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RESERS FINE FOODS, INC. 401k Plan overview

Plan NameRESERS FINE FOODS, INC.
Plan identification number 501

RESERS FINE FOODS, INC. Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Other welfare benefit cover

401k Sponsoring company profile

RESERS FINE FOODS, INC. has sponsored the creation of one or more 401k plans.

Company Name:RESERS FINE FOODS, INC.
Employer identification number (EIN):930476628
NAIC Classification:311900
NAIC Description: Other Food Manufacturing

Additional information about RESERS FINE FOODS, INC.

Jurisdiction of Incorporation: Oregon Secretary of State Corporations Division
Incorporation Date: 2059-05-14
Company Identification Number: 6213714
Legal Registered Office Address: 15570 SW JENKINS ROAD

BEAVERTON
United States of America (USA)
97006

More information about RESERS FINE FOODS, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan RESERS FINE FOODS, INC.

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01
5012021-01-01
5012020-01-01
5012019-01-01
5012018-01-01
5012017-01-01JULIE STEWART JULIE STEWART2018-10-08
5012016-01-01PATTY OROZCO PATTY OROZCO2017-08-08
5012015-01-01KRISTINE EHLERS KRISTINE EHLERS2016-10-12
5012014-01-01ELAINE HOUSE PAUL LEAVY2015-09-29
5012013-01-01ELAINE HOUSE PAUL LEAVY2014-09-08
5012012-01-01ELAINE HOUSE PAUL LEAVY2013-07-25
5012011-01-01ELAINE HOUSE PAUL LEAVY2012-10-02
5012009-01-01AMBER RHEMREV

Plan Statistics for RESERS FINE FOODS, INC.

401k plan membership statisitcs for RESERS FINE FOODS, INC.

Measure Date Value
2022: RESERS FINE FOODS, INC. 2022 401k membership
Total participants, beginning-of-year2022-01-013,397
Total number of active participants reported on line 7a of the Form 55002022-01-013,581
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-013,581
2021: RESERS FINE FOODS, INC. 2021 401k membership
Total participants, beginning-of-year2021-01-013,605
Total number of active participants reported on line 7a of the Form 55002021-01-013,397
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-013,397
2020: RESERS FINE FOODS, INC. 2020 401k membership
Total participants, beginning-of-year2020-01-013,158
Total number of active participants reported on line 7a of the Form 55002020-01-013,784
Number of retired or separated participants receiving benefits2020-01-018
Number of other retired or separated participants entitled to future benefits2020-01-01735
Total of all active and inactive participants2020-01-014,527
2019: RESERS FINE FOODS, INC. 2019 401k membership
Total participants, beginning-of-year2019-01-013,898
Total number of active participants reported on line 7a of the Form 55002019-01-013,158
Number of retired or separated participants receiving benefits2019-01-0113
Number of other retired or separated participants entitled to future benefits2019-01-0114
Total of all active and inactive participants2019-01-013,185
2018: RESERS FINE FOODS, INC. 2018 401k membership
Total participants, beginning-of-year2018-01-013,210
Total number of active participants reported on line 7a of the Form 55002018-01-013,888
Number of retired or separated participants receiving benefits2018-01-0110
Number of other retired or separated participants entitled to future benefits2018-01-01218
Total of all active and inactive participants2018-01-014,116
2017: RESERS FINE FOODS, INC. 2017 401k membership
Total participants, beginning-of-year2017-01-013,345
Total number of active participants reported on line 7a of the Form 55002017-01-012,811
Number of retired or separated participants receiving benefits2017-01-0112
Number of other retired or separated participants entitled to future benefits2017-01-01258
Total of all active and inactive participants2017-01-013,081
2016: RESERS FINE FOODS, INC. 2016 401k membership
Total participants, beginning-of-year2016-01-013,270
Total number of active participants reported on line 7a of the Form 55002016-01-013,345
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-013,345
2015: RESERS FINE FOODS, INC. 2015 401k membership
Total participants, beginning-of-year2015-01-012,926
Total number of active participants reported on line 7a of the Form 55002015-01-013,012
Number of retired or separated participants receiving benefits2015-01-018
Number of other retired or separated participants entitled to future benefits2015-01-018
Total of all active and inactive participants2015-01-013,028
2014: RESERS FINE FOODS, INC. 2014 401k membership
Total participants, beginning-of-year2014-01-012,266
Total number of active participants reported on line 7a of the Form 55002014-01-012,886
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-010
Total of all active and inactive participants2014-01-012,886
2013: RESERS FINE FOODS, INC. 2013 401k membership
Total participants, beginning-of-year2013-01-012,911
Total number of active participants reported on line 7a of the Form 55002013-01-012,266
Number of retired or separated participants receiving benefits2013-01-0123
Total of all active and inactive participants2013-01-012,289
2012: RESERS FINE FOODS, INC. 2012 401k membership
Total participants, beginning-of-year2012-01-012,687
Total number of active participants reported on line 7a of the Form 55002012-01-012,659
Number of retired or separated participants receiving benefits2012-01-0115
Total of all active and inactive participants2012-01-012,674
2011: RESERS FINE FOODS, INC. 2011 401k membership
Total participants, beginning-of-year2011-01-012,400
Total number of active participants reported on line 7a of the Form 55002011-01-012,687
Number of retired or separated participants receiving benefits2011-01-0110
Total of all active and inactive participants2011-01-012,697
2009: RESERS FINE FOODS, INC. 2009 401k membership
Total participants, beginning-of-year2009-01-011,765
Total number of active participants reported on line 7a of the Form 55002009-01-012,060
Number of retired or separated participants receiving benefits2009-01-018
Number of other retired or separated participants entitled to future benefits2009-01-0129
Total of all active and inactive participants2009-01-012,097
Total participants2009-01-012,097

