TRI-STARR MGMT SVCS D/B/A LEGACY SUPPLY CHAIN SVCS has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan TRI-STARR MANAGEMENT SERVICES, INC. SEC 125 WELFARE PLAN
401k plan membership statisitcs for TRI-STARR MANAGEMENT SERVICES, INC. SEC 125 WELFARE PLAN
| Measure | Date | Value |
|---|
| 2016 : TRI-STARR MANAGEMENT SERVICES, INC. SEC 125 WELFARE PLAN 2016 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-03-31 | $622,429 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-03-31 | $1,259,712 |
| Total income from all sources (including contributions) | 2016-03-31 | $8,113,751 |
| Total of all expenses incurred | 2016-03-31 | $7,843,863 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2016-03-31 | $7,109,890 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2016-03-31 | $8,113,751 |
| Value of total assets at end of year | 2016-03-31 | $569,700 |
| Value of total assets at beginning of year | 2016-03-31 | $937,095 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2016-03-31 | $733,973 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2016-03-31 | No |
| Was this plan covered by a fidelity bond | 2016-03-31 | Yes |
| Value of fidelity bond cover | 2016-03-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2016-03-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2016-03-31 | No |
| Contributions received from participants | 2016-03-31 | $3,191,701 |
| Participant contributions at end of year | 2016-03-31 | $64,141 |
| Participant contributions at beginning of year | 2016-03-31 | $59,909 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2016-03-31 | $420,445 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2016-03-31 | $23,268 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2016-03-31 | $148,312 |
| Administrative expenses (other) incurred | 2016-03-31 | $90,073 |
| Liabilities. Value of operating payables at end of year | 2016-03-31 | $8,635 |
| Liabilities. Value of operating payables at beginning of year | 2016-03-31 | $154,665 |
| Total non interest bearing cash at end of year | 2016-03-31 | $36,030 |
| Total non interest bearing cash at beginning of year | 2016-03-31 | $80,589 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-03-31 | No |
| Value of net income/loss | 2016-03-31 | $269,888 |
| Value of net assets at end of year (total assets less liabilities) | 2016-03-31 | $-52,729 |
| Value of net assets at beginning of year (total assets less liabilities) | 2016-03-31 | $-322,617 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2016-03-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2016-03-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2016-03-31 | No |
| Investment advisory and management fees | 2016-03-31 | $120,243 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2016-03-31 | $1,217,855 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2016-03-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2016-03-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2016-03-31 | No |
| Contributions received in cash from employer | 2016-03-31 | $4,501,605 |
| Employer contributions (assets) at end of year | 2016-03-31 | $446,261 |
| Employer contributions (assets) at beginning of year | 2016-03-31 | $648,285 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2016-03-31 | $5,892,035 |
| Contract administrator fees | 2016-03-31 | $523,657 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2016-03-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2016-03-31 | $613,794 |
| Liabilities. Value of benefit claims payable at beginning of year | 2016-03-31 | $1,105,047 |
| Did the plan have assets held for investment | 2016-03-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-03-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2016-03-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2016-03-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2016-03-31 | Unqualified |
| Accountancy firm name | 2016-03-31 | ENNIS, PELLUM & ASSOCIATES, CPAS |
| Accountancy firm EIN | 2016-03-31 | 591843700 |
| 2015 : TRI-STARR MANAGEMENT SERVICES, INC. SEC 125 WELFARE PLAN 2015 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-03-31 | $1,259,712 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-03-31 | $715,282 |
| Total income from all sources (including contributions) | 2015-03-31 | $9,788,323 |
| Total of all expenses incurred | 2015-03-31 | $9,834,523 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2015-03-31 | $9,022,223 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2015-03-31 | $9,788,323 |
| Value of total assets at end of year | 2015-03-31 | $937,095 |
| Value of total assets at beginning of year | 2015-03-31 | $438,865 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2015-03-31 | $812,300 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2015-03-31 | No |
| Was this plan covered by a fidelity bond | 2015-03-31 | Yes |
| Value of fidelity bond cover | 2015-03-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2015-03-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2015-03-31 | No |
| Contributions received from participants | 2015-03-31 | $3,404,865 |
| Participant contributions at end of year | 2015-03-31 | $59,909 |
| Participant contributions at beginning of year | 2015-03-31 | $41,350 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2015-03-31 | $459,995 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2015-03-31 | $148,312 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2015-03-31 | $123,039 |
| Administrative expenses (other) incurred | 2015-03-31 | $104,154 |
| Liabilities. Value of operating payables at end of year | 2015-03-31 | $154,665 |
| Liabilities. Value of operating payables at beginning of year | 2015-03-31 | $106,571 |
| Total non interest bearing cash at end of year | 2015-03-31 | $80,589 |
| Total non interest bearing cash at beginning of year | 2015-03-31 | $14,706 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-03-31 | No |
| Value of net income/loss | 2015-03-31 | $-46,200 |
| Value of net assets at end of year (total assets less liabilities) | 2015-03-31 | $-322,617 |
| Value of net assets at beginning of year (total assets less liabilities) | 2015-03-31 | $-276,417 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2015-03-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2015-03-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2015-03-31 | No |
