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ENERGY CORPORATION OF AMERICA GROUP LIFE INSURANCE 401k Plan overview

Plan NameENERGY CORPORATION OF AMERICA GROUP LIFE INSURANCE
Plan identification number 502

ENERGY CORPORATION OF AMERICA GROUP LIFE INSURANCE Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Life insurance

401k Sponsoring company profile

ENERGY CORPORATION OF AMERICA has sponsored the creation of one or more 401k plans.

Company Name:ENERGY CORPORATION OF AMERICA
Employer identification number (EIN):841235822
NAIC Classification:211110
NAIC Description: Oil and Gas Extraction, Oil

Additional information about ENERGY CORPORATION OF AMERICA

Jurisdiction of Incorporation: Nevada Department of State
Incorporation Date: 1997-07-28
Company Identification Number: 19971230954
Legal Registered Office Address: 2350 S. JONES STE. 860

LAS VEGAS
United States of America (USA)
89109

More information about ENERGY CORPORATION OF AMERICA

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ENERGY CORPORATION OF AMERICA GROUP LIFE INSURANCE

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022017-07-01
5022016-07-01
5022015-07-01SARAH D'AGOSTINO
5022014-07-01SARAH D'AGOSTINO
5022013-07-01JAIME CARPENTER
5022012-07-01JAIME CARPENTER
5022011-07-01JAIME CARPENTER
5022009-07-01BRANNON KRIEG

Plan Statistics for ENERGY CORPORATION OF AMERICA GROUP LIFE INSURANCE

401k plan membership statisitcs for ENERGY CORPORATION OF AMERICA GROUP LIFE INSURANCE

Measure Date Value
2017: ENERGY CORPORATION OF AMERICA GROUP LIFE INSURANCE 2017 401k membership
Total participants, beginning-of-year2017-07-01168
Total number of active participants reported on line 7a of the Form 55002017-07-010
Number of retired or separated participants receiving benefits2017-07-010
Number of other retired or separated participants entitled to future benefits2017-07-010
Total of all active and inactive participants2017-07-010
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-07-010
2016: ENERGY CORPORATION OF AMERICA GROUP LIFE INSURANCE 2016 401k membership
Total participants, beginning-of-year2016-07-01284
Total number of active participants reported on line 7a of the Form 55002016-07-01168
Number of retired or separated participants receiving benefits2016-07-010
Number of other retired or separated participants entitled to future benefits2016-07-010
Total of all active and inactive participants2016-07-01168
2015: ENERGY CORPORATION OF AMERICA GROUP LIFE INSURANCE 2015 401k membership
Total participants, beginning-of-year2015-07-01284
Total number of active participants reported on line 7a of the Form 55002015-07-010
Number of retired or separated participants receiving benefits2015-07-010
Number of other retired or separated participants entitled to future benefits2015-07-010
Total of all active and inactive participants2015-07-010
2014: ENERGY CORPORATION OF AMERICA GROUP LIFE INSURANCE 2014 401k membership
Total participants, beginning-of-year2014-07-01285
Total number of active participants reported on line 7a of the Form 55002014-07-01284
Number of retired or separated participants receiving benefits2014-07-010
Number of other retired or separated participants entitled to future benefits2014-07-010
Total of all active and inactive participants2014-07-01284
2013: ENERGY CORPORATION OF AMERICA GROUP LIFE INSURANCE 2013 401k membership
Total participants, beginning-of-year2013-07-01273
Total number of active participants reported on line 7a of the Form 55002013-07-01285
Total of all active and inactive participants2013-07-01285
2012: ENERGY CORPORATION OF AMERICA GROUP LIFE INSURANCE 2012 401k membership
Total participants, beginning-of-year2012-07-01280
Total number of active participants reported on line 7a of the Form 55002012-07-01273
Total of all active and inactive participants2012-07-01273
2011: ENERGY CORPORATION OF AMERICA GROUP LIFE INSURANCE 2011 401k membership
Total participants, beginning-of-year2011-07-01264
Total number of active participants reported on line 7a of the Form 55002011-07-01280
Total of all active and inactive participants2011-07-01280
2009: ENERGY CORPORATION OF AMERICA GROUP LIFE INSURANCE 2009 401k membership
Total participants, beginning-of-year2009-07-01277
Total number of active participants reported on line 7a of the Form 55002009-07-01267
Total of all active and inactive participants2009-07-01267

