COLLOM & CARNEY CLINIC ASSOCIATION has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan COLLOM & CARNEY CLINIC ASSOCIATION HEALTH INSURANCE PLAN
401k plan membership statisitcs for COLLOM & CARNEY CLINIC ASSOCIATION HEALTH INSURANCE PLAN
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GUC 0BRFT |
Policy instance | 3 |
Insurance contract or identification number | GUC 0BRFT | Number of Individuals Covered | 293 | Insurance policy start date | 2021-08-01 | Insurance policy end date | 2022-08-01 | Total amount of commissions paid to insurance broker | USD $10,736 | Total amount of fees paid to insurance company | USD $5,129 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $71,573 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $10,736 | Amount paid for insurance broker fees | 4245 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
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QBE A&H (National Association of Insurance Commissioners NAIC id number: 39217 ) |
Policy contract number | LGS01105-21 |
Policy instance | 1 |
Insurance contract or identification number | LGS01105-21 | Number of Individuals Covered | 429 | Insurance policy start date | 2021-08-01 | Insurance policy end date | 2022-07-31 | Welfare Benefit Premiums Paid to Carrier | USD $148,073 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GLUG0BRFT |
Policy instance | 2 |
Insurance contract or identification number | GLUG0BRFT | Number of Individuals Covered | 476 | Insurance policy start date | 2021-08-01 | Insurance policy end date | 2022-08-01 | Total amount of fees paid to insurance company | USD $1,445 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $20,223 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 1196 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
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AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
Policy contract number | 010-053920 |
Policy instance | 8 |
Insurance contract or identification number | 010-053920 | Number of Individuals Covered | 752 | Insurance policy start date | 2021-08-01 | Insurance policy end date | 2022-07-31 | Total amount of commissions paid to insurance broker | USD $20,907 | Total amount of fees paid to insurance company | USD $1,113 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $209,065 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $20,907 | Amount paid for insurance broker fees | 1113 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GUDE0BRFT |
Policy instance | 4 |
Insurance contract or identification number | GUDE0BRFT | Number of Individuals Covered | 339 | Insurance policy start date | 2021-08-01 | Insurance policy end date | 2022-08-01 | Total amount of commissions paid to insurance broker | USD $12,468 | Total amount of fees paid to insurance company | USD $6,037 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $83,120 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $12,468 | Amount paid for insurance broker fees | 4996 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GUPR0BRFT |
Policy instance | 5 |
Insurance contract or identification number | GUPR0BRFT | Number of Individuals Covered | 293 | Insurance policy start date | 2021-08-01 | Insurance policy end date | 2022-08-01 | Total amount of commissions paid to insurance broker | USD $8,054 | Total amount of fees paid to insurance company | USD $3,863 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $53,695 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8,054 | Amount paid for insurance broker fees | 3197 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GVTL0BRFT |
Policy instance | 6 |
Insurance contract or identification number | GVTL0BRFT | Number of Individuals Covered | 307 | Insurance policy start date | 2021-08-01 | Insurance policy end date | 2022-08-01 | Total amount of commissions paid to insurance broker | USD $20,944 | Total amount of fees paid to insurance company | USD $9,766 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $139,629 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $20,944 | Amount paid for insurance broker fees | 8082 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
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CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 ) |
Policy contract number | 27096 |
Policy instance | 7 |
Insurance contract or identification number | 27096 | Number of Individuals Covered | 280 | Insurance policy start date | 2021-08-01 | Insurance policy end date | 2022-07-31 | Total amount of commissions paid to insurance broker | USD $14,021 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $53,969 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $14,021 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GUC 0BRFT |
Policy instance | 3 |
Insurance contract or identification number | GUC 0BRFT | Number of Individuals Covered | 282 | Insurance policy start date | 2020-08-01 | Insurance policy end date | 2021-08-01 | Total amount of commissions paid to insurance broker | USD $10,789 | Total amount of fees paid to insurance company | USD $1,447 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $71,924 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $10,789 | Amount paid for insurance broker fees | 1066 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GLUG0BRFT |
Policy instance | 2 |