| Investment advisory and management fees | 2015-03-31 | $127,861 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2015-03-31 | $1,666,535 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2015-03-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2015-03-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2015-03-31 | No |
| Contributions received in cash from employer | 2015-03-31 | $5,923,463 |
| Employer contributions (assets) at end of year | 2015-03-31 | $648,285 |
| Employer contributions (assets) at beginning of year | 2015-03-31 | $259,770 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2015-03-31 | $7,355,688 |
| Contract administrator fees | 2015-03-31 | $580,285 |
| Liabilities. Value of benefit claims payable at end of year | 2015-03-31 | $1,105,047 |
| Liabilities. Value of benefit claims payable at beginning of year | 2015-03-31 | $608,711 |
| Did the plan have assets held for investment | 2015-03-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-03-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2015-03-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2015-03-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2015-03-31 | Unqualified |
| Accountancy firm name | 2015-03-31 | ENNIS, PELLUM & ASSOCIATES, CPA'S |
| Accountancy firm EIN | 2015-03-31 | 591843700 |
| 2014 : TRI-STARR MANAGEMENT SERVICES, INC. SEC 125 WELFARE PLAN 2014 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-03-31 | $715,282 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-03-31 | $572,079 |
| Total income from all sources (including contributions) | 2014-03-31 | $1,778,890 |
| Total of all expenses incurred | 2014-03-31 | $2,110,563 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2014-03-31 | $1,986,178 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2014-03-31 | $1,778,890 |
| Value of total assets at end of year | 2014-03-31 | $438,865 |
| Value of total assets at beginning of year | 2014-03-31 | $627,335 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2014-03-31 | $124,385 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2014-03-31 | No |
| Was this plan covered by a fidelity bond | 2014-03-31 | Yes |
| Value of fidelity bond cover | 2014-03-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2014-03-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2014-03-31 | No |
| Contributions received from participants | 2014-03-31 | $564,525 |
| Participant contributions at end of year | 2014-03-31 | $41,350 |
| Participant contributions at beginning of year | 2014-03-31 | $38,895 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2014-03-31 | $16,803 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2014-03-31 | $123,039 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2014-03-31 | $149,713 |
| Liabilities. Value of operating payables at end of year | 2014-03-31 | $106,571 |
| Liabilities. Value of operating payables at beginning of year | 2014-03-31 | $105,105 |
| Total non interest bearing cash at end of year | 2014-03-31 | $14,706 |
| Total non interest bearing cash at beginning of year | 2014-03-31 | $30,541 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-03-31 | No |
| Value of net income/loss | 2014-03-31 | $-331,673 |
| Value of net assets at end of year (total assets less liabilities) | 2014-03-31 | $-276,417 |
| Value of net assets at beginning of year (total assets less liabilities) | 2014-03-31 | $55,256 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2014-03-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2014-03-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2014-03-31 | No |
| Investment advisory and management fees | 2014-03-31 | $22,895 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2014-03-31 | $472,023 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2014-03-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2014-03-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2014-03-31 | No |
| Contributions received in cash from employer | 2014-03-31 | $1,197,562 |
| Employer contributions (assets) at end of year | 2014-03-31 | $259,770 |
| Employer contributions (assets) at beginning of year | 2014-03-31 | $408,186 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2014-03-31 | $1,514,155 |
| Contract administrator fees | 2014-03-31 | $101,490 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2014-03-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2014-03-31 | $608,711 |
| Liabilities. Value of benefit claims payable at beginning of year | 2014-03-31 | $466,974 |
| Did the plan have assets held for investment | 2014-03-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-03-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2014-03-31 | No |
| 2013 : TRI-STARR MANAGEMENT SERVICES, INC. SEC 125 WELFARE PLAN 2013 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-12-31 | $572,079 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-12-31 | $592,493 |
| Total income from all sources (including contributions) | 2013-12-31 | $6,958,084 |
| Total of all expenses incurred | 2013-12-31 | $6,824,578 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2013-12-31 | $6,296,685 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2013-12-31 | $6,958,084 |
| Value of total assets at end of year | 2013-12-31 | $627,335 |
| Value of total assets at beginning of year | 2013-12-31 | $514,243 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2013-12-31 | $527,893 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2013-12-31 | No |
| Administrative expenses professional fees incurred | 2013-12-31 | $24,511 |
| Was this plan covered by a fidelity bond | 2013-12-31 | Yes |
| Value of fidelity bond cover | 2013-12-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2013-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2013-12-31 | No |
| Contributions received from participants | 2013-12-31 | $2,236,899 |
| Participant contributions at end of year | 2013-12-31 | $38,895 |
| Participant contributions at beginning of year | 2013-12-31 | $36,675 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2013-12-31 | $319,995 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2013-12-31 | $149,713 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2013-12-31 | $332,527 |
