OSCAR DE LA RENTA, LLC has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN FOR THE EMPLOYEES OF OSCAR DE LA RENTA, LLC
401k plan membership statisitcs for GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN FOR THE EMPLOYEES OF OSCAR DE LA RENTA, LLC
| Measure | Date | Value |
|---|
| 2019: GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN FOR THE EMPLOYEES OF OSCAR DE LA RENTA, LLC 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-12-01 | 155 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-12-01 | 152 |
| Number of retired or separated participants receiving benefits | 2019-12-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-12-01 | 0 |
| Total of all active and inactive participants | 2019-12-01 | 152 |
| Number of employers contributing to the scheme | 2019-12-01 | 0 |
| 2018: GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN FOR THE EMPLOYEES OF OSCAR DE LA RENTA, LLC 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-12-01 | 144 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-12-01 | 160 |
| Number of retired or separated participants receiving benefits | 2018-12-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-12-01 | 0 |
| Total of all active and inactive participants | 2018-12-01 | 160 |
| Number of employers contributing to the scheme | 2018-12-01 | 0 |
| 2017: GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN FOR THE EMPLOYEES OF OSCAR DE LA RENTA, LLC 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-12-01 | 154 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-12-01 | 144 |
| Total of all active and inactive participants | 2017-12-01 | 144 |
| 2016: GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN FOR THE EMPLOYEES OF OSCAR DE LA RENTA, LLC 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-12-01 | 171 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-12-01 | 154 |
| Total of all active and inactive participants | 2016-12-01 | 154 |
| 2015: GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN FOR THE EMPLOYEES OF OSCAR DE LA RENTA, LLC 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-12-01 | 182 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-12-01 | 171 |
| Total of all active and inactive participants | 2015-12-01 | 171 |
| 2014: GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN FOR THE EMPLOYEES OF OSCAR DE LA RENTA, LLC 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-12-01 | 200 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-12-01 | 182 |
| Total of all active and inactive participants | 2014-12-01 | 182 |
| 2013: GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN FOR THE EMPLOYEES OF OSCAR DE LA RENTA, LLC 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-12-01 | 184 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-12-01 | 200 |
| Total of all active and inactive participants | 2013-12-01 | 200 |
| 2012: GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN FOR THE EMPLOYEES OF OSCAR DE LA RENTA, LLC 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-12-01 | 186 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-12-01 | 184 |
| Total of all active and inactive participants | 2012-12-01 | 184 |
| 2011: GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN FOR THE EMPLOYEES OF OSCAR DE LA RENTA, LLC 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-12-01 | 161 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-12-01 | 186 |
| Total of all active and inactive participants | 2011-12-01 | 186 |
| 2010: GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN FOR THE EMPLOYEES OF OSCAR DE LA RENTA, LLC 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-12-01 | 145 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-12-01 | 161 |
| Total of all active and inactive participants | 2010-12-01 | 161 |
| 2009: GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN FOR THE EMPLOYEES OF OSCAR DE LA RENTA, LLC 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-12-01 | 147 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-12-01 | 145 |
| Total of all active and inactive participants | 2009-12-01 | 145 |
| Total participants | 2009-12-01 | 0 |
| 2019: GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN FOR THE EMPLOYEES OF OSCAR DE LA RENTA, LLC 2019 form 5500 responses |
|---|
| 2019-12-01 | Type of plan entity | Single employer plan |
| 2019-12-01 | Submission has been amended | Yes |
| 2019-12-01 | Plan funding arrangement – Insurance | Yes |
| 2019-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN FOR THE EMPLOYEES OF OSCAR DE LA RENTA, LLC 2018 form 5500 responses |
|---|
| 2018-12-01 | Type of plan entity | Single employer plan |
| 2018-12-01 | Plan funding arrangement – Insurance | Yes |
| 2018-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN FOR THE EMPLOYEES OF OSCAR DE LA RENTA, LLC 2017 form 5500 responses |
|---|
| 2017-12-01 | Type of plan entity | Single employer plan |
| 2017-12-01 | Submission has been amended | No |
| 2017-12-01 | This submission is the final filing | No |