Insurance contract or identification number | GLUG0BRFT | Number of Individuals Covered | 459 | Insurance policy start date | 2020-08-01 | Insurance policy end date | 2021-08-01 | Total amount of fees paid to insurance company | USD $384 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $19,832 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 283 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
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QBE A&H (National Association of Insurance Commissioners NAIC id number: 39217 ) |
Policy contract number | LGS01105-20 |
Policy instance | 1 |
Insurance contract or identification number | LGS01105-20 | Number of Individuals Covered | 441 | Insurance policy start date | 2020-08-01 | Insurance policy end date | 2021-07-31 | Welfare Benefit Premiums Paid to Carrier | USD $129,777 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GUDE0BRFT |
Policy instance | 4 |
Insurance contract or identification number | GUDE0BRFT | Number of Individuals Covered | 212 | Insurance policy start date | 2020-08-01 | Insurance policy end date | 2021-08-01 | Total amount of commissions paid to insurance broker | USD $12,508 | Total amount of fees paid to insurance company | USD $1,546 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $83,385 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $12,508 | Amount paid for insurance broker fees | 1139 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GVTL0BRFT |
Policy instance | 6 |
Insurance contract or identification number | GVTL0BRFT | Number of Individuals Covered | 294 | Insurance policy start date | 2020-08-01 | Insurance policy end date | 2021-08-01 | Total amount of commissions paid to insurance broker | USD $19,922 | Total amount of fees paid to insurance company | USD $2,717 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $132,817 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $19,922 | Amount paid for insurance broker fees | 2002 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
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AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
Policy contract number | 010-053920 |
Policy instance | 8 |
Insurance contract or identification number | 010-053920 | Number of Individuals Covered | 739 | Insurance policy start date | 2020-08-01 | Insurance policy end date | 2021-07-31 | Total amount of commissions paid to insurance broker | USD $21,254 | Total amount of fees paid to insurance company | USD $4,329 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $212,544 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $21,254 | Amount paid for insurance broker fees | 4329 | Insurance broker organization code? | 3 |
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CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 ) |
Policy contract number | 27096 |
Policy instance | 7 |
Insurance contract or identification number | 27096 | Number of Individuals Covered | 236 | Insurance policy start date | 2020-08-01 | Insurance policy end date | 2021-07-31 | Total amount of commissions paid to insurance broker | USD $10,044 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $68,708 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $10,044 | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GUPR0BRFT |
Policy instance | 5 |
Insurance contract or identification number | GUPR0BRFT | Number of Individuals Covered | 282 | Insurance policy start date | 2020-08-01 | Insurance policy end date | 2021-08-01 | Total amount of commissions paid to insurance broker | USD $8,147 | Total amount of fees paid to insurance company | USD $945 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $54,311 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8,147 | Amount paid for insurance broker fees | 696 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
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KANSAS CITY LIFE (National Association of Insurance Commissioners NAIC id number: 65129 ) |
Policy contract number | MS6 90MS6-I1.1 |
Policy instance | 6 |
Insurance contract or identification number | MS6 90MS6-I1.1 | Number of Individuals Covered | 315 | Insurance policy start date | 2019-08-01 | Insurance policy end date | 2020-07-31 | Total amount of commissions paid to insurance broker | USD $22,504 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $225,031 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $11,252 | Insurance broker organization code? | 3 |
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AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | 82-2723296 |
Policy instance | 2 |
Insurance contract or identification number | 82-2723296 | Number of Individuals Covered | 223 | Insurance policy start date | 2019-08-01 | Insurance policy end date | 2020-07-31 | Total amount of commissions paid to insurance broker | USD $22,305 | Total amount of fees paid to insurance company | USD $665 | Health Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $145,950 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $10,825 | Amount paid for insurance broker fees | 475 | Insurance broker organization code? | 3 |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 468351 |
Policy instance | 5 |