| Liabilities. Value of operating payables at end of year | 2013-12-31 | $105,105 |
| Liabilities. Value of operating payables at beginning of year | 2013-12-31 | $114,136 |
| Total non interest bearing cash at end of year | 2013-12-31 | $30,541 |
| Total non interest bearing cash at beginning of year | 2013-12-31 | $7,196 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-12-31 | No |
| Value of net income/loss | 2013-12-31 | $133,506 |
| Value of net assets at end of year (total assets less liabilities) | 2013-12-31 | $55,256 |
| Value of net assets at beginning of year (total assets less liabilities) | 2013-12-31 | $-78,250 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2013-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2013-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2013-12-31 | No |
| Investment advisory and management fees | 2013-12-31 | $90,766 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2013-12-31 | $1,126,798 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2013-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2013-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2013-12-31 | No |
| Contributions received in cash from employer | 2013-12-31 | $4,401,190 |
| Employer contributions (assets) at end of year | 2013-12-31 | $408,186 |
| Employer contributions (assets) at beginning of year | 2013-12-31 | $137,845 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2013-12-31 | $5,169,887 |
| Contract administrator fees | 2013-12-31 | $412,616 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2013-12-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2013-12-31 | $466,974 |
| Liabilities. Value of benefit claims payable at beginning of year | 2013-12-31 | $478,357 |
| Did the plan have assets held for investment | 2013-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2013-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2013-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2013-12-31 | Unqualified |
| Accountancy firm name | 2013-12-31 | ENNIS, PELLUM & ASSOCIATES, CPAS |
| Accountancy firm EIN | 2013-12-31 | 591843700 |
| 2012 : TRI-STARR MANAGEMENT SERVICES, INC. SEC 125 WELFARE PLAN 2012 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-12-31 | $592,493 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-12-31 | $300,097 |
| Total income from all sources (including contributions) | 2012-12-31 | $6,713,338 |
| Total of all expenses incurred | 2012-12-31 | $6,891,856 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2012-12-31 | $6,382,685 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2012-12-31 | $6,713,338 |
| Value of total assets at end of year | 2012-12-31 | $514,243 |
| Value of total assets at beginning of year | 2012-12-31 | $400,365 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2012-12-31 | $509,171 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2012-12-31 | No |
| Administrative expenses professional fees incurred | 2012-12-31 | $16,227 |
| Was this plan covered by a fidelity bond | 2012-12-31 | Yes |
| Value of fidelity bond cover | 2012-12-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2012-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2012-12-31 | No |
| Contributions received from participants | 2012-12-31 | $2,112,321 |
| Participant contributions at end of year | 2012-12-31 | $36,675 |
| Participant contributions at beginning of year | 2012-12-31 | $35,526 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2012-12-31 | $332,527 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2012-12-31 | $332,527 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2012-12-31 | $42,740 |
| Liabilities. Value of operating payables at end of year | 2012-12-31 | $114,136 |
| Liabilities. Value of operating payables at beginning of year | 2012-12-31 | $6,135 |
| Total non interest bearing cash at end of year | 2012-12-31 | $7,196 |
| Total non interest bearing cash at beginning of year | 2012-12-31 | $1,161 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-12-31 | No |
| Value of net income/loss | 2012-12-31 | $-178,518 |
| Value of net assets at end of year (total assets less liabilities) | 2012-12-31 | $-78,250 |
| Value of net assets at beginning of year (total assets less liabilities) | 2012-12-31 | $100,268 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2012-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2012-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2012-12-31 | No |
| Investment advisory and management fees | 2012-12-31 | $92,263 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2012-12-31 | $1,140,625 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2012-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2012-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2012-12-31 | No |
| Contributions received in cash from employer | 2012-12-31 | $4,268,490 |
| Employer contributions (assets) at end of year | 2012-12-31 | $137,845 |
| Employer contributions (assets) at beginning of year | 2012-12-31 | $320,938 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2012-12-31 | $5,242,060 |
| Contract administrator fees | 2012-12-31 | $400,681 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2012-12-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2012-12-31 | $478,357 |
| Liabilities. Value of benefit claims payable at beginning of year | 2012-12-31 | $293,962 |
| Did the plan have assets held for investment | 2012-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2012-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2012-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2012-12-31 | Unqualified |
| Accountancy firm name | 2012-12-31 | ENNIS, PELLUM & ASSOCIATES, CPAS |
| Accountancy firm EIN | 2012-12-31 | 591843700 |
| 2011 : TRI-STARR MANAGEMENT SERVICES, INC. SEC 125 WELFARE PLAN 2011 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-12-31 | $300,097 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-12-31 | $371,846 |
| Total income from all sources (including contributions) | 2011-12-31 | $6,393,738 |
| Total of all expenses incurred | 2011-12-31 | $6,544,698 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2011-12-31 | $6,084,047 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2011-12-31 | $6,393,738 |