Form 5500 Responses for ENERGY CORPORATION OF AMERICA GROUP LIFE INSURANCE

2017: ENERGY CORPORATION OF AMERICA GROUP LIFE INSURANCE 2017 form 5500 responses
2017-07-01Type of plan entitySingle employer plan
2017-07-01Submission has been amendedNo
2017-07-01This submission is the final filingYes
2017-07-01This return/report is a short plan year return/report (less than 12 months)Yes
2017-07-01Plan is a collectively bargained planNo
2017-07-01Plan funding arrangement – InsuranceYes
2017-07-01Plan benefit arrangement – InsuranceYes
2016: ENERGY CORPORATION OF AMERICA GROUP LIFE INSURANCE 2016 form 5500 responses
2016-07-01Type of plan entitySingle employer plan
2016-07-01Plan funding arrangement – InsuranceYes
2016-07-01Plan benefit arrangement – InsuranceYes
2015: ENERGY CORPORATION OF AMERICA GROUP LIFE INSURANCE 2015 form 5500 responses
2015-07-01Type of plan entitySingle employer plan
2015-07-01Plan funding arrangement – InsuranceYes
2015-07-01Plan benefit arrangement – InsuranceYes
2014: ENERGY CORPORATION OF AMERICA GROUP LIFE INSURANCE 2014 form 5500 responses
2014-07-01Type of plan entitySingle employer plan
2014-07-01Plan funding arrangement – InsuranceYes
2014-07-01Plan benefit arrangement – InsuranceYes
2013: ENERGY CORPORATION OF AMERICA GROUP LIFE INSURANCE 2013 form 5500 responses
2013-07-01Type of plan entitySingle employer plan
2013-07-01Plan funding arrangement – InsuranceYes
2013-07-01Plan benefit arrangement – InsuranceYes
2012: ENERGY CORPORATION OF AMERICA GROUP LIFE INSURANCE 2012 form 5500 responses
2012-07-01Type of plan entitySingle employer plan
2012-07-01Plan funding arrangement – InsuranceYes
2012-07-01Plan benefit arrangement – InsuranceYes
2011: ENERGY CORPORATION OF AMERICA GROUP LIFE INSURANCE 2011 form 5500 responses
2011-07-01Type of plan entitySingle employer plan
2011-07-01Plan funding arrangement – InsuranceYes
2011-07-01Plan benefit arrangement – InsuranceYes
2009: ENERGY CORPORATION OF AMERICA GROUP LIFE INSURANCE 2009 form 5500 responses
2009-07-01Type of plan entitySingle employer plan
2009-07-01Plan funding arrangement – InsuranceYes
2009-07-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberF018200
Policy instance 5
Insurance contract or identification numberF018200
Number of Individuals Covered153
Insurance policy start date2017-07-01
Insurance policy end date2017-11-30
Total amount of commissions paid to insurance brokerUSD $1,382
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $27,634
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,382
Insurance broker organization code?3
Insurance broker nameUSI INSURANCE SERVICES LLC
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE7492457
Policy instance 4
Insurance contract or identification numberE7492457
Number of Individuals Covered6
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $15,992
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL 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 CarrierUSD $72,934
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,349
Amount paid for insurance broker fees2748
Additional information about fees paid to insurance brokerFEES PAID
Insurance broker organization code?3
Insurance broker nameBENECHOICE ENROLLMENT SOLUTIONS INC
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract number64045492
Policy instance 3
Insurance contract or identification number64045492
Number of Individuals Covered0
Insurance policy start date2017-07-01
Insurance policy end date2017-11-29
Total amount of commissions paid to insurance brokerUSD $2,150
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL 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 CarrierUSD $6,143
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $1,229
Insurance broker organization code?3
Insurance broker nameMCGRIFF SEIBELS & WILLIAMS
ATLANTIC SPECIALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 27154 )
Policy contract number212-000-002
Policy instance 2
Insurance contract or identification number212-000-002
Number of Individuals Covered22
Insurance policy start date2017-07-01
Insurance policy end date2017-11-30
Total amount of commissions paid to insurance brokerUSD $137
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL 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 CarrierUSD $915
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $137
Insurance broker organization code?3
Insurance broker nameUSI INSURANCE SERVICES, LLC
ATLANTIC SPECIALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 27154 )
Policy contract number212-000-001
Policy instance 1
Insurance contract or identification number212-000-001
Number of Individuals Covered153
Insurance policy start date2017-07-01
Insurance policy end date2017-11-30
Total amount of commissions paid to insurance brokerUSD $605
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL 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 CarrierUSD $4,036
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $605
Insurance broker organization code?3
Insurance broker nameUSI INSURANCE SERVICES, LLC
ATLANTIC SPECIALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 27154 )
Policy contract number212-000-001
Policy instance 2
Insurance contract or identification number212-000-001
Number of Individuals Covered242
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $2,574
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $17,160
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,574
Insurance broker organization code?3
Insurance broker nameUSI INSURANCE SERVICES, LLC
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract number6404-5492
Policy instance 3
Insurance contract or identification number6404-5492
Number of Individuals Covered284
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $2,229
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $7,429
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $1,486