Form 5500 Responses for RESERS FINE FOODS, INC.

2022: RESERS FINE FOODS, INC. 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: RESERS FINE FOODS, INC. 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: RESERS FINE FOODS, INC. 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: RESERS FINE FOODS, INC. 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – General assets of the sponsorYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – General assets of the sponsorYes
2018: RESERS FINE FOODS, INC. 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: RESERS FINE FOODS, INC. 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: RESERS FINE FOODS, INC. 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – General assets of the sponsorYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – General assets of the sponsorYes
2015: RESERS FINE FOODS, INC. 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – General assets of the sponsorYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – General assets of the sponsorYes
2014: RESERS FINE FOODS, INC. 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – General assets of the sponsorYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – General assets of the sponsorYes
2013: RESERS FINE FOODS, INC. 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – General assets of the sponsorYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – General assets of the sponsorYes
2012: RESERS FINE FOODS, INC. 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – General assets of the sponsorYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – General assets of the sponsorYes
2011: RESERS FINE FOODS, INC. 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – General assets of the sponsorYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – General assets of the sponsorYes
2009: RESERS FINE FOODS, INC. 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – General assets of the sponsorYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number093648
Policy instance 1
Insurance contract or identification number093648
Number of Individuals Covered850
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $23,414
Total amount of fees paid to insurance companyUSD $7,805
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $390,245
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,512
Amount paid for insurance broker fees7805
Additional information about fees paid to insurance brokerADDTL COMP
Insurance broker organization code?3
CASCADE CENTERS INC. (National Association of Insurance Commissioners NAIC id number: 62133 )
Policy contract numberRESERS
Policy instance 6
Insurance contract or identification numberRESERS
Number of Individuals Covered3581
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Other welfare benefits providedEAP
Welfare Benefit Premiums Paid to CarrierUSD $42,113
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number0008460853
Policy instance 5
Insurance contract or identification number0008460853
Number of Individuals Covered9
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $200
Health Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Other welfare benefits providedOTHER (SPECIFY)
Welfare Benefit Premiums Paid to CarrierUSD $2,847
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $71
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract numberR0122739
Policy instance 4
Insurance contract or identification numberR0122739
Number of Individuals Covered2487
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $65,299
Total amount of fees paid to insurance companyUSD $436
Health Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedCRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $420,807
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $58,064
Amount paid for insurance broker fees436
Insurance broker organization code?3
Additional information about fees paid to insurance brokerADDTL COMPENSATION
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number093650
Policy instance 3
Insurance contract or identification number093650
Number of Individuals Covered3425
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $4,466
Total amount of fees paid to insurance companyUSD $8,932
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $446,617
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees8932
Additional information about fees paid to insurance brokerADDITONAL COMP
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $4,466
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number093649
Policy instance 2
Insurance contract or identification number093649
Number of Individuals Covered979
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $72,325
Total amount of fees paid to insurance companyUSD $9,041
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $452,031
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $67,805
Amount paid for insurance broker fees9041
Additional information about fees paid to insurance brokerADDTL COMP
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number093649
Policy instance 2
Insurance contract or identification number093649
Number of Individuals Covered1018
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $69,039
Total amount of fees paid to insurance companyUSD $8,908
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $445,410
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $66,812
Amount paid for insurance broker fees8908
Additional information about fees paid to insurance brokerADDTL COMP
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract numberR0122739
Policy instance 4
Insurance contract or identification numberR0122739
Number of Individuals Covered2916
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $9,579
Total amount of fees paid to insurance companyUSD $-284
Health Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedCRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $371,064
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,248
Insurance broker organization code?3
Amount paid for insurance broker fees142
Additional information about fees paid to insurance brokerADDTL COMPENSATION
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number093650
Policy instance 3
Insurance contract or identification number093650
Number of Individuals Covered3393
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $2,062
Total amount of fees paid to insurance companyUSD $8,247
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $412,328
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees8247