| Value of total assets at end of year | 2011-12-31 | $400,365 |
| Value of total assets at beginning of year | 2011-12-31 | $623,074 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2011-12-31 | $460,651 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2011-12-31 | No |
| Administrative expenses professional fees incurred | 2011-12-31 | $19,450 |
| Was this plan covered by a fidelity bond | 2011-12-31 | Yes |
| Value of fidelity bond cover | 2011-12-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2011-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2011-12-31 | No |
| Contributions received from participants | 2011-12-31 | $2,063,978 |
| Participant contributions at end of year | 2011-12-31 | $35,526 |
| Participant contributions at beginning of year | 2011-12-31 | $30,413 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2011-12-31 | $185,283 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2011-12-31 | $42,740 |
| Administrative expenses (other) incurred | 2011-12-31 | $1,772 |
| Liabilities. Value of operating payables at end of year | 2011-12-31 | $6,135 |
| Liabilities. Value of operating payables at beginning of year | 2011-12-31 | $82,803 |
| Total non interest bearing cash at end of year | 2011-12-31 | $1,161 |
| Total non interest bearing cash at beginning of year | 2011-12-31 | $6,550 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-12-31 | No |
| Value of net income/loss | 2011-12-31 | $-150,960 |
| Value of net assets at end of year (total assets less liabilities) | 2011-12-31 | $100,268 |
| Value of net assets at beginning of year (total assets less liabilities) | 2011-12-31 | $251,228 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2011-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2011-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2011-12-31 | No |
| Investment advisory and management fees | 2011-12-31 | $78,358 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2011-12-31 | $2,370,344 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2011-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2011-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2011-12-31 | No |
| Contributions received in cash from employer | 2011-12-31 | $4,144,477 |
| Employer contributions (assets) at end of year | 2011-12-31 | $320,938 |
| Employer contributions (assets) at beginning of year | 2011-12-31 | $586,111 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2011-12-31 | $3,713,703 |
| Contract administrator fees | 2011-12-31 | $361,071 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2011-12-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2011-12-31 | $293,962 |
| Liabilities. Value of benefit claims payable at beginning of year | 2011-12-31 | $289,043 |
| Did the plan have assets held for investment | 2011-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2011-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2011-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2011-12-31 | Unqualified |
| Accountancy firm name | 2011-12-31 | ENNIS, PELLUM & ASSOCIATES, CPAS |
| Accountancy firm EIN | 2011-12-31 | 591843700 |
| 2010 : TRI-STARR MANAGEMENT SERVICES, INC. SEC 125 WELFARE PLAN 2010 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2010-12-31 | $371,846 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2010-12-31 | $555,571 |
| Total income from all sources (including contributions) | 2010-12-31 | $6,523,316 |
| Total of all expenses incurred | 2010-12-31 | $6,234,327 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2010-12-31 | $5,859,280 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2010-12-31 | $6,523,316 |
| Value of total assets at end of year | 2010-12-31 | $623,074 |
| Value of total assets at beginning of year | 2010-12-31 | $517,810 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2010-12-31 | $375,047 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2010-12-31 | No |
| Was this plan covered by a fidelity bond | 2010-12-31 | Yes |
| Value of fidelity bond cover | 2010-12-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2010-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2010-12-31 | No |
| Contributions received from participants | 2010-12-31 | $1,767,192 |
| Participant contributions at end of year | 2010-12-31 | $30,413 |
| Participant contributions at beginning of year | 2010-12-31 | $30,708 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2010-12-31 | $241,267 |
| Administrative expenses (other) incurred | 2010-12-31 | $1,069 |
| Liabilities. Value of operating payables at end of year | 2010-12-31 | $82,803 |
| Liabilities. Value of operating payables at beginning of year | 2010-12-31 | $109,092 |
| Total non interest bearing cash at end of year | 2010-12-31 | $6,550 |
| Total non interest bearing cash at beginning of year | 2010-12-31 | $600 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2010-12-31 | No |
| Value of net income/loss | 2010-12-31 | $288,989 |
| Value of net assets at end of year (total assets less liabilities) | 2010-12-31 | $251,228 |
| Value of net assets at beginning of year (total assets less liabilities) | 2010-12-31 | $-37,761 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2010-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2010-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2010-12-31 | No |
| Investment advisory and management fees | 2010-12-31 | $69,607 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2010-12-31 | $2,492,108 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2010-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2010-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2010-12-31 | No |
| Contributions received in cash from employer | 2010-12-31 | $4,514,857 |
| Employer contributions (assets) at end of year | 2010-12-31 | $586,111 |
| Employer contributions (assets) at beginning of year | 2010-12-31 | $486,502 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2010-12-31 | $3,367,172 |
| Contract administrator fees | 2010-12-31 | $304,371 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2010-12-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2010-12-31 | $289,043 |