Insurance contract or identification number | 468351 | Number of Individuals Covered | 431 | Insurance policy start date | 2019-08-01 | Insurance policy end date | 2020-08-01 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $23,354 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 467995 |
Policy instance | 4 |
Insurance contract or identification number | 467995 | Number of Individuals Covered | 233 | Insurance policy start date | 2019-08-01 | Insurance policy end date | 2020-08-01 | Total amount of commissions paid to insurance broker | USD $10,671 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $98,249 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $9,825 | Insurance broker organization code? | 3 |
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QBE A&H (National Association of Insurance Commissioners NAIC id number: 39217 ) |
Policy contract number | LGS01105-19 |
Policy instance | 3 |
Insurance contract or identification number | LGS01105-19 | Number of Individuals Covered | 445 | Insurance policy start date | 2019-08-01 | Insurance policy end date | 2020-07-31 | Welfare Benefit Premiums Paid to Carrier | USD $114,628 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 595879 |
Policy instance | 1 |
Insurance contract or identification number | 595879 | Number of Individuals Covered | 263 | Insurance policy start date | 2019-08-01 | Insurance policy end date | 2020-08-01 | Total amount of commissions paid to insurance broker | USD $8,107 | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $107,561 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,876 | Insurance broker organization code? | 3 |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 467995 |
Policy instance | 4 |
Insurance contract or identification number | 467995 | Number of Individuals Covered | 270 | Insurance policy start date | 2018-08-01 | Insurance policy end date | 2019-08-01 | Total amount of commissions paid to insurance broker | USD $10,808 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $108,075 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $10,808 | Insurance broker organization code? | 3 |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 595879 |
Policy instance | 1 |
Insurance contract or identification number | 595879 | Number of Individuals Covered | 305 | Insurance policy start date | 2018-08-01 | Insurance policy end date | 2019-08-01 | Total amount of commissions paid to insurance broker | USD $8,147 | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $119,657 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8,147 | Insurance broker organization code? | 3 |
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AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | 82-2723296 |
Policy instance | 2 |
Insurance contract or identification number | 82-2723296 | Number of Individuals Covered | 253 | Insurance policy start date | 2018-08-01 | Insurance policy end date | 2019-07-31 | Total amount of commissions paid to insurance broker | USD $27,370 | Total amount of fees paid to insurance company | USD $728 | Health Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $162,444 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $13,848 | Amount paid for insurance broker fees | 520 | Insurance broker organization code? | 3 |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 468351 |
Policy instance | 5 |
Insurance contract or identification number | 468351 | Number of Individuals Covered | 498 | Insurance policy start date | 2018-08-01 | Insurance policy end date | 2019-08-01 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $26,106 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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QBE A&H (National Association of Insurance Commissioners NAIC id number: 39217 ) |
Policy contract number | LGS01105-18 |
Policy instance | 3 |
Insurance contract or identification number | LGS01105-18 | Number of Individuals Covered | 5606 | Insurance policy start date | 2018-08-01 | Insurance policy end date | 2019-07-31 | Welfare Benefit Premiums Paid to Carrier | USD $102,253 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 468351 |
Policy instance | 5 |
Insurance contract or identification number | 468351 | Number of Individuals Covered | 540 | Insurance policy start date | 2017-08-01 | Insurance policy end date | 2018-08-01 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $24,634 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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QBE A&H (National Association of Insurance Commissioners NAIC id number: 39217 ) |
Policy contract number | LGS01105-17 |
Policy instance | 3 |
Insurance contract or identification number | LGS01105-17 | Number of Individuals Covered | 498 | Insurance policy start date | 2017-08-01 | Insurance policy end date | 2018-07-31 | Total amount of commissions paid to insurance broker | USD $11,253 | Welfare Benefit Premiums Paid to Carrier | USD $112,528 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $11,253 | Insurance broker organization code? | 3 |
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AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | 82-2723296 |
Policy instance | 2 |
