ENERGY CORPORATION OF AMERICA has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan ENERGY CORPORATION OF AMERICA GROUP LIFE INSURANCE
401k plan membership statisitcs for ENERGY CORPORATION OF AMERICA GROUP LIFE INSURANCE
Measure | Date | Value |
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2017: ENERGY CORPORATION OF AMERICA GROUP LIFE INSURANCE 2017 401k membership |
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Total participants, beginning-of-year | 2017-07-01 | 168 |
Total number of active participants reported on line 7a of the Form 5500 | 2017-07-01 | 0 |
Number of retired or separated participants receiving benefits | 2017-07-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2017-07-01 | 0 |
Total of all active and inactive participants | 2017-07-01 | 0 |
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2017-07-01 | 0 |
2016: ENERGY CORPORATION OF AMERICA GROUP LIFE INSURANCE 2016 401k membership |
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Total participants, beginning-of-year | 2016-07-01 | 284 |
Total number of active participants reported on line 7a of the Form 5500 | 2016-07-01 | 168 |
Number of retired or separated participants receiving benefits | 2016-07-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2016-07-01 | 0 |
Total of all active and inactive participants | 2016-07-01 | 168 |
2015: ENERGY CORPORATION OF AMERICA GROUP LIFE INSURANCE 2015 401k membership |
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Total participants, beginning-of-year | 2015-07-01 | 284 |
Total number of active participants reported on line 7a of the Form 5500 | 2015-07-01 | 0 |
Number of retired or separated participants receiving benefits | 2015-07-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2015-07-01 | 0 |
Total of all active and inactive participants | 2015-07-01 | 0 |
2014: ENERGY CORPORATION OF AMERICA GROUP LIFE INSURANCE 2014 401k membership |
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Total participants, beginning-of-year | 2014-07-01 | 285 |
Total number of active participants reported on line 7a of the Form 5500 | 2014-07-01 | 284 |
Number of retired or separated participants receiving benefits | 2014-07-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2014-07-01 | 0 |
Total of all active and inactive participants | 2014-07-01 | 284 |
2013: ENERGY CORPORATION OF AMERICA GROUP LIFE INSURANCE 2013 401k membership |
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Total participants, beginning-of-year | 2013-07-01 | 273 |
Total number of active participants reported on line 7a of the Form 5500 | 2013-07-01 | 285 |
Total of all active and inactive participants | 2013-07-01 | 285 |
2012: ENERGY CORPORATION OF AMERICA GROUP LIFE INSURANCE 2012 401k membership |
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Total participants, beginning-of-year | 2012-07-01 | 280 |
Total number of active participants reported on line 7a of the Form 5500 | 2012-07-01 | 273 |
Total of all active and inactive participants | 2012-07-01 | 273 |
2011: ENERGY CORPORATION OF AMERICA GROUP LIFE INSURANCE 2011 401k membership |
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Total participants, beginning-of-year | 2011-07-01 | 264 |
Total number of active participants reported on line 7a of the Form 5500 | 2011-07-01 | 280 |
Total of all active and inactive participants | 2011-07-01 | 280 |
2009: ENERGY CORPORATION OF AMERICA GROUP LIFE INSURANCE 2009 401k membership |
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Total participants, beginning-of-year | 2009-07-01 | 277 |
Total number of active participants reported on line 7a of the Form 5500 | 2009-07-01 | 267 |
Total of all active and inactive participants | 2009-07-01 | 267 |
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
Policy contract number | F018200 |
Policy instance | 5 |
Insurance contract or identification number | F018200 | Number of Individuals Covered | 153 | Insurance policy start date | 2017-07-01 | Insurance policy end date | 2017-11-30 | Total amount of commissions paid to insurance broker | USD $1,382 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating 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 | Yes | Temporary Disability Insurance Welfare Benefit | No | 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 | Welfare Benefit Premiums Paid to Carrier | USD $27,634 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,382 | Insurance broker organization code? | 3 | Insurance broker name | USI INSURANCE SERVICES LLC |
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COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E7492457 |
Policy instance | 4 |
Insurance contract or identification number | E7492457 | Number of Individuals Covered | 6 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $15,992 | Total amount of fees paid to insurance company | USD $3,288 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating 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 | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $72,934 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,349 | Amount paid for insurance broker fees | 2748 | Additional information about fees paid to insurance broker | FEES PAID | Insurance broker organization code? | 3 | Insurance broker name | BENECHOICE ENROLLMENT SOLUTIONS INC |
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FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 ) |
Policy contract number | 64045492 |
Policy instance | 3 |
Insurance contract or identification number | 64045492 | Number of Individuals Covered | 0 | Insurance policy start date | 2017-07-01 | Insurance policy end date | 2017-11-29 | Total amount of commissions paid to insurance broker | USD $2,150 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating 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 | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT INSURANCE | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $6,143 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $1,229 | Insurance broker organization code? | 3 | Insurance broker name | MCGRIFF SEIBELS & WILLIAMS |
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ATLANTIC SPECIALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 27154 ) |