Additional information about fees paid to insurance brokerADDITONAL COMP
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $2,062
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number0008460853
Policy instance 5
Insurance contract or identification number0008460853
Number of Individuals Covered471
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $634
Health Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Other welfare benefits providedOTHER (SPECIFY)
Welfare Benefit Premiums Paid to CarrierUSD $11,332
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $306
Insurance broker organization code?3
CASCADE CENTERS INC. (National Association of Insurance Commissioners NAIC id number: 62133 )
Policy contract numberRESERS
Policy instance 6
Insurance contract or identification numberRESERS
Number of Individuals Covered3414
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Other welfare benefits providedEAP
Welfare Benefit Premiums Paid to CarrierUSD $41,092
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number093648
Policy instance 1
Insurance contract or identification number093648
Number of Individuals Covered901
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $21,952
Total amount of fees paid to insurance companyUSD $7,982
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $399,120
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,956
Amount paid for insurance broker fees7982
Additional information about fees paid to insurance brokerADDTL COMP
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number093649
Policy instance 2
Insurance contract or identification number093649
Number of Individuals Covered1044
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $70,866
Total amount of fees paid to insurance companyUSD $5,753
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $460,227
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $69,034
Amount paid for insurance broker fees5753
Additional information about fees paid to insurance brokerADDTL COMP
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number093650
Policy instance 3
Insurance contract or identification number093650
Number of Individuals Covered3540
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $2,005
Total amount of fees paid to insurance companyUSD $8,340
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $498,448
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees8340
Additional information about fees paid to insurance brokerADDITONAL COMP
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $2,005
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract numberR0122739
Policy instance 4
Insurance contract or identification numberR0122739
Number of Individuals Covered2859
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $81,346
Total amount of fees paid to insurance companyUSD $4,610
Health Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedCRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $426,451
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $35,075
Amount paid for insurance broker fees107
Additional information about fees paid to insurance brokerADDTIONAL COMP
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number093648
Policy instance 1
Insurance contract or identification number093648
Number of Individuals Covered992
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $23,746
Total amount of fees paid to insurance companyUSD $5,513
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $441,012
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $22,051
Amount paid for insurance broker fees5513
Additional information about fees paid to insurance brokerADDTL COMP
Insurance broker organization code?3
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number0008460853
Policy instance 5
Insurance contract or identification number0008460853
Number of Individuals Covered1489
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $23,081
Total amount of fees paid to insurance companyUSD $216
Health Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Other welfare benefits providedOTHER (SPECIFY)
Welfare Benefit Premiums Paid to CarrierUSD $371,186
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,692
Amount paid for insurance broker fees203
Additional information about fees paid to insurance brokerADDTIONAL COMP
Insurance broker organization code?3
CASCADE CENTERS INC. (National Association of Insurance Commissioners NAIC id number: 62133 )
Policy contract numberRESERS
Policy instance 6
Insurance contract or identification numberRESERS
Number of Individuals Covered3554
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Other welfare benefits providedEAP
Welfare Benefit Premiums Paid to CarrierUSD $43,200
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract numberR0122739
Policy instance 4
Insurance contract or identification numberR0122739
Number of Individuals Covered3050
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $63,303
Total amount of fees paid to insurance companyUSD $5,375
Health Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedCRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $474,278
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $43,176
Amount paid for insurance broker fees5375
Additional information about fees paid to insurance brokerADDTL COMPENSATION
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number093650
Policy instance 3
Insurance contract or identification number093650
Number of Individuals Covered4173
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $372,507
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number093648
Policy instance 1
Insurance contract or identification number093648
Number of Individuals Covered1244
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $17,879
Total amount of fees paid to insurance companyUSD $1,235
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $357,576
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,879
Amount paid for insurance broker fees1235
Additional information about fees paid to insurance brokerADDTL COMP
Insurance broker organization code?3
FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )
Policy contract numberR0122739
Policy instance 5
Insurance contract or identification numberR0122739
Number of Individuals Covered1
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $70
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $186
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $42
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number093649
Policy instance 2
Insurance contract or identification number093649
Number of Individuals Covered1215