Insurance contract or identification number | 82-2723296 | Number of Individuals Covered | 253 | Insurance policy start date | 2017-08-01 | Insurance policy end date | 2018-07-31 | Total amount of commissions paid to insurance broker | USD $52,843 | Total amount of fees paid to insurance company | USD $999 | Health Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $320,850 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $25,818 | Amount paid for insurance broker fees | 693 | Insurance broker organization code? | 3 |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 595879 |
Policy instance | 1 |
Insurance contract or identification number | 595879 | Number of Individuals Covered | 336 | Insurance policy start date | 2017-08-01 | Insurance policy end date | 2018-08-01 | Total amount of commissions paid to insurance broker | USD $8,203 | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $114,593 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8,203 | Insurance broker organization code? | 3 |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 467995 |
Policy instance | 4 |
Insurance contract or identification number | 467995 | Number of Individuals Covered | 294 | Insurance policy start date | 2017-08-01 | Insurance policy end date | 2018-08-01 | Total amount of commissions paid to insurance broker | USD $11,239 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $102,062 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $11,239 | Insurance broker organization code? | 3 |
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QBE A&H (National Association of Insurance Commissioners NAIC id number: 39217 ) |
Policy contract number | LGS01105-16 |
Policy instance | 3 |
Insurance contract or identification number | LGS01105-16 | Number of Individuals Covered | 516 | Insurance policy start date | 2016-08-01 | Insurance policy end date | 2017-07-31 | Total amount of commissions paid to insurance broker | USD $11,468 | Welfare Benefit Premiums Paid to Carrier | USD $114,682 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $11,468 | Insurance broker name | BLUEADVANTAGE ADMINISTRATORS OF ARK |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 467995 |
Policy instance | 4 |
Insurance contract or identification number | 467995 | Number of Individuals Covered | 299 | Insurance policy start date | 2016-08-01 | Insurance policy end date | 2017-08-01 | Total amount of commissions paid to insurance broker | USD $11,903 | Total amount of fees paid to insurance company | USD $621 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $129,355 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,936 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 621 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION PAID | Insurance broker name | PERRY HALL |
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AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | 82-2723296 |
Policy instance | 2 |
Insurance contract or identification number | 82-2723296 | Number of Individuals Covered | 281 | Insurance policy start date | 2016-08-01 | Insurance policy end date | 2017-07-31 | Total amount of commissions paid to insurance broker | USD $27,380 | Total amount of fees paid to insurance company | USD $820 | Health Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $177,674 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $11,095 | Amount paid for insurance broker fees | 559 | Insurance broker organization code? | 3 | Insurance broker name | VICKIE HENDERSON |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 595879 |
Policy instance | 1 |
Insurance contract or identification number | 595879 | Number of Individuals Covered | 339 | Insurance policy start date | 2016-08-01 | Insurance policy end date | 2017-08-01 | Total amount of commissions paid to insurance broker | USD $8,234 | Total amount of fees paid to insurance company | USD $661 | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $139,174 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,321 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 661 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION PAID | Insurance broker name | PERRY HALL |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 468351 |
Policy instance | 5 |
Insurance contract or identification number | 468351 | Number of Individuals Covered | 558 | Insurance policy start date | 2016-08-01 | Insurance policy end date | 2017-08-01 | Total amount of fees paid to insurance company | USD $147 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $30,560 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 147 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION PAID | Insurance broker organization code? | 3 | Insurance broker name | PERRY B HALL |
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COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E9173626 |
Policy instance | 1 |
Insurance contract or identification number | E9173626 | Number of Individuals Covered | 2 | Insurance policy start date | 2014-08-01 | Insurance policy end date | 2015-07-31 | Total amount of commissions paid to insurance broker | USD $49 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,421 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $24 | Insurance broker organization code? | 3 | Insurance broker name | TAMMIE PEARSON |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 595879 |
Policy instance | 2 |
