds on sale of assets2015-12-31$5,328,228
Aggregate carrying amount (costs) on sale of assets2015-12-31$5,008,667
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-12-31No
Opinion of an independent qualified public accountant for this plan2015-12-31Unqualified
Accountancy firm name2015-12-31CURTIS, BLAKELY AND CO., INC.
Accountancy firm EIN2015-12-31751545734
2014 : GUADALUPE VALLEY TELEPHONE COOPERATIVE, INC. INSURANCE PLAN 2014 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2014-12-31$34,844
Total unrealized appreciation/depreciation of assets2014-12-31$34,844
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$496,782
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$275,000
Total income from all sources (including contributions)2014-12-31$4,405,205
Total loss/gain on sale of assets2014-12-31$28,259
Total of all expenses incurred2014-12-31$4,729,110
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-12-31$4,483,074
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-12-31$4,127,828
Value of total assets at end of year2014-12-31$9,184,732
Value of total assets at beginning of year2014-12-31$9,286,855
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-12-31$246,036
Total interest from all sources2014-12-31$66,867
Total dividends received (eg from common stock, registered investment company shares)2014-12-31$147,407
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2014-12-31$139,855
Administrative expenses professional fees incurred2014-12-31$49,249
Was this plan covered by a fidelity bond2014-12-31Yes
Value of fidelity bond cover2014-12-31$500,000
Were there any nonexempt tranactions with any party-in-interest2014-12-31No
Contributions received from participants2014-12-31$616,075
Value of other receiveables (less allowance for doubtful accounts) at end of year2014-12-31$131,742
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2014-12-31$291,202
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2014-12-31$76,782
Administrative expenses (other) incurred2014-12-31$28,337
Total non interest bearing cash at end of year2014-12-31$1,181,183
Total non interest bearing cash at beginning of year2014-12-31$1,444,129
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Value of net income/loss2014-12-31$-323,905
Value of net assets at end of year (total assets less liabilities)2014-12-31$8,687,950
Value of net assets at beginning of year (total assets less liabilities)2014-12-31$9,011,855
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2014-12-31No
Were any leases to which the plan was party in default or uncollectible2014-12-31No
Investment advisory and management fees2014-12-31$32,785
Value of interest in registered invesment companies (eg mutual funds) at end of year2014-12-31$3,531,162
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2014-12-31$3,359,578
Income. Interest from US Government securities2014-12-31$11,596
Income. Interest from corporate debt instruments2014-12-31$55,227
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2014-12-31$701,487
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2014-12-31$705,943
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2014-12-31$705,943
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2014-12-31$44
Expenses. Payments to insurance carriers foe the provision of benefits2014-12-31$824,551
Asset value of US Government securities at end of year2014-12-31$1,042,578
Asset value of US Government securities at beginning of year2014-12-31$968,819
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-12-31No
Was there a failure to transmit to the plan any participant contributions2014-12-31No
Has the plan failed to provide any benefit when due under the plan2014-12-31No
Contributions received in cash from employer2014-12-31$3,511,753
Income. Dividends from common stock2014-12-31$7,552
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-12-31$3,658,523
Asset. Corporate debt instrument preferred debt at end of year2014-12-31$1,986,758
Asset. Corporate debt instrument preferred debt at beginning of year2014-12-31$1,885,781
Contract administrator fees2014-12-31$135,665
Assets. Corporate common stocks other than exployer securities at end of year2014-12-31$609,822
Assets. Corporate common stocks other than exployer securities at beginning of year2014-12-31$631,403
Liabilities. Value of benefit claims payable at end of year2014-12-31$420,000
Liabilities. Value of benefit claims payable at beginning of year2014-12-31$275,000
Did the plan have assets held for investment2014-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-12-31No
Aggregate proceeds on sale of assets2014-12-31$3,198,028
Aggregate carrying amount (costs) on sale of assets2014-12-31$3,169,769
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-12-31No
Opinion of an independent qualified public accountant for this plan2014-12-31Unqualified
Accountancy firm name2014-12-31CURTIS, BLAKELY AND CO., INC.
Accountancy firm EIN2014-12-31751545734
2013 : GUADALUPE VALLEY TELEPHONE COOPERATIVE, INC. INSURANCE PLAN 2013 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2013-12-31$724,340
Total unrealized appreciation/depreciation of assets2013-12-31$724,340
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$275,000
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$295,797
Total income from all sources (including contributions)2013-12-31$4,564,014
Total loss/gain on sale of assets2013-12-31$99,273
Total of all expenses incurred2013-12-31$4,717,326
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-12-31$4,506,869
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-12-31$3,597,974
Value of total assets at end of year2013-12-31$9,286,855
Value of total assets at beginning of year2013-12-31$9,460,964
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-12-31$210,457
Total interest from all sources2013-12-31$62,442
Total dividends received (eg from common stock, registered investment company shares)2013-12-31$79,985
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2013-12-31$68,209
Administrative expenses professional fees incurred2013-12-31$41,650
Was this plan covered by a fidelity bond2013-12-31Yes
Value of fidelity bond cover2013-12-31$500,000
Were there any nonexempt tranactions with any party-in-interest2013-12-31No
Contributions received from participants2013-12-31$626,630
Value of other receiveables (less allowance for doubtful accounts) at end of year2013-12-31$291,202
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2013-12-31$57,550
Administrative expenses (other) incurred2013-12-31$227
Liabilities. Value of operating payables at beginning of year2013-12-31$100,797
Total non interest bearing cash at end of year2013-12-31$1,444,129
Total non interest bearing cash at beginning of year2013-12-31$2,385,692
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Value of net income/loss2013-12-31$-153,312
Value of net assets at end of year (total assets less liabilities)2013-12-31$9,011,855
Value of net assets at beginning of year (total assets less liabilities)2013-12-31$9,165,167
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2013-12-31No
Were any leases to which the plan was party in default or uncollectible2013-12-31No
Investment advisory and management fees2013-12-31$29,943
Value of interest in registered invesment companies (eg mutual funds) at end of year2013-12-31$3,359,578
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2013-12-31$2,992,555
Income. Interest from US Government securities2013-12-31$10,680
Income. Interest from corporate debt instruments2013-12-31$51,733
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2013-12-31$705,943
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2013-12-31$571,964
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2013-12-31$571,964
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2013-12-31$29
Expenses. Payments to insurance carriers foe the provision of benefits2013-12-31$817,140
Asset value of US Government securities at end of year2013-12-31$968,819
Asset value of US Government securities at beginning of year2013-12-31$1,323,165
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-12-31Yes
Was there a failure to transmit to the plan any participant contributions2013-12-31No
Has the plan failed to provide any benefit when due under the plan2013-12-31No
Contributions received in cash from employer2013-12-31$2,971,344
Income. Dividends from common stock2013-12-31$11,776
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-12-31$3,689,729
Asset. Corporate debt instrument preferred debt at end of year2013-12-31$1,885,781
Asset. Corporate debt instrument preferred debt at beginning of year2013-12-31$1,597,201
Contract administrator fees2013-12-31$138,637
Assets. Corporate common stocks other than exployer securities at end of year2013-12-31$631,403
Assets. Corporate common stocks other than exployer securities at beginning of year2013-12-31$532,837
Liabilities. Value of benefit claims payable at end of year2013-12-31$275,000
Liabilities. Value of benefit claims payable at beginning of year2013-12-31$195,000
Did the plan have assets held for investment2013-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-12-31No
Aggregate proceeds on sale of assets2013-12-31$4,977,124
Aggregate carrying amount (costs) on sale of assets2013-12-31$4,877,851
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-12-31No
Opinion of an independent qualified public accountant for this plan2013-12-31Unqualified
Accountancy firm name2013-12-31CURTIS, BLAKELY AND CO., INC.