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $52,108
Total amount of fees paid to insurance companyUSD $1,197
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $347,386
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $52,108
Amount paid for insurance broker fees1197
Additional information about fees paid to insurance brokerADDTL COMP
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number093650 001-004
Policy instance 3
Insurance contract or identification number093650 001-004
Number of Individuals Covered3898
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of fees paid to insurance companyUSD $1,211
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $341,555
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees1211
Additional information about fees paid to insurance brokerADDTL COMP
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract numberR0122739
Policy instance 4
Insurance contract or identification numberR0122739
Number of Individuals Covered3064
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $71,429
Total amount of fees paid to insurance companyUSD $5,268
Health Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $430,411
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $41,942
Amount paid for insurance broker fees5268
Additional information about fees paid to insurance brokerADDTL COMPENSATION
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number093648 001-003
Policy instance 1
Insurance contract or identification number093648 001-003
Number of Individuals Covered1201
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $14,597
Total amount of fees paid to insurance companyUSD $2,180
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $291,931
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,597
Amount paid for insurance broker fees2180
Additional information about fees paid to insurance brokerADDTL COMP
Insurance broker organization code?3
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number141247
Policy instance 7
Insurance contract or identification number141247
Number of Individuals Covered16
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $161
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $8,656
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $122
Insurance broker organization code?3
FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )
Policy contract numberR0122739
Policy instance 6
Insurance contract or identification numberR0122739
Number of Individuals Covered1
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $90
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $100
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $54
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number093649
Policy instance 2
Insurance contract or identification number093649
Number of Individuals Covered1175
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $48,612
Total amount of fees paid to insurance companyUSD $2,428
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $324,081
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $48,612
Amount paid for insurance broker fees2428
Additional information about fees paid to insurance brokerADDTL COMP
Insurance broker organization code?3
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number0008460853
Policy instance 5
Insurance contract or identification number0008460853
Number of Individuals Covered2131
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $84,001
Total amount of fees paid to insurance companyUSD $5,538
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedCRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $433,599
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $46,395
Amount paid for insurance broker fees5173
Insurance broker organization code?3
Additional information about fees paid to insurance brokerADDTL COMP
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number0008460853
Policy instance 5
Insurance contract or identification number0008460853
Number of Individuals Covered2607
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $158,941
Total amount of fees paid to insurance companyUSD $5,932
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedCRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $560,257
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $91,763
Amount paid for insurance broker fees5650
Insurance broker organization code?3
Insurance broker nameDALE NICHOLS
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract numberR0122739
Policy instance 4
Insurance contract or identification numberR0122739
Number of Individuals Covered3788
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $121,973
Total amount of fees paid to insurance companyUSD $10,458
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedCRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $548,904
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $70,378
Amount paid for insurance broker fees9921
Additional information about fees paid to insurance brokerADDTL COMPENSATION
Insurance broker organization code?3
Insurance broker nameDAVIDSON BENEFITS PLANNING LLC
FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )
Policy contract numberR0122739
Policy instance 6
Insurance contract or identification numberR0122739
Number of Individuals Covered1
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $14
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $288
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13
Insurance broker organization code?3
Insurance broker nameKERR, BRUCE, E WIL
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number093648 001-003
Policy instance 1
Insurance contract or identification number093648 001-003
Number of Individuals Covered1250
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $17,945
Total amount of fees paid to insurance companyUSD $4,486
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $358,910
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,945
Amount paid for insurance broker fees4486
Additional information about fees paid to insurance brokerADDTL COMP
Insurance broker organization code?3
Insurance broker nameDAVIDSON BENEFITS PLANNING LLC
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number093649
Policy instance 2
Insurance contract or identification number093649
Number of Individuals Covered1176
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $52,585
Total amount of fees paid to insurance companyUSD $4,382
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $350,563
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $52,585
Amount paid for insurance broker fees4382