| 2017-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-12-01 | Plan is a collectively bargained plan | No |
| 2017-12-01 | Plan funding arrangement – Insurance | Yes |
| 2017-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN FOR THE EMPLOYEES OF OSCAR DE LA RENTA, LLC 2016 form 5500 responses |
|---|
| 2016-12-01 | Type of plan entity | Single employer plan |
| 2016-12-01 | Submission has been amended | No |
| 2016-12-01 | This submission is the final filing | No |
| 2016-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-12-01 | Plan is a collectively bargained plan | No |
| 2016-12-01 | Plan funding arrangement – Insurance | Yes |
| 2016-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN FOR THE EMPLOYEES OF OSCAR DE LA RENTA, LLC 2015 form 5500 responses |
|---|
| 2015-12-01 | Type of plan entity | Single employer plan |
| 2015-12-01 | Submission has been amended | No |
| 2015-12-01 | This submission is the final filing | No |
| 2015-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-12-01 | Plan is a collectively bargained plan | No |
| 2015-12-01 | Plan funding arrangement – Insurance | Yes |
| 2015-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN FOR THE EMPLOYEES OF OSCAR DE LA RENTA, LLC 2014 form 5500 responses |
|---|
| 2014-12-01 | Type of plan entity | Single employer plan |
| 2014-12-01 | Submission has been amended | No |
| 2014-12-01 | This submission is the final filing | No |
| 2014-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-12-01 | Plan is a collectively bargained plan | No |
| 2014-12-01 | Plan funding arrangement – Insurance | Yes |
| 2014-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN FOR THE EMPLOYEES OF OSCAR DE LA RENTA, LLC 2013 form 5500 responses |
|---|
| 2013-12-01 | Type of plan entity | Single employer plan |
| 2013-12-01 | Submission has been amended | No |
| 2013-12-01 | This submission is the final filing | No |
| 2013-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-12-01 | Plan is a collectively bargained plan | No |
| 2013-12-01 | Plan funding arrangement – Insurance | Yes |
| 2013-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN FOR THE EMPLOYEES OF OSCAR DE LA RENTA, LLC 2012 form 5500 responses |
|---|
| 2012-12-01 | Type of plan entity | Single employer plan |
| 2012-12-01 | Submission has been amended | No |
| 2012-12-01 | This submission is the final filing | No |
| 2012-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-12-01 | Plan is a collectively bargained plan | No |
| 2012-12-01 | Plan funding arrangement – Insurance | Yes |
| 2012-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN FOR THE EMPLOYEES OF OSCAR DE LA RENTA, LLC 2011 form 5500 responses |
|---|
| 2011-12-01 | Type of plan entity | Single employer plan |
| 2011-12-01 | Submission has been amended | No |
| 2011-12-01 | This submission is the final filing | No |
| 2011-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-12-01 | Plan is a collectively bargained plan | No |
| 2011-12-01 | Plan funding arrangement – Insurance | Yes |
| 2011-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2010: GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN FOR THE EMPLOYEES OF OSCAR DE LA RENTA, LLC 2010 form 5500 responses |
|---|
| 2010-12-01 | Type of plan entity | Single employer plan |
| 2010-12-01 | Submission has been amended | No |
| 2010-12-01 | This submission is the final filing | No |
| 2010-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2010-12-01 | Plan is a collectively bargained plan | No |
| 2010-12-01 | Plan funding arrangement – Insurance | Yes |
| 2010-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN FOR THE EMPLOYEES OF OSCAR DE LA RENTA, LLC 2009 form 5500 responses |
|---|
| 2009-12-01 | Type of plan entity | Single employer plan |
| 2009-12-01 | Submission has been amended | No |
| 2009-12-01 | This submission is the final filing | No |
| 2009-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-12-01 | Plan is a collectively bargained plan | No |
| 2009-12-01 | Plan funding arrangement – Insurance | Yes |
| 2009-12-01 | Plan benefit arrangement – Insurance | Yes |
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 ) |
| Policy contract number | MP0857K |
| Policy instance | 2 |
| Insurance contract or identification number | MP0857K | | Number of Individuals Covered | 76 | | Insurance policy start date | 2019-12-01 | | Insurance policy end date | 2020-11-30 | | Total amount of commissions paid to insurance broker | USD $252 | | Total amount of fees paid to insurance company | USD $196 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $1,467 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $252 | | Amount paid for insurance broker fees | 196 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| COMPANION LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62243 ) |
| Policy contract number | GLCL0857K |
| Policy instance | 1 |