Policy contract number | 212-000-002 |
Policy instance | 2 |
Insurance contract or identification number | 212-000-002 | Number of Individuals Covered | 22 | Insurance policy start date | 2017-07-01 | Insurance policy end date | 2017-11-30 | Total amount of commissions paid to insurance broker | USD $137 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating 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 | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH & DISABILITY | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $915 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $137 | Insurance broker organization code? | 3 | Insurance broker name | USI INSURANCE SERVICES, LLC |
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ATLANTIC SPECIALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 27154 ) |
Policy contract number | 212-000-001 |
Policy instance | 1 |
Insurance contract or identification number | 212-000-001 | Number of Individuals Covered | 153 | Insurance policy start date | 2017-07-01 | Insurance policy end date | 2017-11-30 | Total amount of commissions paid to insurance broker | USD $605 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating 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 | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISABILITY | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $4,036 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $605 | Insurance broker organization code? | 3 | Insurance broker name | USI INSURANCE SERVICES, LLC |
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ATLANTIC SPECIALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 27154 ) |
Policy contract number | 212-000-001 |
Policy instance | 2 |
Insurance contract or identification number | 212-000-001 | Number of Individuals Covered | 242 | Insurance policy start date | 2015-07-01 | Insurance policy end date | 2016-06-30 | Total amount of commissions paid to insurance broker | USD $2,574 | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $17,160 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,574 | Insurance broker organization code? | 3 | Insurance broker name | USI INSURANCE SERVICES, LLC |
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FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 ) |
Policy contract number | 6404-5492 |
Policy instance | 3 |
Insurance contract or identification number | 6404-5492 | Number of Individuals Covered | 284 | Insurance policy start date | 2015-07-01 | Insurance policy end date | 2016-06-30 | Total amount of commissions paid to insurance broker | USD $2,229 | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $7,429 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $1,486 | Insurance broker organization code? | 3 | Insurance broker name | MCGRIFF, SEIBELS AND WILLIAMS |
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DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
Policy contract number | F018200 |
Policy instance | 4 |
Insurance contract or identification number | F018200 | Number of Individuals Covered | 242 | Insurance policy start date | 2015-07-01 | Insurance policy end date | 2016-06-30 | Total amount of commissions paid to insurance broker | USD $18,346 | Total amount of fees paid to insurance company | USD $6,523 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $123,452 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Insurance broker organization code? | 3 | Commission paid to Insurance Broker | USD $18,346 | Amount paid for insurance broker fees | 6523 | Insurance broker name | USI INSURANCE SERVICES LLC |
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COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E7492457 |
Policy instance | 5 |
Insurance contract or identification number | E7492457 | Number of Individuals Covered | 113 | Insurance policy start date | 2015-07-01 | Insurance policy end date | 2016-06-30 | Total amount of commissions paid to insurance broker | USD $8,017 | Total amount of fees paid to insurance company | USD $1,693 | Other welfare benefits provided | ACCIDENTAL DEATH | Welfare Benefit Premiums Paid to Carrier | USD $78,643 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,089 | Amount paid for insurance broker fees | 719 | Insurance broker organization code? | 3 | Insurance broker name | CBF BENFITS INC |
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ATLANTIC SPECIALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 27154 ) |
Policy contract number | 212-000-002 |
Policy instance | 1 |
Insurance contract or identification number | 212-000-002 | Number of Individuals Covered | 31 | Insurance policy start date | 2015-07-01 | Insurance policy end date | 2016-06-30 | Total amount of commissions paid to insurance broker | USD $503 | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $3,353 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $503 | Insurance broker organization code? | 3 | Insurance broker name | USI INSURANCE SERVICES, LLC |
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ATLANTIC SPECIALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 27154 ) |
Policy contract number | 212-000-001 |
Policy instance | 2 |
Insurance contract or identification number | 212-000-001 | Number of Individuals Covered | 284 | Insurance policy start date | 2014-07-01 | Insurance policy end date | 2015-06-30 | Total amount of commissions paid to insurance broker | USD $2,789 | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $18,592 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,789 | Insurance broker organization code? | 3 | Insurance broker name | USI INSURANCE SERVICES, LLC |
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FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 ) |
Policy contract number | 6404-5492 |
Policy instance | 3 |
Insurance contract or identification number | 6404-5492 | Number of Individuals Covered | 284 | Insurance policy start date | 2014-07-01 | Insurance policy end date | 2015-06-30 | Total amount of commissions paid to insurance broker | USD $2,216 | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $7,386 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $1,477 | Insurance broker organization code? | 3 | Insurance broker name | MCGRIFF, SEIBELS AND WILLIAMS |