Insurance broker organization code?3
Insurance broker nameMCGRIFF, SEIBELS AND WILLIAMS
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberF018200
Policy instance 4
Insurance contract or identification numberF018200
Number of Individuals Covered242
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $18,346
Total amount of fees paid to insurance companyUSD $6,523
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $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 BrokerUSD $18,346
Amount paid for insurance broker fees6523
Insurance broker nameUSI INSURANCE SERVICES LLC
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE7492457
Policy instance 5
Insurance contract or identification numberE7492457
Number of Individuals Covered113
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $8,017
Total amount of fees paid to insurance companyUSD $1,693
Other welfare benefits providedACCIDENTAL DEATH
Welfare Benefit Premiums Paid to CarrierUSD $78,643
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,089
Amount paid for insurance broker fees719
Insurance broker organization code?3
Insurance broker nameCBF BENFITS INC
ATLANTIC SPECIALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 27154 )
Policy contract number212-000-002
Policy instance 1
Insurance contract or identification number212-000-002
Number of Individuals Covered31
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $503
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $3,353
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $503
Insurance broker organization code?3
Insurance broker nameUSI INSURANCE SERVICES, LLC
ATLANTIC SPECIALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 27154 )
Policy contract number212-000-001
Policy instance 2
Insurance contract or identification number212-000-001
Number of Individuals Covered284
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $2,789
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $18,592
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,789
Insurance broker organization code?3
Insurance broker nameUSI INSURANCE SERVICES, LLC
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract number6404-5492
Policy instance 3
Insurance contract or identification number6404-5492
Number of Individuals Covered284
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $2,216
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $7,386
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $1,477
Insurance broker organization code?3
Insurance broker nameMCGRIFF, SEIBELS AND WILLIAMS
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberF018200
Policy instance 4
Insurance contract or identification numberF018200
Number of Individuals Covered284
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $19,833
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $135,453
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,287
Insurance broker organization code?3
Insurance broker nameUSI INSURANCE SERVICES LLC
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE7492457
Policy instance 5
Insurance contract or identification numberE7492457
Number of Individuals Covered114
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $7,179
Total amount of fees paid to insurance companyUSD $653
Other welfare benefits providedACCIDENTAL DEATH
Welfare Benefit Premiums Paid to CarrierUSD $77,386
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,666
Amount paid for insurance broker fees98
Insurance broker organization code?3
Insurance broker nameTIMOTHY J SLATER
ATLANTIC SPECIALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 27154 )
Policy contract number212-000-002
Policy instance 1
Insurance contract or identification number212-000-002
Number of Individuals Covered45
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $582
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $3,879
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $582
Insurance broker organization code?3
Insurance broker nameUSI INSURANCE SERVICES, LLC
ATLANTIC SPECIALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 27154 )
Policy contract number212-000-001
Policy instance 2
Insurance contract or identification number212-000-001
Number of Individuals Covered285
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $2,524
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $16,824
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,524
Insurance broker organization code?3
Insurance broker nameUSI INSURANCE SERVICES, LLC
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract number6404-5492
Policy instance 3
Insurance contract or identification number6404-5492
Number of Individuals Covered285
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Other welfare benefits providedACCIDENTAL 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 nameMCGRIFF, SEIBELS AND WILLIAMS OF GA
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberF018200
Policy instance 4
Insurance contract or identification numberF018200
Number of Individuals Covered285
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $14,003
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $95,093
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,003
Insurance broker organization code?3
Insurance broker nameWELLS FARGO INSURANCE SERVICES
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE7492457
Policy instance 5
Insurance contract or identification numberE7492457
Number of Individuals Covered113
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $7,328
Total amount of fees paid to insurance companyUSD $946
Other welfare benefits providedACCIDENTAL DEATH
Welfare Benefit Premiums Paid to CarrierUSD $76,075
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,807
Amount paid for insurance broker fees381
Insurance broker organization code?3
Insurance broker nameTIMOTHY J SLATER
ATLANTIC SPECIALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 27154 )