Accountancy firm EIN2013-12-31751545734
2012 : GUADALUPE VALLEY TELEPHONE COOPERATIVE, INC. INSURANCE PLAN 2012 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2012-12-31$600,969
Total unrealized appreciation/depreciation of assets2012-12-31$600,969
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$295,797
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$346,802
Total income from all sources (including contributions)2012-12-31$4,364,795
Total loss/gain on sale of assets2012-12-31$0
Total of all expenses incurred2012-12-31$3,921,146
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-12-31$3,709,647
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-12-31$3,636,417
Value of total assets at end of year2012-12-31$9,460,964
Value of total assets at beginning of year2012-12-31$9,068,320
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-12-31$211,499
Total interest from all sources2012-12-31$54,564
Total dividends received (eg from common stock, registered investment company shares)2012-12-31$72,845
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2012-12-31$72,845
Administrative expenses professional fees incurred2012-12-31$43,101
Was this plan covered by a fidelity bond2012-12-31Yes
Value of fidelity bond cover2012-12-31$500,000
Were there any nonexempt tranactions with any party-in-interest2012-12-31No
Contributions received from participants2012-12-31$496,286
Participant contributions at beginning of year2012-12-31$553
Value of other receiveables (less allowance for doubtful accounts) at end of year2012-12-31$57,550
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2012-12-31$137,357
Liabilities. Value of operating payables at end of year2012-12-31$100,797
Liabilities. Value of operating payables at beginning of year2012-12-31$101,802
Total non interest bearing cash at end of year2012-12-31$2,385,692
Total non interest bearing cash at beginning of year2012-12-31$103,473
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Value of net income/loss2012-12-31$443,649
Value of net assets at end of year (total assets less liabilities)2012-12-31$9,165,167
Value of net assets at beginning of year (total assets less liabilities)2012-12-31$8,721,518
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2012-12-31No
Were any leases to which the plan was party in default or uncollectible2012-12-31No
Investment advisory and management fees2012-12-31$28,052
Value of interest in registered invesment companies (eg mutual funds) at end of year2012-12-31$2,992,555
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2012-12-31$2,965,286
Income. Interest from US Government securities2012-12-31$9,862
Income. Interest from corporate debt instruments2012-12-31$44,507
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2012-12-31$571,964
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2012-12-31$3,385,092
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2012-12-31$3,385,092
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2012-12-31$195
Expenses. Payments to insurance carriers foe the provision of benefits2012-12-31$788,590
Asset value of US Government securities at end of year2012-12-31$1,323,165
Asset value of US Government securities at beginning of year2012-12-31$502,197
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-12-31Yes
Was there a failure to transmit to the plan any participant contributions2012-12-31No
Has the plan failed to provide any benefit when due under the plan2012-12-31No
Contributions received in cash from employer2012-12-31$3,140,131
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-12-31$2,921,057
Asset. Corporate debt instrument preferred debt at end of year2012-12-31$1,597,201
Asset. Corporate debt instrument preferred debt at beginning of year2012-12-31$1,339,132
Contract administrator fees2012-12-31$140,346
Assets. Corporate common stocks other than exployer securities at end of year2012-12-31$532,837
Assets. Corporate common stocks other than exployer securities at beginning of year2012-12-31$635,230
Liabilities. Value of benefit claims payable at end of year2012-12-31$195,000
Liabilities. Value of benefit claims payable at beginning of year2012-12-31$245,000
Did the plan have assets held for investment2012-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-12-31No
Opinion of an independent qualified public accountant for this plan2012-12-31Unqualified
Accountancy firm name2012-12-31CURTIS, BLAKELY AND CO., INC.
Accountancy firm EIN2012-12-31751545734
2011 : GUADALUPE VALLEY TELEPHONE COOPERATIVE, INC. INSURANCE PLAN 2011 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2011-12-31$-147,291
Total unrealized appreciation/depreciation of assets2011-12-31$-147,291
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$346,802
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$200,189
Total income from all sources (including contributions)2011-12-31$4,186,730
Total loss/gain on sale of assets2011-12-31$0
Total of all expenses incurred2011-12-31$4,157,259
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-12-31$3,983,298
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-12-31$4,114,362
Value of total assets at end of year2011-12-31$9,068,320
Value of total assets at beginning of year2011-12-31$8,892,236
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-12-31$173,961
Total interest from all sources2011-12-31$55,113
Total dividends received (eg from common stock, registered investment company shares)2011-12-31$57,219
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2011-12-31$57,219
Administrative expenses professional fees incurred2011-12-31$74,464
Was this plan covered by a fidelity bond2011-12-31Yes
Value of fidelity bond cover2011-12-31$500,000
If this is an individual account plan, was there a blackout period2011-12-31No
Were there any nonexempt tranactions with any party-in-interest2011-12-31No
Contributions received from participants2011-12-31$424,632
Participant contributions at end of year2011-12-31$553
Participant contributions at beginning of year2011-12-31$470
Value of other receiveables (less allowance for doubtful accounts) at end of year2011-12-31$137,357
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2011-12-31$50,970
Other income not declared elsewhere2011-12-31$107,327
Liabilities. Value of operating payables at end of year2011-12-31$101,802
Liabilities. Value of operating payables at beginning of year2011-12-31$30,189
Total non interest bearing cash at end of year2011-12-31$103,473
Total non interest bearing cash at beginning of year2011-12-31$214
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Value of net income/loss2011-12-31$29,471
Value of net assets at end of year (total assets less liabilities)2011-12-31$8,721,518
Value of net assets at beginning of year (total assets less liabilities)2011-12-31$8,692,047
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2011-12-31No
Were any leases to which the plan was party in default or uncollectible2011-12-31No
Investment advisory and management fees2011-12-31$19,964
Value of interest in registered invesment companies (eg mutual funds) at end of year2011-12-31$2,965,286
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2011-12-31$3,445,767
Income. Interest from US Government securities2011-12-31$8,929
Income. Interest from corporate debt instruments2011-12-31$45,552
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2011-12-31$3,385,092
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2011-12-31$3,365,275
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2011-12-31$3,365,275
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2011-12-31$632
Expenses. Payments to insurance carriers foe the provision of benefits2011-12-31$797,950
Asset value of US Government securities at end of year2011-12-31$502,197
Asset value of US Government securities at beginning of year2011-12-31$604,711
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-12-31No
Was there a failure to transmit to the plan any participant contributions2011-12-31No
Has the plan failed to provide any benefit when due under the plan2011-12-31No
Contributions received in cash from employer2011-12-31$3,689,730
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-12-31$3,185,348
Asset. Corporate debt instrument preferred debt at end of year2011-12-31$1,339,132
Asset. Corporate debt instrument preferred debt at beginning of year2011-12-31$1,118,454
Contract administrator fees2011-12-31$79,533
Assets. Corporate common stocks other than exployer securities at end of year2011-12-31$635,230
Assets. Corporate common stocks other than exployer securities at beginning of year2011-12-31$306,375
Liabilities. Value of benefit claims payable at end of year2011-12-31$245,000
Liabilities. Value of benefit claims payable at beginning of year2011-12-31$170,000
Did the plan have assets held for investment2011-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-12-31No
Opinion of an independent qualified public accountant for this plan2011-12-31Unqualified
Accountancy firm name2011-12-31CURTIS, BLAKELY AND CO., INC.