| Liabilities. Value of benefit claims payable at beginning of year | 2010-12-31 | $446,479 |
| Did the plan have assets held for investment | 2010-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2010-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2010-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2010-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2010-12-31 | Unqualified |
| Accountancy firm name | 2010-12-31 | ENNIS, PELLUM & ASSOCIATES, CPAS |
| Accountancy firm EIN | 2010-12-31 | 591843700 |
| AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 ) |
| Policy contract number | GROUP HI/GAP |
| Policy instance | 1 |
| Insurance contract or identification number | GROUP HI/GAP | | Number of Individuals Covered | 33 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $1,128 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | SUPPLEMENTAL MEDICAL GAP | | Welfare Benefit Premiums Paid to Carrier | USD $8,052 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,128 | | Insurance broker organization code? | 3 | | Insurance broker name | WILLIS OF TN DBA WILLIS OF FLORIDA |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLX962520 |
| Policy instance | 6 |
| Insurance contract or identification number | FLX962520 | | Number of Individuals Covered | 630 | | Insurance policy start date | 2015-04-01 | | Insurance policy end date | 2016-03-31 | | Total amount of commissions paid to insurance broker | USD $28,744 | | Total amount of fees paid to insurance company | USD $2,479 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $191,629 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $28,744 | | Amount paid for insurance broker fees | 2479 | | Additional information about fees paid to insurance broker | OVERRIDE | | Insurance broker organization code? | 3 | | Insurance broker name | WILLIS OF FLORIDA INC |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | OK964153 |
| Policy instance | 5 |
| Insurance contract or identification number | OK964153 | | Number of Individuals Covered | 1128 | | Insurance policy start date | 2015-04-01 | | Insurance policy end date | 2016-03-31 | | Total amount of commissions paid to insurance broker | USD $990 | | Total amount of fees paid to insurance company | USD $86 | | Other welfare benefits provided | ACCIDENTAL DEATH | | Welfare Benefit Premiums Paid to Carrier | USD $6,600 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $990 | | Amount paid for insurance broker fees | 86 | | Additional information about fees paid to insurance broker | OVERRIDE | | Insurance broker organization code? | 3 | | Insurance broker name | WILLIS OF FLORIDA INC |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | LK750577 |
| Policy instance | 4 |
| Insurance contract or identification number | LK750577 | | Number of Individuals Covered | 577 | | Insurance policy start date | 2015-04-01 | | Insurance policy end date | 2016-03-31 | | Total amount of commissions paid to insurance broker | USD $34,303 | | Total amount of fees paid to insurance company | USD $2,904 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $228,687 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $34,303 | | Amount paid for insurance broker fees | 2904 | | Additional information about fees paid to insurance broker | OVERRIDE | | Insurance broker organization code? | 3 | | Insurance broker name | WILLIS OF FLORIDA INC |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | LK961850 |
| Policy instance | 3 |
| Insurance contract or identification number | LK961850 | | Number of Individuals Covered | 577 | | Insurance policy start date | 2015-04-01 | | Insurance policy end date | 2016-03-31 | | Total amount of commissions paid to insurance broker | USD $15,980 | | Total amount of fees paid to insurance company | USD $1,826 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $106,536 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $15,980 | | Amount paid for insurance broker fees | 1826 | | Additional information about fees paid to insurance broker | OVERRIDE | | Insurance broker organization code? | 3 | | Insurance broker name | WILLIS OF FLORIDA INC |
|
| BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 ) |
| Policy contract number | 405523-0010 |
| Policy instance | 2 |
| Insurance contract or identification number | 405523-0010 | | Number of Individuals Covered | 957 | | Insurance policy start date | 2015-04-01 | | Insurance policy end date | 2016-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $732,643 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $0 | | Insurance broker organization code? | 3 | | Insurance broker name | WILLIS OF FLORIDA |
|
| HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | 404060-0010 |
| Policy instance | 2 |
| Insurance contract or identification number | 404060-0010 | | Number of Individuals Covered | 1124 | | Insurance policy start date | 2014-04-01 | | Insurance policy end date | 2015-03-31 | | Welfare Benefit Premiums Paid to Carrier | USD $968,642 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | LK961850 |
| Policy instance | 3 |
| Insurance contract or identification number | LK961850 | | Number of Individuals Covered | 796 | | Insurance policy start date | 2014-04-01 | | Insurance policy end date | 2015-03-31 | | Total amount of commissions paid to insurance broker | USD $19,571 | | Total amount of fees paid to insurance company | USD $803 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $130,475 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $19,571 | | Amount paid for insurance broker fees | 803 | | Additional information about fees paid to insurance broker | OVERRIDE | | Insurance broker organization code? | 3 | | Insurance broker name | WILLIS OF FLORIDA INC |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | LK750577 |
| Policy instance | 4 |
| Insurance contract or identification number | LK750577 | | Number of Individuals Covered | 796 | | Insurance policy start date | 2014-04-01 | | Insurance policy end date | 2015-03-31 | | Total amount of commissions paid to insurance broker | USD $44,869 | | Total amount of fees paid to insurance company | USD $2,031 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $299,128 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $44,869 | | Amount paid for insurance broker fees | 2031 | | Additional information about fees paid to insurance broker | OVERRIDE | | Insurance broker organization code? | 3 | | Insurance broker name | WILLIS OF FLORIDA INC |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | OK964153 |