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DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
Policy contract number | F018200 |
Policy instance | 4 |
Insurance contract or identification number | F018200 | Number of Individuals Covered | 284 | Insurance policy start date | 2014-07-01 | Insurance policy end date | 2015-06-30 | Total amount of commissions paid to insurance broker | USD $19,833 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $135,453 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,287 | Insurance broker organization code? | 3 | Insurance broker name | USI INSURANCE SERVICES LLC |
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COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E7492457 |
Policy instance | 5 |
Insurance contract or identification number | E7492457 | Number of Individuals Covered | 114 | Insurance policy start date | 2014-07-01 | Insurance policy end date | 2015-06-30 | Total amount of commissions paid to insurance broker | USD $7,179 | Total amount of fees paid to insurance company | USD $653 | Other welfare benefits provided | ACCIDENTAL DEATH | Welfare Benefit Premiums Paid to Carrier | USD $77,386 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,666 | Amount paid for insurance broker fees | 98 | Insurance broker organization code? | 3 | Insurance broker name | TIMOTHY J SLATER |
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ATLANTIC SPECIALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 27154 ) |
Policy contract number | 212-000-002 |
Policy instance | 1 |
Insurance contract or identification number | 212-000-002 | Number of Individuals Covered | 45 | Insurance policy start date | 2014-07-01 | Insurance policy end date | 2015-06-30 | Total amount of commissions paid to insurance broker | USD $582 | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $3,879 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $582 | Insurance broker organization code? | 3 | Insurance broker name | USI INSURANCE SERVICES, LLC |
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ATLANTIC SPECIALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 27154 ) |
Policy contract number | 212-000-001 |
Policy instance | 2 |
Insurance contract or identification number | 212-000-001 | Number of Individuals Covered | 285 | Insurance policy start date | 2013-07-01 | Insurance policy end date | 2014-06-30 | Total amount of commissions paid to insurance broker | USD $2,524 | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $16,824 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,524 | Insurance broker organization code? | 3 | Insurance broker name | USI INSURANCE SERVICES, LLC |
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FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 ) |
Policy contract number | 6404-5492 |
Policy instance | 3 |
Insurance contract or identification number | 6404-5492 | Number of Individuals Covered | 285 | Insurance policy start date | 2013-07-01 | Insurance policy end date | 2014-06-30 | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Insurance broker organization code? | 3 | Insurance broker name | MCGRIFF, SEIBELS AND WILLIAMS OF GA |
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DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
Policy contract number | F018200 |
Policy instance | 4 |
Insurance contract or identification number | F018200 | Number of Individuals Covered | 285 | Insurance policy start date | 2013-07-01 | Insurance policy end date | 2014-06-30 | Total amount of commissions paid to insurance broker | USD $14,003 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $95,093 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $14,003 | Insurance broker organization code? | 3 | Insurance broker name | WELLS FARGO INSURANCE SERVICES |
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COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E7492457 |
Policy instance | 5 |
Insurance contract or identification number | E7492457 | Number of Individuals Covered | 113 | Insurance policy start date | 2013-07-01 | Insurance policy end date | 2014-06-30 | Total amount of commissions paid to insurance broker | USD $7,328 | Total amount of fees paid to insurance company | USD $946 | Other welfare benefits provided | ACCIDENTAL DEATH | Welfare Benefit Premiums Paid to Carrier | USD $76,075 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,807 | Amount paid for insurance broker fees | 381 | Insurance broker organization code? | 3 | Insurance broker name | TIMOTHY J SLATER |
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ATLANTIC SPECIALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 27154 ) |
Policy contract number | 212-000-002 |
Policy instance | 1 |
Insurance contract or identification number | 212-000-002 | Number of Individuals Covered | 49 | Insurance policy start date | 2013-07-01 | Insurance policy end date | 2014-06-30 | Total amount of commissions paid to insurance broker | USD $633 | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $4,222 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $633 | Insurance broker organization code? | 3 | Insurance broker name | USI INSURANCE SERVICES, LLC |
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ATLANTIC SPECIALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 27154 ) |
Policy contract number | 212-000-001 |
Policy instance | 2 |
Insurance contract or identification number | 212-000-001 | Number of Individuals Covered | 273 | Insurance policy start date | 2012-07-01 | Insurance policy end date | 2013-06-30 | Total amount of commissions paid to insurance broker | USD $2,448 | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $16,321 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,448 | Insurance broker organization code? | 3 | Insurance broker name | WELLS FARGO INS SERVICES OF WV |
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FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 ) |
Policy contract number | 6404-5492 |
Policy instance | 3 |
Insurance contract or identification number | 6404-5492 | Number of Individuals Covered | 273 | Insurance policy start date | 2012-07-01 | Insurance policy end date | 2013-06-30 | Total amount of commissions paid to insurance broker | USD $484 | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $4,836 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $484 | Insurance broker organization code? | 3 | Insurance broker name | MCGRIFF, SIEBELS AND WILLIAMS OF GA |