Insurance contract or identification number | 595879 | Number of Individuals Covered | 301 | Insurance policy start date | 2014-08-01 | Insurance policy end date | 2015-08-01 | Total amount of commissions paid to insurance broker | USD $8,082 | Total amount of fees paid to insurance company | USD $469 | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $134,000 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,041 | Amount paid for insurance broker fees | 469 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION PAID | Insurance broker organization code? | 3 | Insurance broker name | LINDA ROGERS |
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AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | F8265 |
Policy instance | 3 |
Insurance contract or identification number | F8265 | Number of Individuals Covered | 288 | Insurance policy start date | 2014-08-01 | Insurance policy end date | 2015-07-31 | Total amount of commissions paid to insurance broker | USD $37,877 | Total amount of fees paid to insurance company | USD $1,192 | Health Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $202,788 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $15,095 | Amount paid for insurance broker fees | 643 | Insurance broker organization code? | 3 | Insurance broker name | MARK LEE |
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QBE A&H (National Association of Insurance Commissioners NAIC id number: 39217 ) |
Policy contract number | LGS01105-14 |
Policy instance | 4 |
Insurance contract or identification number | LGS01105-14 | Number of Individuals Covered | 495 | Insurance policy start date | 2014-08-01 | Insurance policy end date | 2015-07-31 | Total amount of commissions paid to insurance broker | USD $12,688 | Welfare Benefit Premiums Paid to Carrier | USD $126,883 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $12,688 | Insurance broker organization code? | 3 | Insurance broker name | BLUEADVANTAGE ADMINISTRATORS OF AR |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 467995 |
Policy instance | 5 |
Insurance contract or identification number | 467995 | Number of Individuals Covered | 275 | Insurance policy start date | 2014-12-01 | Insurance policy end date | 2015-08-01 | Total amount of commissions paid to insurance broker | USD $6,708 | Total amount of fees paid to insurance company | USD $671 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $76,103 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,354 | Amount paid for insurance broker fees | 671 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION PAID | Insurance broker organization code? | 3 | Insurance broker name | LINDA ROGERS |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 468351 |
Policy instance | 6 |
Insurance contract or identification number | 468351 | Number of Individuals Covered | 518 | Insurance policy start date | 2014-12-01 | Insurance policy end date | 2015-08-01 | Total amount of fees paid to insurance company | USD $177 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $19,994 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 177 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION PAID | Insurance broker organization code? | 3 | Insurance broker name | PERRY HALL |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 595879 |
Policy instance | 2 |
Insurance contract or identification number | 595879 | Number of Individuals Covered | 235 | Insurance policy start date | 2013-08-01 | Insurance policy end date | 2014-08-01 | Total amount of commissions paid to insurance broker | USD $8,266 | Total amount of fees paid to insurance company | USD $561 | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $138,459 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,133 | Amount paid for insurance broker fees | 561 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION PAID | Insurance broker organization code? | 3 | Insurance broker name | LINDA ROGERS |
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COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E9173626 |
Policy instance | 1 |
Insurance contract or identification number | E9173626 | Number of Individuals Covered | 3 | Insurance policy start date | 2013-08-01 | Insurance policy end date | 2014-07-31 | Total amount of commissions paid to insurance broker | USD $57 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,618 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $23 | Insurance broker organization code? | 3 | Insurance broker name | TAMMIE PEARSON |
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EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
Policy contract number | SL10000059-121 |
Policy instance | 5 |
Insurance contract or identification number | SL10000059-121 | Number of Individuals Covered | 489 | Insurance policy start date | 2013-08-01 | Insurance policy end date | 2014-07-31 | Total amount of commissions paid to insurance broker | USD $11,307 | Welfare Benefit Premiums Paid to Carrier | USD $113,068 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $11,307 | Insurance broker organization code? | 3 | Insurance broker name | GROUP SERVICE UNDERWRITERS INC |
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USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
Policy contract number | 50006029 |
Policy instance | 3 |