| Policy instance | 5 |
| Insurance contract or identification number | OK964153 | | Number of Individuals Covered | 1376 | | Insurance policy start date | 2014-04-01 | | Insurance policy end date | 2015-03-31 | | Total amount of commissions paid to insurance broker | USD $1,125 | | Total amount of fees paid to insurance company | USD $45 | | Other welfare benefits provided | ACCIDENTAL DEATH | | Welfare Benefit Premiums Paid to Carrier | USD $7,502 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,125 | | Amount paid for insurance broker fees | 45 | | Additional information about fees paid to insurance broker | OVERRIDE | | Insurance broker organization code? | 3 | | Insurance broker name | WILLIS OF FLORIDA, INC. |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLX962520 |
| Policy instance | 6 |
| Insurance contract or identification number | FLX962520 | | Number of Individuals Covered | 738 | | Insurance policy start date | 2014-04-01 | | Insurance policy end date | 2015-03-31 | | Total amount of commissions paid to insurance broker | USD $31,399 | | Total amount of fees paid to insurance company | USD $956 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $209,327 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $31,399 | | Amount paid for insurance broker fees | 956 | | Additional information about fees paid to insurance broker | OVERRIDE | | Insurance broker organization code? | 3 | | Insurance broker name | WILLIS OF FLORIDA, INC. |
|
| AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 ) |
| Policy contract number | GROUP HI/GAP |
| Policy instance | 1 |
| Insurance contract or identification number | GROUP HI/GAP | | Number of Individuals Covered | 34 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $1,141 | | Other welfare benefits provided | SUPPLEMENTAL MEDICAL (GAP) | | Welfare Benefit Premiums Paid to Carrier | USD $8,147 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,141 | | Insurance broker organization code? | 3 | | Insurance broker name | WILLIS OF TN DBA WILLIS OF FLORIDA |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | LK961850 |
| Policy instance | 1 |
| Insurance contract or identification number | LK961850 | | Number of Individuals Covered | 657 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-03-31 | | Total amount of commissions paid to insurance broker | USD $4,022 | | Total amount of fees paid to insurance company | USD $33 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $26,812 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,022 | | Amount paid for insurance broker fees | 33 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMMISSION | | Insurance broker organization code? | 3 | | Insurance broker name | WILLIS OF FLORIDA, INC. |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | OK964153 |
| Policy instance | 2 |
| Insurance contract or identification number | OK964153 | | Number of Individuals Covered | 945 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-03-31 | | Total amount of commissions paid to insurance broker | USD $216 | | Total amount of fees paid to insurance company | USD $2 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | ACCIDENTAL DEATH | | Welfare Benefit Premiums Paid to Carrier | USD $1,443 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $216 | | Amount paid for insurance broker fees | 2 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMMISSION | | Insurance broker organization code? | 3 | | Insurance broker name | WILLIS OF FLORIDA, INC. |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLX962520 |
| Policy instance | 4 |
| Insurance contract or identification number | FLX962520 | | Number of Individuals Covered | 544 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-03-31 | | Total amount of commissions paid to insurance broker | USD $4,631 | | Total amount of fees paid to insurance company | USD $42 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $30,875 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,631 | | Amount paid for insurance broker fees | 42 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMMISSION | | Insurance broker organization code? | 3 | | Insurance broker name | WILLIS OF FLORIDA, INC. |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | LK750577 |
| Policy instance | 3 |
| Insurance contract or identification number | LK750577 | | Number of Individuals Covered | 657 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-03-31 | | Total amount of commissions paid to insurance broker | USD $10,159 | | Total amount of fees paid to insurance company | USD $85 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $67,729 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,159 | | Amount paid for insurance broker fees | 85 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMMISSION | | Insurance broker organization code? | 3 | | Insurance broker name | WILLIS OF FLORIDA, INC. |
|
| HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | 404060-0010 |
| Policy instance | 5 |
| Insurance contract or identification number | 404060-0010 | | Number of Individuals Covered | 773 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $146,879 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | 404060-0010 |
| Policy instance | 6 |
| Insurance contract or identification number | 404060-0010 | | Number of Individuals Covered | 762 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $597,158 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | LK750577 |
| Policy instance | 4 |
| Insurance contract or identification number | LK750577 | | Number of Individuals Covered | 651 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $40,670 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $271,133 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $40,670 | | Insurance broker organization code? | 3 | | Insurance broker name | WILLIS OF FLORIDA INC |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | OK964153 |
| Policy instance | 3 |