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DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
Policy contract number | F018200 |
Policy instance | 4 |
Insurance contract or identification number | F018200 | Number of Individuals Covered | 273 | Insurance policy start date | 2012-07-01 | Insurance policy end date | 2013-06-30 | Total amount of commissions paid to insurance broker | USD $16,663 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $112,996 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $16,663 | Insurance broker organization code? | 3 | Insurance broker name | WELLS FARGO INSURANCE SERVICES |
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ATLANTIC SPECIALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 27154 ) |
Policy contract number | 212-000-002 |
Policy instance | 1 |
Insurance contract or identification number | 212-000-002 | Number of Individuals Covered | 51 | Insurance policy start date | 2012-07-01 | Insurance policy end date | 2013-06-30 | Total amount of commissions paid to insurance broker | USD $679 | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $4,525 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $679 | Insurance broker organization code? | 3 | Insurance broker name | WELLS FARGO INSURANCE SERVICES |
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ONE BEACON (National Association of Insurance Commissioners NAIC id number: 21970 ) |
Policy contract number | 212-000-002 |
Policy instance | 1 |
Insurance contract or identification number | 212-000-002 | Number of Individuals Covered | 53 | Insurance policy start date | 2011-07-01 | Insurance policy end date | 2012-06-30 | Total amount of commissions paid to insurance broker | USD $696 | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $4,637 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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ONE BEACON (National Association of Insurance Commissioners NAIC id number: 21970 ) |
Policy contract number | 212-000-001 |
Policy instance | 2 |
Insurance contract or identification number | 212-000-001 | Number of Individuals Covered | 274 | Insurance policy start date | 2011-07-01 | Insurance policy end date | 2012-06-30 | Total amount of commissions paid to insurance broker | USD $2,317 | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $15,446 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 ) |
Policy contract number | 6404-5492 |
Policy instance | 3 |
Insurance contract or identification number | 6404-5492 | Number of Individuals Covered | 264 | Insurance policy start date | 2011-07-01 | Insurance policy end date | 2012-06-30 | Total amount of commissions paid to insurance broker | USD $420 | Total amount of fees paid to insurance company | USD $63 | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $4,200 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
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THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00427059 |
Policy instance | 4 |
Insurance contract or identification number | 00427059 | Number of Individuals Covered | 280 | Insurance policy start date | 2011-07-01 | Insurance policy end date | 2012-06-30 | Total amount of commissions paid to insurance broker | USD $12,901 | Total amount of fees paid to insurance company | USD $3,602 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $88,662 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E7492457 |
Policy instance | 5 |
Insurance contract or identification number | E7492457 | Number of Individuals Covered | 114 | Insurance policy start date | 2011-07-01 | Insurance policy end date | 2012-06-30 | Total amount of commissions paid to insurance broker | USD $6,426 | Total amount of fees paid to insurance company | USD $1,620 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $76,737 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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ONE BEACON (National Association of Insurance Commissioners NAIC id number: 21970 ) |
Policy contract number | 212-000-002 |
Policy instance | 1 |
Insurance contract or identification number | 212-000-002 | Number of Individuals Covered | 264 | Insurance policy start date | 2010-07-01 | Insurance policy end date | 2011-06-30 | Total amount of commissions paid to insurance broker | USD $700 | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $4,666 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
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ONE BEACON (National Association of Insurance Commissioners NAIC id number: 21970 ) |
Policy contract number | 212-000-001 |
Policy instance | 2 |
Insurance contract or identification number | 212-000-001 | Number of Individuals Covered | 264 | Insurance policy start date | 2010-07-01 | Insurance policy end date | 2011-06-30 | Total amount of commissions paid to insurance broker | USD $2,177 | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $14,512 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
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THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00427059 |
Policy instance | 4 |
Insurance contract or identification number | 00427059 | Number of Individuals Covered | 264 | Insurance policy start date | 2010-07-01 | Insurance policy end date | 2011-06-30 | Total amount of commissions paid to insurance broker | USD $12,003 | Total amount of fees paid to insurance company | USD $2,138 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $78,449 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 ) |
Policy contract number | 6404-5492 |
Policy instance | 3 |
Insurance contract or identification number | 6404-5492 | Number of Individuals Covered | 264 | Insurance policy start date | 2010-07-30 | Insurance policy end date | 2011-06-30 | Total amount of commissions paid to insurance broker | USD $420 | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $4,200 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
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