Accountancy firm EIN2011-12-31751545734
2010 : GUADALUPE VALLEY TELEPHONE COOPERATIVE, INC. INSURANCE PLAN 2010 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2010-12-31$535,723
Total unrealized appreciation/depreciation of assets2010-12-31$535,723
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$200,189
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$175,000
Total income from all sources (including contributions)2010-12-31$4,947,291
Total loss/gain on sale of assets2010-12-31$0
Total of all expenses incurred2010-12-31$3,665,659
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2010-12-31$3,481,672
Total contributions o plan (from employers,participants, others, non cash contrinutions)2010-12-31$4,306,592
Value of total assets at end of year2010-12-31$8,892,236
Value of total assets at beginning of year2010-12-31$7,585,415
Total of administrative expenses incurred including professional, contract, advisory and management fees2010-12-31$183,987
Total interest from all sources2010-12-31$54,985
Total dividends received (eg from common stock, registered investment company shares)2010-12-31$49,991
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2010-12-31No
Was this plan covered by a fidelity bond2010-12-31Yes
Value of fidelity bond cover2010-12-31$500,000
If this is an individual account plan, was there a blackout period2010-12-31No
Were there any nonexempt tranactions with any party-in-interest2010-12-31No
Contributions received from participants2010-12-31$422,630
Participant contributions at end of year2010-12-31$470
Participant contributions at beginning of year2010-12-31$2,200
Value of other receiveables (less allowance for doubtful accounts) at end of year2010-12-31$50,970
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2010-12-31$90,888
Liabilities. Value of operating payables at end of year2010-12-31$30,189
Total non interest bearing cash at end of year2010-12-31$214
Total non interest bearing cash at beginning of year2010-12-31$210
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Value of net income/loss2010-12-31$1,281,632
Value of net assets at end of year (total assets less liabilities)2010-12-31$8,692,047
Value of net assets at beginning of year (total assets less liabilities)2010-12-31$7,410,415
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2010-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2010-12-31No
Were any leases to which the plan was party in default or uncollectible2010-12-31No
Investment advisory and management fees2010-12-31$28,823
Value of interest in registered invesment companies (eg mutual funds) at end of year2010-12-31$3,445,767
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2010-12-31$2,881,193
Income. Interest from US Government securities2010-12-31$11,251
Income. Interest from corporate debt instruments2010-12-31$42,735
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2010-12-31$3,365,275
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2010-12-31$3,123,750
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2010-12-31$3,123,750
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2010-12-31$999
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2010-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2010-12-31$0
Expenses. Payments to insurance carriers foe the provision of benefits2010-12-31$801,358
Asset value of US Government securities at end of year2010-12-31$604,711
Asset value of US Government securities at beginning of year2010-12-31$579,477
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2010-12-31No
Was there a failure to transmit to the plan any participant contributions2010-12-31No
Has the plan failed to provide any benefit when due under the plan2010-12-31No
Contributions received in cash from employer2010-12-31$3,883,962
Income. Dividends from common stock2010-12-31$49,991
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2010-12-31$2,680,314
Asset. Corporate debt instrument preferred debt at end of year2010-12-31$1,118,454
Asset. Corporate debt instrument preferred debt at beginning of year2010-12-31$649,979
Contract administrator fees2010-12-31$155,164
Assets. Corporate common stocks other than exployer securities at end of year2010-12-31$306,375
Assets. Corporate common stocks other than exployer securities at beginning of year2010-12-31$257,718
Liabilities. Value of benefit claims payable at end of year2010-12-31$170,000
Liabilities. Value of benefit claims payable at beginning of year2010-12-31$175,000
Did the plan have assets held for investment2010-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2010-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2010-12-31No
Opinion of an independent qualified public accountant for this plan2010-12-31Unqualified
Accountancy firm name2010-12-31CURTIS, BLAKELY AND CO., INC.