Additional information about fees paid to insurance brokerADDTL COMP
Insurance broker organization code?3
Insurance broker nameDAVIDSON BENEFITS PLANNING LLC
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number093650 001-004
Policy instance 3
Insurance contract or identification number093650 001-004
Number of Individuals Covered3391
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of fees paid to insurance companyUSD $5,009
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $400,714
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees5009
Additional information about fees paid to insurance brokerADDTL COMP
Insurance broker organization code?3
Insurance broker nameDAVIDSON BENEFITS PLANNING LLC
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number093648 001-003
Policy instance 1
Insurance contract or identification number093648 001-003
Number of Individuals Covered1014
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $14,555
Total amount of fees paid to insurance companyUSD $2,183
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $291,100
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,555
Amount paid for insurance broker fees2183
Additional information about fees paid to insurance brokerADDTL COMP
Insurance broker organization code?3
Insurance broker nameDAVIDSON BENEFITS PLANNING LLC
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number093649
Policy instance 2
Insurance contract or identification number093649
Number of Individuals Covered1333
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $58,881
Total amount of fees paid to insurance companyUSD $2,944
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $392,542
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $58,881
Amount paid for insurance broker fees2944
Additional information about fees paid to insurance brokerADDTL COMP
Insurance broker organization code?3
Insurance broker nameDAVIDSON BENEFITS PLANNING LLC
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number093650 001-004
Policy instance 3
Insurance contract or identification number093650 001-004
Number of Individuals Covered3401
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of fees paid to insurance companyUSD $2,382
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $317,581
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees2382
Additional information about fees paid to insurance brokerADDTL COMP
Insurance broker organization code?3
Insurance broker nameDAVIDSON BENEFITS PLANNING LLC
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract numberR0122739
Policy instance 4
Insurance contract or identification numberR0122739
Number of Individuals Covered3033
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $83,875
Total amount of fees paid to insurance companyUSD $7,037
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedCRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $401,236
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $40,558
Amount paid for insurance broker fees6914
Additional information about fees paid to insurance brokerADDTL COMPENSATION
Insurance broker organization code?3
Insurance broker nameDAVIDSON BENEFITS PLANNING LLC
FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )
Policy contract numberR0122739
Policy instance 6
Insurance contract or identification numberR0122739
Number of Individuals Covered1
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $15
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $265
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2
Insurance broker organization code?3
Insurance broker nameBENEFIT COMMUNICATIONS INC
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number0008460853
Policy instance 5
Insurance contract or identification number0008460853
Number of Individuals Covered2031
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $128,583
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedCRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $393,224
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,312
Insurance broker organization code?3
Insurance broker nameJOHN J DAVIDSON
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number093649
Policy instance 2
Insurance contract or identification number093649
Number of Individuals Covered1359
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $49,036
Total amount of fees paid to insurance companyUSD $2,452
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $326,906
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $49,036
Amount paid for insurance broker fees2452
Additional information about fees paid to insurance brokerADDTL COMP
Insurance broker organization code?3
Insurance broker nameDAVIDSON BENEFITS PLANNING LLC
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number093648 0001
Policy instance 1
Insurance contract or identification number093648 0001
Number of Individuals Covered989
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $11,084
Total amount of fees paid to insurance companyUSD $1,663
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $221,684
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,084
Amount paid for insurance broker fees1663
Additional information about fees paid to insurance brokerADDTL COMP
Insurance broker organization code?3
Insurance broker nameDAVIDSON BENEFITS PLANNING LLC
FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )
Policy contract number8460853
Policy instance 5
Insurance contract or identification number8460853
Number of Individuals Covered1
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $12
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $265
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1
Insurance broker organization code?3
Insurance broker nameBENEFIT COMMUNICATIONS INC
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number0008460853
Policy instance 6
Insurance contract or identification number0008460853
Number of Individuals Covered1528
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $21,800
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedCRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $313,209
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,126
Insurance broker organization code?3
Insurance broker nameJOHN J DAVIDSON
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number093650
Policy instance 3
Insurance contract or identification number093650
Number of Individuals Covered3169
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $2,594
Total amount of fees paid to insurance companyUSD $2,262
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $262,880