Insurance contract or identification number | 50006029 | Number of Individuals Covered | 520 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-11-30 | Total amount of commissions paid to insurance broker | USD $4,212 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $36,830 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,685 | Insurance broker organization code? | 3 | Insurance broker name | CHRISTOPHER SHUMAKE |
|
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | F8265 |
Policy instance | 4 |
Insurance contract or identification number | F8265 | Number of Individuals Covered | 305 | Insurance policy start date | 2013-08-01 | Insurance policy end date | 2014-07-31 | Total amount of commissions paid to insurance broker | USD $34,821 | Total amount of fees paid to insurance company | USD $330 | Health Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $193,809 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $13,716 | Amount paid for insurance broker fees | 177 | Insurance broker organization code? | 3 | Insurance broker name | MARK LEE |
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USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
Policy contract number | 50006029 |
Policy instance | 7 |
Insurance contract or identification number | 50006029 | Number of Individuals Covered | 467 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-11-30 | Total amount of commissions paid to insurance broker | USD $17,921 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | VOL GROUP LIFE | Welfare Benefit Premiums Paid to Carrier | USD $75,541 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $11,338 | Insurance broker organization code? | 3 | Insurance broker name | CHRISTOPHER SHUMAKE |
|
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
Policy contract number | 50006029 |
Policy instance | 6 |
Insurance contract or identification number | 50006029 | Number of Individuals Covered | 336 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-11-30 | Total amount of commissions paid to insurance broker | USD $1,928 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | VOL AD&D | Welfare Benefit Premiums Paid to Carrier | USD $8,065 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,220 | Insurance broker organization code? | 3 | Insurance broker name | CHRISTOPHER SHUMAKE |
|
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E9173626 |
Policy instance | 1 |
Insurance contract or identification number | E9173626 | Number of Individuals Covered | 3 | Insurance policy start date | 2012-08-01 | Insurance policy end date | 2013-07-31 | Total amount of commissions paid to insurance broker | USD $59 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $24 | Insurance broker organization code? | 3 | Insurance broker name | TAMMIE PEARSON |
|
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
Policy contract number | 50006029 |
Policy instance | 7 |
Insurance contract or identification number | 50006029 | Number of Individuals Covered | 409 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $18,159 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | VOL GROUP LIFE | Welfare Benefit Premiums Paid to Carrier | USD $86,470 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $12,971 | Insurance broker organization code? | 3 | Insurance broker name | CLIFFORD FARMER |
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AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | F8265 |
Policy instance | 4 |
Insurance contract or identification number | F8265 | Number of Individuals Covered | 292 | Insurance policy start date | 2012-09-01 | Insurance policy end date | 2013-08-31 | Total amount of commissions paid to insurance broker | USD $37,741 | Total amount of fees paid to insurance company | USD $1,376 | Health Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $186,889 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $15,090 | Amount paid for insurance broker fees | 740 | Insurance broker organization code? | 3 | Insurance broker name | DAVID GORDON WALKER |
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USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
Policy contract number | 50006029 |
Policy instance | 6 |
Insurance contract or identification number | 50006029 | Number of Individuals Covered | 293 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $1,474 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | VOL AD&D | Welfare Benefit Premiums Paid to Carrier | USD $7,017 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,053 | Insurance broker organization code? | 3 | Insurance broker name | CLIFFORD FARMER |
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EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
Policy contract number | SL10000059-121 |
Policy instance | 5 |
Insurance contract or identification number | SL10000059-121 | Number of Individuals Covered | 443 | Insurance policy start date | 2012-08-01 | Insurance policy end date | 2013-07-31 | Total amount of commissions paid to insurance broker | USD $9,532 | Welfare Benefit Premiums Paid to Carrier | USD $95,318 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $9,532 | Insurance broker organization code? | 3 | Insurance broker name | GROUP SERVICE UNDERWRITERS INC |
|
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
Policy contract number | 50006029 |
Policy instance | 3 |