| Insurance contract or identification number | GLCL0857K | | Number of Individuals Covered | 76 | | Insurance policy start date | 2019-12-01 | | Insurance policy end date | 2020-11-30 | | Total amount of commissions paid to insurance broker | USD $1,954 | | Total amount of fees paid to insurance company | USD $1,516 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $11,370 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,954 | | Amount paid for insurance broker fees | 1516 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 ) |
| Policy contract number | MP0857K |
| Policy instance | 2 |
| Insurance contract or identification number | MP0857K | | Number of Individuals Covered | 155 | | Insurance policy start date | 2018-12-01 | | Insurance policy end date | 2019-11-30 | | Total amount of commissions paid to insurance broker | USD $348 | | Total amount of fees paid to insurance company | USD $224 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $1,740 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $348 | | Amount paid for insurance broker fees | 224 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| COMPANION LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62243 ) |
| Policy contract number | GLCL0857K |
| Policy instance | 1 |
| Insurance contract or identification number | GLCL0857K | | Number of Individuals Covered | 155 | | Insurance policy start date | 2018-12-01 | | Insurance policy end date | 2019-11-30 | | Total amount of commissions paid to insurance broker | USD $2,697 | | Total amount of fees paid to insurance company | USD $1,734 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $13,486 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,697 | | Amount paid for insurance broker fees | 1734 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 ) |
| Policy contract number | MP0857K |
| Policy instance | 2 |
| Insurance contract or identification number | MP0857K | | Number of Individuals Covered | 144 | | Insurance policy start date | 2017-12-01 | | Insurance policy end date | 2018-11-30 | | Total amount of commissions paid to insurance broker | USD $412 | | Total amount of fees paid to insurance company | USD $98 | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $2,100 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| COMPANION LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62243 ) |
| Policy contract number | GLCL0857K |
| Policy instance | 1 |
| Insurance contract or identification number | GLCL0857K | | Number of Individuals Covered | 144 | | Insurance policy start date | 2017-12-01 | | Insurance policy end date | 2018-11-30 | | Total amount of commissions paid to insurance broker | USD $3,194 | | Total amount of fees paid to insurance company | USD $757 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $16,279 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 ) |
| Policy contract number | MP0857K |
| Policy instance | 2 |
| Insurance contract or identification number | MP0857K | | Number of Individuals Covered | 171 | | Insurance policy start date | 2015-12-01 | | Insurance policy end date | 2016-11-30 | | Total amount of commissions paid to insurance broker | USD $411 | | Total amount of fees paid to insurance company | USD $113 | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $2,054 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $411 | | Amount paid for insurance broker fees | 113 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | LADMAR ASSOCIATES LLC |
|
| COMPANION LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62243 ) |
| Policy contract number | GLCL0857K |
| Policy instance | 1 |
| Insurance contract or identification number | GLCL0857K | | Number of Individuals Covered | 171 | | Insurance policy start date | 2015-12-01 | | Insurance policy end date | 2016-11-30 | | Total amount of commissions paid to insurance broker | USD $3,185 | | Total amount of fees paid to insurance company | USD $872 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $15,923 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,185 | | Amount paid for insurance broker fees | 872 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | LADMAR ASSOCIATES LLC |
|
| COMPANION LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62243 ) |
| Policy contract number | GLCL0857K |
| Policy instance | 1 |
| Insurance contract or identification number | GLCL0857K | | Number of Individuals Covered | 182 | | Insurance policy start date | 2014-12-01 | | Insurance policy end date | 2015-11-30 | | Total amount of commissions paid to insurance broker | USD $3,400 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $17,000 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,400 | | Amount paid for insurance broker fees | 0 | | Additional information about fees paid to insurance broker | N/A | | Insurance broker organization code? | 3 | | Insurance broker name | LADMAR ASSOCIATES LLC |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 ) |
| Policy contract number | MP0857K |
| Policy instance | 2 |