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,594
Amount paid for insurance broker fees2262
Additional information about fees paid to insurance brokerADDTL COMP
Insurance broker organization code?3
Insurance broker nameDAVIDSON BENEFITS PLANNING LLC
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract numberR0122739
Policy instance 4
Insurance contract or identification numberR0122739
Number of Individuals Covered2536
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $40,223
Total amount of fees paid to insurance companyUSD $1,119
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedCRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $382,343
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $40,223
Amount paid for insurance broker fees1119
Additional information about fees paid to insurance brokerADDTL COMP
Insurance broker organization code?3
Insurance broker nameDAVIDSON BENEFITS PLANNING LLC
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number8460853
Policy instance 9
Insurance contract or identification number8460853
Number of Individuals Covered1874
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $32,268
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedCRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $359,763
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,515
Insurance broker organization code?3
Insurance broker nameJOHN J DAVIDSON
FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )
Policy contract number8460853
Policy instance 8
Insurance contract or identification number8460853
Number of Individuals Covered1
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $15
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $288
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2
Insurance broker organization code?3
Insurance broker nameBENEFIT COMMUNICATIONS INC
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract numberR0122739
Policy instance 7
Insurance contract or identification numberR0122739
Number of Individuals Covered2265
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $20,873
Total amount of fees paid to insurance companyUSD $659
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedCRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $326,082
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $20,873
Amount paid for insurance broker fees659
Additional information about fees paid to insurance brokerADDTL COMP
Insurance broker organization code?3
Insurance broker nameDAVIDSON BENEFITS PLANNING LLC
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30014863
Policy instance 6
Insurance contract or identification number30014863
Number of Individuals Covered5350
Insurance policy start date2013-04-01
Insurance policy end date2013-12-31
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number093649
Policy instance 4
Insurance contract or identification number093649
Number of Individuals Covered1194
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $57,283
Total amount of fees paid to insurance companyUSD $2,864
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $383,445
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $57,283
Amount paid for insurance broker fees2864
Additional information about fees paid to insurance brokerADDTL COMP
Insurance broker organization code?3
Insurance broker nameDAVIDSON BENEFITS PLANNING LLC
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number093648
Policy instance 3
Insurance contract or identification number093648
Number of Individuals Covered1039
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $12,448
Total amount of fees paid to insurance companyUSD $1,867
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $250,067
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,448
Amount paid for insurance broker fees1867
Additional information about fees paid to insurance brokerADDTL COMP
Insurance broker organization code?3
Insurance broker nameDAVIDSON BENEFITS PLANNING LLC
RELIANT BEHAVIORAL HEALTH (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number15020077
Policy instance 2
Insurance contract or identification number15020077
Number of Individuals Covered2687
Insurance policy start date2013-01-01
Insurance policy end date2013-03-31
Other welfare benefits providedEAP
Welfare Benefit Premiums Paid to CarrierUSD $1,800
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number03328888
Policy instance 1
Insurance contract or identification number03328888
Number of Individuals Covered2623
Insurance policy start date2013-01-01
Insurance policy end date2013-03-31
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number093650
Policy instance 5
Insurance contract or identification number093650
Number of Individuals Covered2911
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $14,722
Total amount of fees paid to insurance companyUSD $1,899
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $285,756
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,722
Amount paid for insurance broker fees1899
Additional information about fees paid to insurance brokerADDTL COMP
Insurance broker organization code?3
Insurance broker nameDAVIDSON BENEFITS PLANNING LLC
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number093650
Policy instance 5
Insurance contract or identification number093650
Number of Individuals Covered2847
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $11,444
Total amount of fees paid to insurance companyUSD $1,491
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $198,821
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,444
Amount paid for insurance broker fees1491
Additional information about fees paid to insurance brokerADDTL COMP
Insurance broker organization code?3
Insurance broker nameDAVIDSON BENEFITS PLANNING LLC
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number093649
Policy instance 4
Insurance contract or identification number093649
Number of Individuals Covered1169
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $37,330
Total amount of fees paid to insurance companyUSD $1,867
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $247,304
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $37,330
Amount paid for insurance broker fees1867
Additional information about fees paid to insurance brokerADDTL COMP
Insurance broker organization code?3
Insurance broker nameDAVIDSON BENEFITS PLANNING LLC
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number093648
Policy instance 3
Insurance contract or identification number093648
Number of Individuals Covered990