Insurance contract or identification number | 50006029 | Number of Individuals Covered | 455 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $4,793 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $44,465 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,446 | Insurance broker organization code? | 3 | Insurance broker name | CLIFFORD FARMER |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 595879 |
Policy instance | 2 |
Insurance contract or identification number | 595879 | Number of Individuals Covered | 235 | Insurance policy start date | 2012-09-01 | Insurance policy end date | 2013-09-01 | Total amount of commissions paid to insurance broker | USD $7,924 | Total amount of fees paid to insurance company | USD $502 | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $133,976 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,962 | Amount paid for insurance broker fees | 502 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION PAID | Insurance broker organization code? | 3 | Insurance broker name | LINDA ROGERS |
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USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
Policy contract number | 50006029 |
Policy instance | 2 |
Insurance contract or identification number | 50006029 | Number of Individuals Covered | 307 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $2,317 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | VOL AD&D | Welfare Benefit Premiums Paid to Carrier | USD $10,581 | 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 | Insurance broker organization code? | 3 | Insurance broker name | DAINES INSURANCE AGENCY |
|
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E9173626 |
Policy instance | 7 |
Insurance contract or identification number | E9173626 | Number of Individuals Covered | 3 | Insurance policy start date | 2011-08-01 | Insurance policy end date | 2012-07-31 | Total amount of commissions paid to insurance broker | USD $225 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1 | Insurance broker organization code? | 3 | Insurance broker name | DAVID BARNETTE |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 595879 |
Policy instance | 6 |
Insurance contract or identification number | 595879 | Number of Individuals Covered | 210 | Insurance policy start date | 2011-08-01 | Insurance policy end date | 2012-08-01 | Total amount of commissions paid to insurance broker | USD $6,686 | Total amount of fees paid to insurance company | USD $500 | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $145,097 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,343 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 500 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION PAID | Insurance broker name | PERRY HALL |
|
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
Policy contract number | 50006029 |
Policy instance | 5 |
Insurance contract or identification number | 50006029 | Number of Individuals Covered | 448 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $3,444 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $31,466 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $297 | Insurance broker organization code? | 3 | Insurance broker name | DAINES INSURANCE AGENCY |
|
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | F8265 |
Policy instance | 4 |
Insurance contract or identification number | F8265 | Number of Individuals Covered | 282 | Insurance policy start date | 2011-08-01 | Insurance policy end date | 2012-07-31 | Total amount of commissions paid to insurance broker | USD $46,979 | Total amount of fees paid to insurance company | USD $1,352 | Health Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $207,759 | 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 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 60 | Insurance broker name | LINDA ROGERS |
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EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
Policy contract number | SL10000059-111 |
Policy instance | 3 |
Insurance contract or identification number | SL10000059-111 | Number of Individuals Covered | 462 | Insurance policy start date | 2011-08-01 | Insurance policy end date | 2012-07-31 | Total amount of commissions paid to insurance broker | USD $11,132 | Welfare Benefit Premiums Paid to Carrier | USD $111,317 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $11,132 | Insurance broker organization code? | 3 | Insurance broker name | GROUP SERVICE UNDERWRITERS INC |
|
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
Policy contract number | 50006029 |
Policy instance | 1 |
Insurance contract or identification number | 50006029 | Number of Individuals Covered | 420 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $12,795 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | VOL GROUP LIFE | Welfare Benefit Premiums Paid to Carrier | USD $60,929 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $316 | Insurance broker organization code? | 3 | Insurance broker name | DAINES INSURANCE AGENCY |
|
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
Policy contract number | 50006029 |
Policy instance | 2 |
Insurance contract or identification number | 50006029 | Number of Individuals Covered | 500 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Total amount of commissions paid to insurance broker | USD $178 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | VOL AD&D | Welfare Benefit Premiums Paid to Carrier | USD $848 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E9173626 |