Policy contract number212-000-002
Policy instance 1
Insurance contract or identification number212-000-002
Number of Individuals Covered49
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $633
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $4,222
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $633
Insurance broker organization code?3
Insurance broker nameUSI INSURANCE SERVICES, LLC
ATLANTIC SPECIALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 27154 )
Policy contract number212-000-001
Policy instance 2
Insurance contract or identification number212-000-001
Number of Individuals Covered273
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $2,448
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $16,321
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,448
Insurance broker organization code?3
Insurance broker nameWELLS FARGO INS SERVICES OF WV
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract number6404-5492
Policy instance 3
Insurance contract or identification number6404-5492
Number of Individuals Covered273
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $484
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $4,836
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $484
Insurance broker organization code?3
Insurance broker nameMCGRIFF, SIEBELS AND WILLIAMS OF GA
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberF018200
Policy instance 4
Insurance contract or identification numberF018200
Number of Individuals Covered273
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $16,663
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $112,996
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,663
Insurance broker organization code?3
Insurance broker nameWELLS FARGO INSURANCE SERVICES
ATLANTIC SPECIALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 27154 )
Policy contract number212-000-002
Policy instance 1
Insurance contract or identification number212-000-002
Number of Individuals Covered51
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $679
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $4,525
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $679
Insurance broker organization code?3
Insurance broker nameWELLS FARGO INSURANCE SERVICES
ONE BEACON (National Association of Insurance Commissioners NAIC id number: 21970 )
Policy contract number212-000-002
Policy instance 1
Insurance contract or identification number212-000-002
Number of Individuals Covered53
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $696
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $4,637
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ONE BEACON (National Association of Insurance Commissioners NAIC id number: 21970 )
Policy contract number212-000-001
Policy instance 2
Insurance contract or identification number212-000-001
Number of Individuals Covered274
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $2,317
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $15,446
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract number6404-5492
Policy instance 3
Insurance contract or identification number6404-5492
Number of Individuals Covered264
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $420
Total amount of fees paid to insurance companyUSD $63
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $4,200
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00427059
Policy instance 4
Insurance contract or identification number00427059
Number of Individuals Covered280
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $12,901
Total amount of fees paid to insurance companyUSD $3,602
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $88,662
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 numberE7492457
Policy instance 5
Insurance contract or identification numberE7492457
Number of Individuals Covered114
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $6,426
Total amount of fees paid to insurance companyUSD $1,620
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $76,737
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ONE BEACON (National Association of Insurance Commissioners NAIC id number: 21970 )
Policy contract number212-000-002
Policy instance 1
Insurance contract or identification number212-000-002
Number of Individuals Covered264
Insurance policy start date2010-07-01
Insurance policy end date2011-06-30
Total amount of commissions paid to insurance brokerUSD $700
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $4,666
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
ONE BEACON (National Association of Insurance Commissioners NAIC id number: 21970 )
Policy contract number212-000-001
Policy instance 2
Insurance contract or identification number212-000-001
Number of Individuals Covered264
Insurance policy start date2010-07-01
Insurance policy end date2011-06-30
Total amount of commissions paid to insurance brokerUSD $2,177
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $14,512
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00427059
Policy instance 4
Insurance contract or identification number00427059
Number of Individuals Covered264
Insurance policy start date2010-07-01
Insurance policy end date2011-06-30
Total amount of commissions paid to insurance brokerUSD $12,003
Total amount of fees paid to insurance companyUSD $2,138
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $78,449
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract number6404-5492
Policy instance 3
Insurance contract or identification number6404-5492
Number of Individuals Covered264
Insurance policy start date2010-07-30
Insurance policy end date2011-06-30
Total amount of commissions paid to insurance brokerUSD $420
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $4,200
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes

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