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $7,811
Total amount of fees paid to insurance companyUSD $1,172
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $154,942
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,811
Amount paid for insurance broker fees1172
Additional information about fees paid to insurance brokerADDTL COMP
Insurance broker organization code?3
Insurance broker nameDAVIDSON BENEFITS PLANNING LLC
RELIANT BEHAVIORAL HEALTH (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number15020077
Policy instance 2
Insurance contract or identification number15020077
Number of Individuals Covered2687
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Other welfare benefits providedEAP
Welfare Benefit Premiums Paid to CarrierUSD $7,853
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number03328888
Policy instance 1
Insurance contract or identification number03328888
Number of Individuals Covered2641
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $249,476
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number093650
Policy instance 6
Insurance contract or identification number093650
Number of Individuals Covered2364
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $13,192
Total amount of fees paid to insurance companyUSD $959
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $194,533
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number093648
Policy instance 4
Insurance contract or identification number093648
Number of Individuals Covered315
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $3,828
Total amount of fees paid to insurance companyUSD $302
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $66,449
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number093649
Policy instance 5
Insurance contract or identification number093649
Number of Individuals Covered501
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $18,338
Total amount of fees paid to insurance companyUSD $651
Life Insurance Welfare BenefitYes
Other welfare benefits providedADD
Welfare Benefit Premiums Paid to CarrierUSD $122,247
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIANT BEHAVIORAL HEALTH (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number15020077
Policy instance 3
Insurance contract or identification number15020077
Number of Individuals Covered2687
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Other welfare benefits providedEAP
Welfare Benefit Premiums Paid to CarrierUSD $18,541
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number03328888
Policy instance 2
Insurance contract or identification number03328888
Number of Individuals Covered2183
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $195,982
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )
Policy contract numberPF00327402
Policy instance 1
Insurance contract or identification numberPF00327402
Number of Individuals Covered2173
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Welfare Benefit Premiums Paid to CarrierUSD $52,461
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )
Policy contract numberPF00327401
Policy instance 1
Insurance contract or identification numberPF00327401
Number of Individuals Covered2139
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Welfare Benefit Premiums Paid to CarrierUSD $51,826
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number093650
Policy instance 7
Insurance contract or identification number093650
Number of Individuals Covered2375
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $21,286
Total amount of fees paid to insurance companyUSD $2,442
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $348,676
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $21,286
Amount paid for insurance broker fees2442
Additional information about fees paid to insurance brokerADDTL COMP
Insurance broker organization code?3
Insurance broker nameTHE PARTNERS GROUP
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number093649
Policy instance 6
Insurance contract or identification number093649
Number of Individuals Covered525
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $15,861
Total amount of fees paid to insurance companyUSD $793
Life Insurance Welfare BenefitYes
Other welfare benefits providedADD
Welfare Benefit Premiums Paid to CarrierUSD $105,738
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,861
Amount paid for insurance broker fees793
Additional information about fees paid to insurance brokerADDTL COMP
Insurance broker organization code?3
Insurance broker nameTHE PARTNERS GROUP LTD
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number093648
Policy instance 5
Insurance contract or identification number093648
Number of Individuals Covered316
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $3,453
Total amount of fees paid to insurance companyUSD $492
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $65,650
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,453
Amount paid for insurance broker fees492
Additional information about fees paid to insurance brokerADDTL COMP
Insurance broker organization code?3
Insurance broker nameTHE PARTNERS GROUP LTD
RELIANT BEHAVIORAL HEALTH (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number15020077
Policy instance 4
Insurance contract or identification number15020077
Number of Individuals Covered2687
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Other welfare benefits providedEAP
Welfare Benefit Premiums Paid to CarrierUSD $13,945
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number0008460853
Policy instance 2
Insurance contract or identification number0008460853
Number of Individuals Covered3340
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $103,091
Total amount of fees paid to insurance companyUSD $6,760
Other welfare benefits providedCRITICAL ILLNESSACCIDENTWHOLE LIF
Welfare Benefit Premiums Paid to CarrierUSD $495,006
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $87,183
Amount paid for insurance broker fees6801
Additional information about fees paid to insurance brokerADDTL COMP
Insurance broker organization code?3
Insurance broker nameDALE A NICHOLS
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number03328888
Policy instance 3
Insurance contract or identification number03328888
Number of Individuals Covered2112
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $10,435
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $190,950
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,435
Insurance broker organization code?3
Insurance broker nameTHE PARTNERS GROUP, LTD

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