Policy instance | 8 |
Insurance contract or identification number | E9173626 | Number of Individuals Covered | 8 | Insurance policy start date | 2010-08-01 | Insurance policy end date | 2011-07-31 | Total amount of commissions paid to insurance broker | USD $386 | Total amount of fees paid to insurance company | USD $1 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
Policy contract number | 101054401 |
Policy instance | 6 |
Insurance contract or identification number | 101054401 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $382 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
Policy contract number | 50006029 |
Policy instance | 5 |
Insurance contract or identification number | 50006029 | Number of Individuals Covered | 458 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Total amount of commissions paid to insurance broker | USD $4,838 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $44,136 | 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 number | 595879 |
Policy instance | 7 |
Insurance contract or identification number | 595879 | Number of Individuals Covered | 226 | Insurance policy start date | 2010-08-01 | Insurance policy end date | 2011-08-01 | Total amount of commissions paid to insurance broker | USD $9,908 | Total amount of fees paid to insurance company | USD $641 | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $170,935 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | F8265 |
Policy instance | 4 |
Insurance contract or identification number | F8265 | Number of Individuals Covered | 320 | Insurance policy start date | 2010-08-01 | Insurance policy end date | 2011-07-31 | Total amount of commissions paid to insurance broker | USD $36,857 | Total amount of fees paid to insurance company | USD $1,775 | Health Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $173,221 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
Policy contract number | 50006029 |
Policy instance | 1 |
Insurance contract or identification number | 50006029 | Number of Individuals Covered | 500 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Total amount of commissions paid to insurance broker | USD $16,962 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | VOL GROUP LIFE | Welfare Benefit Premiums Paid to Carrier | USD $84,942 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 ) |
Policy contract number | 3738596 |
Policy instance | 3 |
Insurance contract or identification number | 3738596 | Number of Individuals Covered | 514 | Insurance policy start date | 2010-08-01 | Insurance policy end date | 2011-07-31 | Total amount of commissions paid to insurance broker | USD $12,867 | Welfare Benefit Premiums Paid to Carrier | USD $128,671 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 ) |
Policy contract number | 3738596 |
Policy instance | 1 |
Insurance contract or identification number | 3738596 | Number of Individuals Covered | 517 | Insurance policy start date | 2009-08-01 | Insurance policy end date | 2010-08-01 | Total amount of commissions paid to insurance broker | USD $15,194 | Welfare Benefit Premiums Paid to Carrier | USD $126,614 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E9173626 |
Policy instance | 6 |
Insurance contract or identification number | E9173626 | Number of Individuals Covered | 8 | Insurance policy start date | 2009-08-01 | Insurance policy end date | 2010-07-31 | Total amount of commissions paid to insurance broker | USD $394 | Total amount of fees paid to insurance company | USD $2 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | 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 number | 595879 |
Policy instance | 5 |
Insurance contract or identification number | 595879 | Number of Individuals Covered | 246 | Insurance policy start date | 2009-08-01 | Insurance policy end date | 2010-08-01 | Total amount of commissions paid to insurance broker | USD $8,943 | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $155,595 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
Policy contract number | 54401 |
Policy instance | 3 |
Insurance contract or identification number | 54401 | Number of Individuals Covered | 505 | Insurance policy start date | 2010-01-01 | Insurance policy end date | 2010-12-31 | Total amount of commissions paid to insurance broker | USD $14,766 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $80,575 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | F8265 |
Policy instance | 2 |
Insurance contract or identification number | F8265 | Number of Individuals Covered | 308 | Insurance policy start date | 2009-08-01 | Insurance policy end date | 2010-07-31 | Total amount of commissions paid to insurance broker | USD $43,093 | Total amount of fees paid to insurance company | USD $2,170 | Welfare Benefit Premiums Paid to Carrier | USD $184,228 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
Policy contract number | 54401 |
Policy instance | 4 |
Insurance contract or identification number | 54401 | Number of Individuals Covered | 520 | Insurance policy start date | 2010-01-01 | Insurance policy end date | 2010-12-31 | Total amount of commissions paid to insurance broker | USD $4,303 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $43,406 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|