| Insurance contract or identification number | OK964153 | | Number of Individuals Covered | 976 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $889 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | ACCIDENTAL DEATH | | Welfare Benefit Premiums Paid to Carrier | USD $5,928 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $889 | | Insurance broker organization code? | 3 | | Insurance broker name | WILLIS OF FLORIDA INC |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | LK961850 |
| Policy instance | 2 |
| Insurance contract or identification number | LK961850 | | Number of Individuals Covered | 662 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $16,071 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $107,142 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $16,071 | | Insurance broker organization code? | 3 | | Insurance broker name | WILLIS OF FLORIDA INC |
|
| AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 ) |
| Policy contract number | GROUP HI/GAP |
| Policy instance | 1 |
| Insurance contract or identification number | GROUP HI/GAP | | Number of Individuals Covered | 34 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $1,452 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | HOSPITAL GAP PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $10,360 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,452 | | Insurance broker organization code? | 3 | | Insurance broker name | WILLIS OF FLORIDA |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLX962520 |
| Policy instance | 5 |
| Insurance contract or identification number | FLX962520 | | Number of Individuals Covered | 552 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $19,315 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $128,765 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $19,315 | | Insurance broker organization code? | 3 | | Insurance broker name | WILLIS OF FLORIDA INC |
|
| HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | 404060-0010 |
| Policy instance | 6 |
| Insurance contract or identification number | 404060-0010 | | Number of Individuals Covered | 781 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $505,814 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 ) |
| Policy contract number | GROUP HI/GAP |
| Policy instance | 1 |
| Insurance contract or identification number | GROUP HI/GAP | | Number of Individuals Covered | 140 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $5,642 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | HOSPITAL GAP PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $40,273 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,642 | | Insurance broker organization code? | 3 | | Insurance broker name | WILLIS OF FLORIDA |
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| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLX962520 |
| Policy instance | 5 |
| Insurance contract or identification number | FLX962520 | | Number of Individuals Covered | 709 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $22,337 | | Total amount of fees paid to insurance company | USD $350 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $141,526 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $22,337 | | Amount paid for insurance broker fees | 350 | | Additional information about fees paid to insurance broker | MISC. COMMISSION FEES | | Insurance broker organization code? | 3 | | Insurance broker name | WILLIS OF FLORIDA |
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| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | LK750577 |
| Policy instance | 4 |
| Insurance contract or identification number | LK750577 | | Number of Individuals Covered | 676 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $43,244 | | Total amount of fees paid to insurance company | USD $691 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $274,480 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $43,244 | | Amount paid for insurance broker fees | 691 | | Additional information about fees paid to insurance broker | MISC. COMMISSION FEES | | Insurance broker organization code? | 3 | | Insurance broker name | WILLIS OF FLORIDA |
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| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | OK964153 |
| Policy instance | 3 |
| Insurance contract or identification number | OK964153 | | Number of Individuals Covered | 1009 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $871 | | Total amount of fees paid to insurance company | USD $14 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | MEDICAL INDEMNITY, ACCIDENTAL DEATH | | Welfare Benefit Premiums Paid to Carrier | USD $5,535 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $871 | | Amount paid for insurance broker fees | 14 | | Additional information about fees paid to insurance broker | MISC. COMMISSION FEES | | Insurance broker organization code? | 3 | | Insurance broker name | WILLIS OF FLORIDA |
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| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | LK961850 |
| Policy instance | 2 |
| Insurance contract or identification number | LK961850 | | Number of Individuals Covered | 682 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $16,805 | | Total amount of fees paid to insurance company | USD $269 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $106,614 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $16,805 | | Amount paid for insurance broker fees | 269 | | Additional information about fees paid to insurance broker | MISC. COMMISSION FEES | | Insurance broker organization code? | 3 | | Insurance broker name | WILLIS OF FLORIDA |
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| AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 ) |
| Policy contract number | GROUP HI/GAP |
| Policy instance | 2 |
| Insurance contract or identification number | GROUP HI/GAP | | Number of Individuals Covered | 257 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $8,680 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | HOSPITAL GAP PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $61,958 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| GENWORTH LIFE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 63401 ) |