Accountancy firm EIN2010-12-31751545734
2009 : GUADALUPE VALLEY TELEPHONE COOPERATIVE, INC. INSURANCE PLAN 2009 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2009-12-31$676,749
Total unrealized appreciation/depreciation of assets2009-12-31$676,749
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2009-12-31$175,000
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2009-12-31$1,250,026
Total income from all sources (including contributions)2009-12-31$4,709,550
Total loss/gain on sale of assets2009-12-31$0
Total of all expenses incurred2009-12-31$3,460,994
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2009-12-31$3,229,678
Total contributions o plan (from employers,participants, others, non cash contrinutions)2009-12-31$3,919,675
Value of total assets at end of year2009-12-31$7,585,415
Value of total assets at beginning of year2009-12-31$7,411,885
Total of administrative expenses incurred including professional, contract, advisory and management fees2009-12-31$231,316
Total interest from all sources2009-12-31$56,126
Total dividends received (eg from common stock, registered investment company shares)2009-12-31$57,000
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2009-12-31No
Was this plan covered by a fidelity bond2009-12-31Yes
Value of fidelity bond cover2009-12-31$500,000
If this is an individual account plan, was there a blackout period2009-12-31No
Were there any nonexempt tranactions with any party-in-interest2009-12-31No
Contributions received from participants2009-12-31$364,950
Participant contributions at end of year2009-12-31$2,200
Participant contributions at beginning of year2009-12-31$762
Value of other receiveables (less allowance for doubtful accounts) at end of year2009-12-31$90,888
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2009-12-31$343,604
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2009-12-31$489,026
Total non interest bearing cash at end of year2009-12-31$210
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2009-12-31No
Value of net income/loss2009-12-31$1,248,556
Value of net assets at end of year (total assets less liabilities)2009-12-31$7,410,415
Value of net assets at beginning of year (total assets less liabilities)2009-12-31$6,161,859
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2009-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2009-12-31No
Were any leases to which the plan was party in default or uncollectible2009-12-31No
Investment advisory and management fees2009-12-31$16,823
Value of interest in registered invesment companies (eg mutual funds) at end of year2009-12-31$2,881,193
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2009-12-31$1,811,801
Income. Interest from US Government securities2009-12-31$22,113
Income. Interest from corporate debt instruments2009-12-31$28,702
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2009-12-31$3,123,750
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2009-12-31$3,631,271
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2009-12-31$3,631,271
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2009-12-31$5,311
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2009-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2009-12-31$0
Expenses. Payments to insurance carriers foe the provision of benefits2009-12-31$732,520
Asset value of US Government securities at end of year2009-12-31$579,477
Asset value of US Government securities at beginning of year2009-12-31$384,041
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2009-12-31Yes
Was there a failure to transmit to the plan any participant contributions2009-12-31No
Has the plan failed to provide any benefit when due under the plan2009-12-31No
Contributions received in cash from employer2009-12-31$3,554,725
Employer contributions (assets) at beginning of year2009-12-31$375,000
Income. Dividends from common stock2009-12-31$57,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2009-12-31$2,497,158
Asset. Corporate debt instrument preferred debt at end of year2009-12-31$649,979
Asset. Corporate debt instrument preferred debt at beginning of year2009-12-31$600,651
Contract administrator fees2009-12-31$214,493
Assets. Corporate common stocks other than exployer securities at end of year2009-12-31$257,718
Assets. Corporate common stocks other than exployer securities at beginning of year2009-12-31$264,755
Liabilities. Value of benefit claims payable at end of year2009-12-31$175,000
Liabilities. Value of benefit claims payable at beginning of year2009-12-31$761,000
Did the plan have assets held for investment2009-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2009-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2009-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2009-12-31No
Opinion of an independent qualified public accountant for this plan2009-12-31Unqualified
Accountancy firm name2009-12-31CURTIS, BLAKELY AND CO., INC.
Accountancy firm EIN2009-12-31751545734

Form 5500 Responses for GUADALUPE VALLEY TELEPHONE COOPERATIVE, INC. INSURANCE PLAN

2022: GUADALUPE VALLEY TELEPHONE COOPERATIVE, INC. INSURANCE PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – TrustYes
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement - TrustYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: GUADALUPE VALLEY TELEPHONE COOPERATIVE, INC. INSURANCE PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – TrustYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement - TrustYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: GUADALUPE VALLEY TELEPHONE COOPERATIVE, INC. INSURANCE PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – TrustYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement - TrustYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: GUADALUPE VALLEY TELEPHONE COOPERATIVE, INC. INSURANCE PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement - TrustYes
2019-01-01Plan benefit arrangement – General assets of the sponsorYes
2018: GUADALUPE VALLEY TELEPHONE COOPERATIVE, INC. INSURANCE 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 – TrustYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement - TrustYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: GUADALUPE VALLEY TELEPHONE COOPERATIVE, INC. INSURANCE 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 – TrustYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement - TrustYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: GUADALUPE VALLEY TELEPHONE COOPERATIVE, INC. INSURANCE PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement - TrustYes
2016-01-01Plan benefit arrangement – General assets of the sponsorYes
2015: GUADALUPE VALLEY TELEPHONE COOPERATIVE, INC. INSURANCE PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedYes
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement - TrustYes
2015-01-01Plan benefit arrangement – General assets of the sponsorYes
2014: GUADALUPE VALLEY TELEPHONE COOPERATIVE, INC. INSURANCE PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement - TrustYes
2014-01-01Plan benefit arrangement – General assets of the sponsorYes
2013: GUADALUPE VALLEY TELEPHONE COOPERATIVE, INC. INSURANCE PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement - TrustYes
2013-01-01Plan benefit arrangement – General assets of the sponsorYes
2012: GUADALUPE VALLEY TELEPHONE COOPERATIVE, INC. INSURANCE PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement - TrustYes
2012-01-01Plan benefit arrangement – General assets of the sponsorYes
2011: GUADALUPE VALLEY TELEPHONE COOPERATIVE, INC. INSURANCE PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement - TrustYes
2011-01-01Plan benefit arrangement – General assets of the sponsorYes
2010: GUADALUPE VALLEY TELEPHONE COOPERATIVE, INC. INSURANCE PLAN 2010 form 5500 responses
2010-01-01Type of plan entityMulti-employer plan
2010-01-01Submission has been amendedYes
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan funding arrangement – TrustYes
2010-01-01Plan benefit arrangement – InsuranceYes
2010-01-01Plan benefit arrangement - TrustYes
2010-01-01Plan benefit arrangement – General assets of the sponsorYes
2009: GUADALUPE VALLEY TELEPHONE COOPERATIVE, INC. INSURANCE PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement - TrustYes
2009-01-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

EXPRESS SCRIPTS, INC. (National Association of Insurance Commissioners NAIC id number: 60025 )
Policy contract number0
Policy instance 1
Insurance contract or identification number0
Number of Individuals Covered16
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $1,552
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare 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 $40,492
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,552
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0AVXB
Policy instance 5
Insurance contract or identification numberGLUG0AVXB
Number of Individuals Covered323
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $5,441
Total amount of fees paid to insurance companyUSD $5,954
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 BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D
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 $119,110
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,441
Amount paid for insurance broker fees5954
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLTD0AVXB
Policy instance 4
Insurance contract or identification numberGLTD0AVXB
Number of Individuals Covered224
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $4,642
Total amount of fees paid to insurance companyUSD $3,221
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 BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $64,167
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,642
Amount paid for insurance broker fees3221
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number0
Policy instance 8
Insurance contract or identification number0
Number of Individuals Covered212
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
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 BenefitNo
Vision Insurance Welfare BenefitYes
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 $40,663
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberNIS1617 01
Policy instance 3
Insurance contract or identification numberNIS1617 01
Number of Individuals Covered212
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
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 BenefitNo
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 $499,563
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUG 0AVXB
Policy instance 6
Insurance contract or identification numberGUG 0AVXB
Number of Individuals Covered222
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $4,877
Total amount of fees paid to insurance companyUSD $4,273
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 BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
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 $85,084
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,877
Amount paid for insurance broker fees4273
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number10196041001
Policy instance 7
Insurance contract or identification number10196041001
Number of Individuals Covered475
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $4,078
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
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 $37,263