| Insurance contract or identification number | MP0857K | | Number of Individuals Covered | 182 | | Insurance policy start date | 2014-12-01 | | Insurance policy end date | 2015-11-30 | | Total amount of commissions paid to insurance broker | USD $439 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $2,194 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $439 | | Amount paid for insurance broker fees | 0 | | Additional information about fees paid to insurance broker | N/A | | Insurance broker organization code? | 3 | | Insurance broker name | LADMAR ASSOCIATES LLC |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 ) |
| Policy contract number | MP0857K |
| Policy instance | 2 |
| Insurance contract or identification number | MP0857K | | Number of Individuals Covered | 200 | | Insurance policy start date | 2013-12-01 | | Insurance policy end date | 2014-11-30 | | Total amount of commissions paid to insurance broker | USD $452 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $2,258 | | Commission paid to Insurance Broker | USD $414 | | Amount paid for insurance broker fees | 0 | | Additional information about fees paid to insurance broker | N/A | | Insurance broker organization code? | 3 | | Insurance broker name | LADMAR ASSOCIATES LTD |
|
| COMPANION LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62243 ) |
| Policy contract number | GLCL0857K |
| Policy instance | 1 |
| Insurance contract or identification number | GLCL0857K | | Number of Individuals Covered | 200 | | Insurance policy start date | 2013-12-01 | | Insurance policy end date | 2014-11-30 | | Total amount of commissions paid to insurance broker | USD $3,500 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $17,500 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,208 | | Amount paid for insurance broker fees | 0 | | Additional information about fees paid to insurance broker | N/A | | Insurance broker organization code? | 3 | | Insurance broker name | LADMAR ASSOCIATES LTD |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 ) |
| Policy contract number | MP0857K |
| Policy instance | 2 |
| Insurance contract or identification number | MP0857K | | Number of Individuals Covered | 184 | | Insurance policy start date | 2012-12-01 | | Insurance policy end date | 2013-11-30 | | Total amount of commissions paid to insurance broker | USD $428 | | Total amount of fees paid to insurance company | USD $81 | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $2,142 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $428 | | Amount paid for insurance broker fees | 81 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | LADMAR ASSOCIATES LTD. |
|
| COMPANION LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62243 ) |
| Policy contract number | GLCL0857K |
| Policy instance | 1 |
| Insurance contract or identification number | GLCL0857K | | Number of Individuals Covered | 184 | | Insurance policy start date | 2012-12-01 | | Insurance policy end date | 2013-11-30 | | Total amount of commissions paid to insurance broker | USD $3,321 | | Total amount of fees paid to insurance company | USD $624 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $16,605 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,321 | | Amount paid for insurance broker fees | 624 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | LADMAR ASSOCIATES LTD. |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 ) |
| Policy contract number | MP0857K |
| Policy instance | 2 |
| Insurance contract or identification number | MP0857K | | Insurance policy start date | 2011-12-01 | | Insurance policy end date | 2012-11-30 | | Total amount of commissions paid to insurance broker | USD $466 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $2,014 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| COMPANION LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62243 ) |
| Policy contract number | GLCL0857K |
| Policy instance | 1 |
| Insurance contract or identification number | GLCL0857K | | Insurance policy start date | 2011-12-01 | | Insurance policy end date | 2012-11-30 | | Total amount of commissions paid to insurance broker | USD $3,611 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $15,605 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| COMPANION LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62243 ) |
| Policy contract number | GLCL0857K |
| Policy instance | 1 |
| Insurance contract or identification number | GLCL0857K | | Number of Individuals Covered | 161 | | Insurance policy start date | 2010-12-01 | | Insurance policy end date | 2011-11-30 | | Total amount of commissions paid to insurance broker | USD $3,389 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $13,842 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 ) |
| Policy contract number | MP0857K |
| Policy instance | 2 |
| Insurance contract or identification number | MP0857K | | Number of Individuals Covered | 161 | | Insurance policy start date | 2010-12-01 | | Insurance policy end date | 2011-11-30 | | Total amount of commissions paid to insurance broker | USD $437 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $1,786 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