| Policy contract number | D0000456 |
| Policy instance | 3 |
| Insurance contract or identification number | D0000456 | | Number of Individuals Covered | 8 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,275 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | LK961850 |
| Policy instance | 4 |
| Insurance contract or identification number | LK961850 | | Number of Individuals Covered | 709 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $17,820 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $111,502 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | OK964153 |
| Policy instance | 5 |
| Insurance contract or identification number | OK964153 | | Number of Individuals Covered | 981 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $901 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | MEDICAL INDEMNITY, ACCIDENTAL DEATH | | Welfare Benefit Premiums Paid to Carrier | USD $5,640 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | LK750577 |
| Policy instance | 6 |
| Insurance contract or identification number | LK750577 | | Number of Individuals Covered | 697 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $39,122 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $245,077 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| BCS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 38245 ) |
| Policy contract number | EXL-30120 |
| Policy instance | 1 |
| Insurance contract or identification number | EXL-30120 | | Number of Individuals Covered | 676 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $398,996 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLX962520 |
| Policy instance | 7 |
| Insurance contract or identification number | FLX962520 | | Number of Individuals Covered | 765 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $29,829 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $186,296 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | OK964153 |
| Policy instance | 7 |
| Insurance contract or identification number | OK964153 | | Number of Individuals Covered | 950 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $792 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,363 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $792 | | Insurance broker organization code? | 3 | | Insurance broker name | WILLIS OF FLORIDA |
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| BCS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 38245 ) |
| Policy contract number | EXL-30126 |
| Policy instance | 1 |
| Insurance contract or identification number | EXL-30126 | | Number of Individuals Covered | 563 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $289,786 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 ) |
| Policy contract number | G-908B |
| Policy instance | 2 |
| Insurance contract or identification number | G-908B | | Number of Individuals Covered | 158 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $9,437 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | HOSPITAL GAP PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $67,363 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,437 | | Insurance broker organization code? | 3 | | Insurance broker name | WILLIS OF FLORIDA |
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| GOLDEN WEST HEALTH PLAN, INC. (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | NP9535 |
| Policy instance | 3 |
| Insurance contract or identification number | NP9535 | | Number of Individuals Covered | 30 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $240 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,023 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $240 | | Insurance broker organization code? | 3 | | Insurance broker name | WILLIS OF FLORIDA |
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| CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 ) |
| Policy contract number | H53902 |
| Policy instance | 4 |
| Insurance contract or identification number | H53902 | | Number of Individuals Covered | 102 | | Insurance policy start date | 2009-06-01 | | Insurance policy end date | 2010-05-31 | | Total amount of commissions paid to insurance broker | USD $15,733 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $113,311 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $15,733 | | Insurance broker organization code? | 3 | | Insurance broker name | WILLIS OF FLORIDA |
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| GENWORTH LIFE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 63401 ) |
| Policy contract number | D0000456 |
| Policy instance | 5 |
| Insurance contract or identification number | D0000456 | | Number of Individuals Covered | 8 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,738 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLX962520 |
| Policy instance | 9 |
| Insurance contract or identification number | FLX962520 | | Number of Individuals Covered | 856 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $26,166 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $177,379 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $26,166 | | Insurance broker organization code? | 3 | | Insurance broker name | WILLIS OF FLORIDA |
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| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | LK750577 |
| Policy instance | 8 |
| Insurance contract or identification number | LK750577 | | Number of Individuals Covered | 583 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $30,789 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $228,106 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $30,789 | | Insurance broker organization code? | 3 | | Insurance broker name | WILLIS OF FLORIDA |
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| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | LK961850 |
| Policy instance | 6 |
| Insurance contract or identification number | 141599 | | Number of Individuals Covered | 163 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $3,059 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,059 | | Insurance broker organization code? | 3 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $102,009 | | Insurance broker name | WILLIS OF FLORIDA |
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