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,078
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract numberAGP-003139
Policy instance 2
Insurance contract or identification numberAGP-003139
Number of Individuals Covered20
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $11,317
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedMEDICARE SUPPLEMENT
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 $75,448
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,317
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AVXB
Policy instance 5
Insurance contract or identification numberG000AVXB
Number of Individuals Covered316
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $5,441
Total amount of fees paid to insurance companyUSD $4,544
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $119,074
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,441
Additional information about fees paid to insurance brokerAGENT OR BROKER OF RECORD
Insurance broker organization code?3
Amount paid for insurance broker fees4544
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AVXB
Policy instance 4
Insurance contract or identification numberG000AVXB
Number of Individuals Covered212
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $9,531
Total amount of fees paid to insurance companyUSD $5,737
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $149,892
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,531
Additional information about fees paid to insurance brokerAGENT OR BROKER OF RECORD
Insurance broker organization code?3
Amount paid for insurance broker fees5737
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberNIS1617 01
Policy instance 3
Insurance contract or identification numberNIS1617 01
Number of Individuals Covered210
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Welfare Benefit Premiums Paid to CarrierUSD $468,959
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EXPRESS SCRIPTS, INC. (National Association of Insurance Commissioners NAIC id number: 60025 )
Policy contract number
Policy instance 1
Number of Individuals Covered19
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $1,800
Welfare Benefit Premiums Paid to CarrierUSD $46,327
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,800
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract numberAGP-003139
Policy instance 2
Insurance contract or identification numberAGP-003139
Number of Individuals Covered21
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $12,194
Are there contracts with allocated funds for types other than group deferred annuity or individual?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Other information about contractSENIOR MEDICAL INSURANCE PLAN
Commission paid to Insurance BrokerUSD $12,194
Insurance broker organization code?3
EXPRESS SCRIPTS, INC. (National Association of Insurance Commissioners NAIC id number: 60025 )
Policy contract number
Policy instance 1
Number of Individuals Covered22
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $2,072
Welfare Benefit Premiums Paid to CarrierUSD $52,647
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,072
Insurance broker organization code?3
WESTPOINT INSURANCE CORPORATION (National Association of Insurance Commissioners NAIC id number: 39845 )
Policy contract numberESL 1000883 00
Policy instance 3
Insurance contract or identification numberESL 1000883 00
Number of Individuals Covered217
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Welfare Benefit Premiums Paid to CarrierUSD $482,757
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract numberAGP-3139
Policy instance 2
Insurance contract or identification numberAGP-3139
Number of Individuals Covered26
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $13,329
Are there contracts with allocated funds for types other than group deferred annuity or individual?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Other information about contractSENIOR MEDICAL INSURANCE PLAN
Commission paid to Insurance BrokerUSD $13,329
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AVXB
Policy instance 4
Insurance contract or identification numberG000AVXB
Number of Individuals Covered221
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $9,414
Total amount of fees paid to insurance companyUSD $8,698
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $143,430
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,414
Additional information about fees paid to insurance brokerAGENT OR BROKER OF RECORD
Insurance broker organization code?3
Amount paid for insurance broker fees8698
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AVXB
Policy instance 5
Insurance contract or identification numberG000AVXB
Number of Individuals Covered322
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $5,386
Total amount of fees paid to insurance companyUSD $6,841
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $113,600
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees6841
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $5,386
EXPRESS SCRIPTS, INC. (National Association of Insurance Commissioners NAIC id number: 60025 )
Policy contract number
Policy instance 1
Number of Individuals Covered27
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $2,584
Welfare Benefit Premiums Paid to CarrierUSD $64,139
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,584
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AVXB
Policy instance 4
Insurance contract or identification numberG000AVXB
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $14,833
Total amount of fees paid to insurance companyUSD $14,732
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $258,973
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,822
Amount paid for insurance broker fees10105
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
WESTPOINT INSURANCE CORPORATION (National Association of Insurance Commissioners NAIC id number: 39845 )
Policy contract numberESL 1000883 00
Policy instance 3
Insurance contract or identification numberESL 1000883 00
Number of Individuals Covered209
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Welfare Benefit Premiums Paid to CarrierUSD $487,867
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract numberAGP-3139
Policy instance 2
Insurance contract or identification numberAGP-3139
Number of Individuals Covered30
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $15,913
Are there contracts with allocated funds for types other than group deferred annuity or individual?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Other information about contractSENIOR MEDICAL INSURANCE PLAN
Commission paid to Insurance BrokerUSD $15,913
Insurance broker organization code?3
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract numberHCL33523
Policy instance 4
Insurance contract or identification numberHCL33523
Number of Individuals Covered215
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?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 BenefitNo
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 $542,274
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AVXB
Policy instance 3
Insurance contract or identification numberG000AVXB
Number of Individuals Covered330
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $14,612
Total amount of fees paid to insurance companyUSD $9,791
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 BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $245,544
Commission paid to Insurance BrokerUSD $14,612
Amount paid for insurance broker fees9791
Additional information about fees paid to insurance brokerOTHER COMPENSATION PAID
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AVXB
Policy instance 4
Insurance contract or identification numberG000AVXB
Number of Individuals Covered330
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $14,612
Total amount of fees paid to insurance companyUSD $9,791
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 BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $245,544
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,612
Amount paid for insurance broker fees9791
Additional information about fees paid to insurance brokerOTHER COMPENSATION PAID
Insurance broker organization code?3
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract numberHCL33523
Policy instance 3
Insurance contract or identification numberHCL33523
Number of Individuals Covered215
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?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 BenefitNo
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 $542,274
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EXPRESS SCRIPTS, INC. (National Association of Insurance Commissioners NAIC id number: 60025 )
Policy contract number
Policy instance 2
Number of Individuals Covered31
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $2,976
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare 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 $70,591
Commission paid to Insurance BrokerUSD $2,976
Amount paid for insurance broker fees0
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract numberAGP-3139
Policy instance 1
Insurance contract or identification numberAGP-3139
Number of Individuals Covered36
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $17,403
Total amount of fees paid to insurance companyUSD $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?Yes
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare 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
Other information about contractSENIOR MEDICAL INSURANCE PLAN
Commission paid to Insurance BrokerUSD $17,403
Amount paid for insurance broker fees0
Insurance broker organization code?3
EXPRESS SCRIPTS, INC. (National Association of Insurance Commissioners NAIC id number: 60025 )
Policy contract number
Policy instance 1
Number of Individuals Covered31
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $2,976
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare 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 $70,591
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,976
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract numberAGP-3139
Policy instance 2
Insurance contract or identification numberAGP-3139
Number of Individuals Covered36
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $17,403
Total amount of fees paid to insurance companyUSD $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?Yes
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare 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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Other information about contractSENIOR MEDICAL INSURANCE PLAN
Commission paid to Insurance BrokerUSD $17,403
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AVXB
Policy instance 4
Insurance contract or identification numberG000AVXB
Number of Individuals Covered328
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $14,619
Total amount of fees paid to insurance companyUSD $8,029
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 BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $245,405
Commission paid to Insurance BrokerUSD $14,619
Amount paid for insurance broker fees8029
Additional information about fees paid to insurance brokerOTHER COMPENSATION PAID
Insurance broker organization code?3
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker nameBB& T INSURANCE SERVICES INC.
EXPRESS SCRIPTS, INC. (National Association of Insurance Commissioners NAIC id number: 60025 )
Policy contract number
Policy instance 3
Number of Individuals Covered31
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $3,016
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare 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 $66,239
Commission paid to Insurance BrokerUSD $3,016
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameGROUP ADMINISTRATIVE CONCEPTS
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract numberAGP-3139
Policy instance 2
Insurance contract or identification numberAGP-3139
Number of Individuals Covered36
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $12,027
Total amount of fees paid to insurance companyUSD $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?Yes
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare 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
Other information about contractSENIOR MEDICAL INSURANCE PLAN
Commission paid to Insurance BrokerUSD $12,027
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameTAGCO ASSOCIATES LP
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )
Policy contract number949-4656
Policy instance 1
Insurance contract or identification number949-4656
Number of Individuals Covered208
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?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 BenefitNo
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 $511,105
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )
Policy contract number949-4656
Policy instance 3
Insurance contract or identification number949-4656
Number of Individuals Covered208
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?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 BenefitNo
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 $511,105
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EXPRESS SCRIPTS, INC. (National Association of Insurance Commissioners NAIC id number: 60025 )
Policy contract number
Policy instance 1
Number of Individuals Covered31
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $3,016
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare 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 $66,239
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract numberAGP-3139
Policy instance 3
Insurance contract or identification numberAGP-3139
Number of Individuals Covered10
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $1,519
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?Yes
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare 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
Other information about contractSENIOR MEDICAL INSURANCE PLAN
Commission paid to Insurance BrokerUSD $1,519
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameBB&T INSURANCE SERVICES, INC.
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )
Policy contract number949-4656
Policy instance 2
Insurance contract or identification number949-4656
Number of Individuals Covered213
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?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 BenefitNo
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 $410,602
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITED AMERICAN INSURANCE (National Association of Insurance Commissioners NAIC id number: 92916 )
Policy contract numberD3567
Policy instance 4
Insurance contract or identification numberD3567
Number of Individuals Covered10
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $492
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare 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 $19,680
Commission paid to Insurance BrokerUSD $492
Insurance broker organization code?3
Insurance broker nameBB&T INSURANCE SERVICES, INC.
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number047770
Policy instance 5
Insurance contract or identification number047770
Number of Individuals Covered315
Insurance policy start date2015-01-01
Insurance policy end date2015-01-31
Total amount of commissions paid to insurance brokerUSD $933
Total amount of fees paid to insurance companyUSD $135
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 BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $17,646
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $933
Amount paid for insurance broker fees135
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION PAID
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number047770
Policy instance 2
Insurance contract or identification number047770
Number of Individuals Covered315
Insurance policy start date2015-01-01
Insurance policy end date2015-02-01
Total amount of commissions paid to insurance brokerUSD $933
Total amount of fees paid to insurance companyUSD $135
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $17,646
Commission paid to Insurance BrokerUSD $933
Amount paid for insurance broker fees135
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION PAID
Insurance broker organization code?3
Insurance broker nameBB&T INSURANCE SERVICES, INC.
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AVXB
Policy instance 5
Insurance contract or identification numberG000AVXB
Number of Individuals Covered320
Insurance policy start date2015-02-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $14,168
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $219,226
Commission paid to Insurance BrokerUSD $14,168
Insurance broker organization code?3
Insurance broker nameBB& T INSURANCE SERVICES INC.
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG0000AVXB
Policy instance 4
Insurance contract or identification numberG0000AVXB
Number of Individuals Covered320
Insurance policy start date2015-02-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $14,168
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $219,226
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,168
Insurance broker organization code?3
UNITED AMERICAN INSURANCE (National Association of Insurance Commissioners NAIC id number: 92916 )
Policy contract numberD3567
Policy instance 3
Insurance contract or identification numberD3567
Number of Individuals Covered10
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $492
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare 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 $19,680
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $492
Insurance broker organization code?3
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )
Policy contract number949-4656
Policy instance 1
Insurance contract or identification number949-4656
Number of Individuals Covered213
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare 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 $410,602
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract numberAGP-3139
Policy instance 1
Insurance contract or identification numberAGP-3139
Number of Individuals Covered10
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $1,519
Total amount of fees paid to insurance companyUSD $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?Yes
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare 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
Other information about contractSENIOR MEDICAL INSURANCE PLAN
Commission paid to Insurance BrokerUSD $1,519
Insurance broker organization code?3
SILVERSCRIPT (National Association of Insurance Commissioners NAIC id number: 52411 )
Policy contract number10301
Policy instance 4
Insurance contract or identification number10301
Number of Individuals Covered47
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $2,292
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare 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 $86,100
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees2292
Additional information about fees paid to insurance brokerADMINISTRATION FEES
Insurance broker organization code?3
Insurance broker nameBB&T
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract numberAGP-3139
Policy instance 2
Insurance contract or identification numberAGP-3139
Number of Individuals Covered56
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $23,864
Total amount of fees paid to insurance companyUSD $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?Yes
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare 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
Other information about contractSENIOR MEDICAL INSURANCE PLAN
Commission paid to Insurance BrokerUSD $23,864
Insurance broker organization code?3
SILVERSCRIPT (National Association of Insurance Commissioners NAIC id number: 52411 )
Policy contract number10301
Policy instance 3
Insurance contract or identification number10301
Number of Individuals Covered47
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $2,292
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 BenefitNo
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 $86,100
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees2292
Additional information about fees paid to insurance brokerADMINISTRATION FEES
Insurance broker organization code?3
AMERICAN NATIONAL INSURANCE COMPANY OF TEXAS (National Association of Insurance Commissioners NAIC id number: 71773 )
Policy contract numberANT2005
Policy instance 1
Insurance contract or identification numberANT2005
Number of Individuals Covered217
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?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 BenefitNo
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 $347,576
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number047770
Policy instance 4
Insurance contract or identification number047770
Number of Individuals Covered316
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $16,817
Total amount of fees paid to insurance companyUSD $1,616
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 BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $215,441
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,817
Amount paid for insurance broker fees1616
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION PAID
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract numberAGP-3139
Policy instance 3
Insurance contract or identification numberAGP-3139
Number of Individuals Covered56
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $23,864
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?Yes
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare 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
Other information about contractSENIOR MEDICAL INSURANCE PLAN
Commission paid to Insurance BrokerUSD $23,864
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameTAGCO ASSOCIATES LP
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number047770
Policy instance 1
Insurance contract or identification number047770
Number of Individuals Covered316
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $16,817
Total amount of fees paid to insurance companyUSD $1,616
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $215,441
Commission paid to Insurance BrokerUSD $16,817
Amount paid for insurance broker fees1616
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION PAID
Insurance broker organization code?3
Insurance broker nameBB&T INSURANCE SERVICES, INC.
AMERICAN NATIONAL INSURANCE COMPANY OF TEXAS (National Association of Insurance Commissioners NAIC id number: 71773 )
Policy contract numberANT2005
Policy instance 2
Insurance contract or identification numberANT2005
Number of Individuals Covered217
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare 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 $347,576
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract numberAGP-3139
Policy instance 2
Insurance contract or identification numberAGP-3139
Number of Individuals Covered54
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $25,005
Total amount of fees paid to insurance companyUSD $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?Yes
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare 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
Other information about contractSENIOR MEDICAL INSURANCE PLAN
Commission paid to Insurance BrokerUSD $25,005
Insurance broker organization code?3
SILVERSCRIPT (National Association of Insurance Commissioners NAIC id number: 52411 )
Policy contract number10301
Policy instance 4
Insurance contract or identification number10301
Number of Individuals Covered48
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $2,384
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare 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 $96,876
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees2384
Additional information about fees paid to insurance brokerADMINISTRATION FEES
Insurance broker organization code?3
Insurance broker nameBB&T
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract numberAGP-3139
Policy instance 3
Insurance contract or identification numberAGP-3139
Number of Individuals Covered54
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $25,005
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?Yes
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare 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
Other information about contractSENIOR MEDICAL INSURANCE PLAN
Commission paid to Insurance BrokerUSD $25,005
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameTAGCO ASSOCIATES LP
AMERICAN NATIONAL INSURANCE COMPANY OF TEXAS (National Association of Insurance Commissioners NAIC id number: 71773 )
Policy contract numberANT2005
Policy instance 2
Insurance contract or identification numberANT2005
Number of Individuals Covered213
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare 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 $334,770
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number047770
Policy instance 1
Insurance contract or identification number047770
Number of Individuals Covered314
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $16,419
Total amount of fees paid to insurance companyUSD $1,549
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $206,585
Commission paid to Insurance BrokerUSD $16,419
Amount paid for insurance broker fees1549
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION PAID
Insurance broker organization code?3
Insurance broker nameBB&T INSURANCE SERVICES, INC.
AMERICAN NATIONAL INSURANCE COMPANY OF TEXAS (National Association of Insurance Commissioners NAIC id number: 71773 )
Policy contract numberANT2005
Policy instance 1
Insurance contract or identification numberANT2005
Number of Individuals Covered213
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?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 BenefitNo
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 $334,770
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SILVERSCRIPT (National Association of Insurance Commissioners NAIC id number: 52411 )
Policy contract number10301
Policy instance 3
Insurance contract or identification number10301
Number of Individuals Covered48
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $2,384
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 BenefitNo
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 $96,876
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees2384
Additional information about fees paid to insurance brokerADMINISTRATION FEES
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number047770
Policy instance 4
Insurance contract or identification number047770
Number of Individuals Covered314
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $16,419
Total amount of fees paid to insurance companyUSD $1,549
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 BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $206,585
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,419
Amount paid for insurance broker fees1549
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION PAID
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number047770
Policy instance 1
Insurance contract or identification number047770
Number of Individuals Covered304
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $15,886
Total amount of fees paid to insurance companyUSD $1,467
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $195,645
Commission paid to Insurance BrokerUSD $15,886
Amount paid for insurance broker fees1467
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION PAID
Insurance broker organization code?3
Insurance broker nameBB&T INSURANCE SERVICES, INC.
AMERICAN NATIONAL INSURANCE COMPANY OF TEXAS (National Association of Insurance Commissioners NAIC id number: 71773 )
Policy contract numberANT2005
Policy instance 2
Insurance contract or identification numberANT2005
Number of Individuals Covered219
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare 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 $326,093
SILVERSCRIPT (National Association of Insurance Commissioners NAIC id number: 52411 )
Policy contract number10301
Policy instance 4
Insurance contract or identification number10301
Number of Individuals Covered52
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $2,448
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare 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 $99,954
Amount paid for insurance broker fees2448
Additional information about fees paid to insurance brokerADMINISTRATION FEES
Insurance broker organization code?3
Insurance broker nameBB&T
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract numberAGP-3139
Policy instance 3
Insurance contract or identification numberAGP-3139
Number of Individuals Covered59
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $24,039
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?Yes
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare 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
Other information about contractSENIOR MEDICAL INSURANCE PLAN
Commission paid to Insurance BrokerUSD $24,039
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameTAGCO ASSOCIATES LP
AMERICAN NATIONAL INSURANCE COMPANY OF TEXAS (National Association of Insurance Commissioners NAIC id number: 71773 )
Policy contract numberANT2005
Policy instance 1
Insurance contract or identification numberANT2005
Number of Individuals Covered219
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?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 BenefitNo
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 $326,093
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract numberAGP-3139
Policy instance 2
Insurance contract or identification numberAGP-3139
Number of Individuals Covered59
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $24,039
Total amount of fees paid to insurance companyUSD $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?Yes
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare 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
Other information about contractSENIOR MEDICAL INSURANCE PLAN
Commission paid to Insurance BrokerUSD $24,039
Amount paid for insurance broker fees0
Insurance broker organization code?3
SILVERSCRIPT (National Association of Insurance Commissioners NAIC id number: 52411 )
Policy contract number10301
Policy instance 3
Insurance contract or identification number10301
Number of Individuals Covered52
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $2,448
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 BenefitNo
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 $99,954
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees2448
Additional information about fees paid to insurance brokerADMINISTRATION FEES
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number047770
Policy instance 4
Insurance contract or identification number047770
Number of Individuals Covered304
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $15,886
Total amount of fees paid to insurance companyUSD $1,467
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 BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $195,645
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,886
Amount paid for insurance broker fees1467
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION PAID
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number047770
Policy instance 3
Insurance contract or identification number047770
Number of Individuals Covered280
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $15,906
Total amount of fees paid to insurance companyUSD $1,411
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 BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $188,141
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,906
Amount paid for insurance broker fees1411
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION PAID
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number047770
Policy instance 1
Insurance contract or identification number047770
Number of Individuals Covered280
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $15,906
Total amount of fees paid to insurance companyUSD $1,411
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $188,141
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number64780-EXRK
Policy instance 2
Insurance contract or identification number64780-EXRK
Number of Individuals Covered659
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare 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 $341,867
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract numberAGP-3139
Policy instance 3
Insurance contract or identification numberAGP-3139
Number of Individuals Covered56
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $23,688
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?Yes
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare 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 $85,526
Other information about contractSENIOR MEDICAL INSURANCE PLAN
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract numberAGP-3139
Policy instance 1
Insurance contract or identification numberAGP-3139
Number of Individuals Covered56
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $23,688
Total amount of fees paid to insurance companyUSD $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?Yes
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare 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
Other information about contractSENIOR MEDICAL INSURANCE PLAN
Commission paid to Insurance BrokerUSD $23,688
Amount paid for insurance broker fees0
Insurance broker organization code?3
KANAWHA HEALTHCARE SOLUTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 95592 )
Policy contract numberL10330
Policy instance 5
Insurance contract or identification numberL10330
Number of Individuals Covered247
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedFLEXIBLE SPENDING ACCOUNTS
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract numberAGP-3139
Policy instance 3
Insurance contract or identification numberAGP-3139
Number of Individuals Covered60
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $23,730
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?Yes
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare 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
Other information about contractSENIOR MEDICAL INSURANCE PLAN
Commission paid to Insurance BrokerUSD $23,730
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameTAGCO ASSOCIATES LP
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number64780-EXRSK
Policy instance 2
Insurance contract or identification number64780-EXRSK
Number of Individuals Covered233
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare 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 $353,063
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number047770
Policy instance 1
Insurance contract or identification number047770
Number of Individuals Covered282
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $15,920
Total amount of fees paid to insurance companyUSD $1,361
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $181,432
Commission paid to Insurance BrokerUSD $15,920
Amount paid for insurance broker fees1361
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION PAID
Insurance broker organization code?3
Insurance broker nameATLANTIC RISK MANAGEMENT CORP.
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract numberAGP-3139
Policy instance 1
Insurance contract or identification numberAGP-3139
Number of Individuals Covered60
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $23,730
Total amount of fees paid to insurance companyUSD $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?Yes
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare 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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Other information about contractSENIOR MEDICAL INSURANCE PLAN
Commission paid to Insurance BrokerUSD $23,730
Insurance broker organization code?3
KANAWHA HEALTHCARE SOLUTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 95592 )
Policy contract numberL10330
Policy instance 2
Insurance contract or identification numberL10330
Number of Individuals Covered247
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?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 BenefitYes
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
Other welfare benefits providedFLEXIBLE SPENDING ACCOUNTS
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number64780-EXRSK
Policy instance 3
Insurance contract or identification number64780-EXRSK
Number of Individuals Covered233
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?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 BenefitNo
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 $353,063
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number047770
Policy instance 5
Insurance contract or identification number047770
Number of Individuals Covered282
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $15,920
Total amount of fees paid to insurance companyUSD $1,361
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 BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $181,432
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,920
Amount paid for insurance broker fees1361
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION PAID
Insurance broker organization code?3
SILVERSCRIPT (National Association of Insurance Commissioners NAIC id number: 52411 )
Policy contract number10301
Policy instance 4
Insurance contract or identification number10301
Number of Individuals Covered54
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $2,628
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare 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 $101,178
Commission paid to Insurance BrokerUSD $2,628
Amount paid for insurance broker fees0
Insurance broker organization code?3
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker nameCHRIS WHITE
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract numberAGP-3139
Policy instance 1
Insurance contract or identification numberAGP-3139
Number of Individuals Covered60
Insurance policy start date2009-01-01
Insurance policy end date2009-12-31
Total amount of commissions paid to insurance brokerUSD $23,085
Total amount of fees paid to insurance companyUSD $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?Yes
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare 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
Other information about contractSENIOR MEDICAL INSURANCE PLAN
Commission paid to Insurance BrokerUSD $23,085
Insurance broker organization code?3
KANAWHA HEALTHCARE SOLUTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 95592 )
Policy contract numberL10330
Policy instance 3
Insurance contract or identification numberL10330
Number of Individuals Covered237
Insurance policy start date2009-01-01
Insurance policy end date2009-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?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 BenefitYes
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number64780-EXRSK
Policy instance 4
Insurance contract or identification number64780-EXRSK
Number of Individuals Covered237
Insurance policy start date2009-01-01
Insurance policy end date2009-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?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 BenefitNo
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 $285,450
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SILVERSCRIPT (National Association of Insurance Commissioners NAIC id number: 52411 )
Policy contract number10109
Policy instance 5
Insurance contract or identification number10109
Number of Individuals Covered54
Insurance policy start date2009-01-01
Insurance policy end date2009-12-31
Total amount of commissions paid to insurance brokerUSD $2,596
Total amount of fees paid to insurance companyUSD $5,192
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 BenefitNo
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 $97,848
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,596
Amount paid for insurance broker fees5192
Additional information about fees paid to insurance brokerADMINISTRATIVE FEES PAID
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number047770
Policy instance 6
Insurance contract or identification number047770
Number of Individuals Covered285
Insurance policy start date2009-01-01
Insurance policy end date2009-12-31
Total amount of commissions paid to insurance brokerUSD $15,877
Total amount of fees paid to insurance companyUSD $1,366
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 BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $182,069
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,877
Amount paid for insurance broker fees1366
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION PAID
Insurance broker organization code?3
KANAWHA HEALTHCARE SOLUTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 95592 )
Policy contract numberL10330
Policy instance 2
Insurance contract or identification numberL10330
Number of Individuals Covered105
Insurance policy start date2009-01-01
Insurance policy end date2009-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?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 BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedFLEXIBLE SPENDING ACCOUNTS
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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