BROWN & RIDING INSURANCE SERVICES, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan BROWN & RIDING INSURANCE SERVICES HEALTH AND WELFARE PLAN
401k plan membership statisitcs for BROWN & RIDING INSURANCE SERVICES HEALTH AND WELFARE PLAN
Measure | Date | Value |
---|
2021: BROWN & RIDING INSURANCE SERVICES HEALTH AND WELFARE PLAN 2021 401k membership |
---|
Total participants, beginning-of-year | 2021-09-01 | 299 |
Total number of active participants reported on line 7a of the Form 5500 | 2021-09-01 | 324 |
Number of retired or separated participants receiving benefits | 2021-09-01 | 5 |
Number of other retired or separated participants entitled to future benefits | 2021-09-01 | 8 |
Total of all active and inactive participants | 2021-09-01 | 337 |
Number of employers contributing to the scheme | 2021-09-01 | 0 |
2020: BROWN & RIDING INSURANCE SERVICES HEALTH AND WELFARE PLAN 2020 401k membership |
---|
Total participants, beginning-of-year | 2020-09-01 | 217 |
Total number of active participants reported on line 7a of the Form 5500 | 2020-09-01 | 253 |
Number of retired or separated participants receiving benefits | 2020-09-01 | 1 |
Number of other retired or separated participants entitled to future benefits | 2020-09-01 | 4 |
Total of all active and inactive participants | 2020-09-01 | 258 |
Number of employers contributing to the scheme | 2020-09-01 | 0 |
2019: BROWN & RIDING INSURANCE SERVICES HEALTH AND WELFARE PLAN 2019 401k membership |
---|
Total participants, beginning-of-year | 2019-09-01 | 217 |
Total number of active participants reported on line 7a of the Form 5500 | 2019-09-01 | 232 |
Number of retired or separated participants receiving benefits | 2019-09-01 | 2 |
Number of other retired or separated participants entitled to future benefits | 2019-09-01 | 7 |
Total of all active and inactive participants | 2019-09-01 | 241 |
Number of employers contributing to the scheme | 2019-09-01 | 0 |
2018: BROWN & RIDING INSURANCE SERVICES HEALTH AND WELFARE PLAN 2018 401k membership |
---|
Total participants, beginning-of-year | 2018-09-01 | 193 |
Total number of active participants reported on line 7a of the Form 5500 | 2018-09-01 | 216 |
Number of retired or separated participants receiving benefits | 2018-09-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2018-09-01 | 1 |
Total of all active and inactive participants | 2018-09-01 | 217 |
2017: BROWN & RIDING INSURANCE SERVICES HEALTH AND WELFARE PLAN 2017 401k membership |
---|
Total participants, beginning-of-year | 2017-09-01 | 208 |
Total number of active participants reported on line 7a of the Form 5500 | 2017-09-01 | 241 |
Number of retired or separated participants receiving benefits | 2017-09-01 | 1 |
Number of other retired or separated participants entitled to future benefits | 2017-09-01 | 6 |
Total of all active and inactive participants | 2017-09-01 | 248 |
2016: BROWN & RIDING INSURANCE SERVICES HEALTH AND WELFARE PLAN 2016 401k membership |
---|
Total participants, beginning-of-year | 2016-09-01 | 188 |
Total number of active participants reported on line 7a of the Form 5500 | 2016-09-01 | 208 |
Number of retired or separated participants receiving benefits | 2016-09-01 | 2 |
Number of other retired or separated participants entitled to future benefits | 2016-09-01 | 2 |
Total of all active and inactive participants | 2016-09-01 | 212 |
2015: BROWN & RIDING INSURANCE SERVICES HEALTH AND WELFARE PLAN 2015 401k membership |
---|
Total participants, beginning-of-year | 2015-09-01 | 188 |
Total number of active participants reported on line 7a of the Form 5500 | 2015-09-01 | 187 |
Number of retired or separated participants receiving benefits | 2015-09-01 | 1 |
Number of other retired or separated participants entitled to future benefits | 2015-09-01 | 1 |
Total of all active and inactive participants | 2015-09-01 | 189 |
2014: BROWN & RIDING INSURANCE SERVICES HEALTH AND WELFARE PLAN 2014 401k membership |
---|
Total participants, beginning-of-year | 2014-09-01 | 186 |
Total number of active participants reported on line 7a of the Form 5500 | 2014-09-01 | 185 |
Number of retired or separated participants receiving benefits | 2014-09-01 | 3 |
Number of other retired or separated participants entitled to future benefits | 2014-09-01 | 5 |
Total of all active and inactive participants | 2014-09-01 | 193 |
2013: BROWN & RIDING INSURANCE SERVICES HEALTH AND WELFARE PLAN 2013 401k membership |
---|
Total participants, beginning-of-year | 2013-09-01 | 184 |
Total number of active participants reported on line 7a of the Form 5500 | 2013-09-01 | 180 |
Number of retired or separated participants receiving benefits | 2013-09-01 | 4 |
Number of other retired or separated participants entitled to future benefits | 2013-09-01 | 0 |
Total of all active and inactive participants | 2013-09-01 | 184 |
2012: BROWN & RIDING INSURANCE SERVICES HEALTH AND WELFARE PLAN 2012 401k membership |
---|
Total participants, beginning-of-year | 2012-09-01 | 122 |
Total number of active participants reported on line 7a of the Form 5500 | 2012-09-01 | 119 |
Number of retired or separated participants receiving benefits | 2012-09-01 | 3 |
Number of other retired or separated participants entitled to future benefits | 2012-09-01 | 0 |
Total of all active and inactive participants | 2012-09-01 | 122 |
2011: BROWN & RIDING INSURANCE SERVICES HEALTH AND WELFARE PLAN 2011 401k membership |
---|
Total participants, beginning-of-year | 2011-09-01 | 118 |
Total number of active participants reported on line 7a of the Form 5500 | 2011-09-01 | 115 |
Number of retired or separated participants receiving benefits | 2011-09-01 | 3 |
Number of other retired or separated participants entitled to future benefits | 2011-09-01 | 0 |
Total of all active and inactive participants | 2011-09-01 | 118 |
2021: BROWN & RIDING INSURANCE SERVICES HEALTH AND WELFARE PLAN 2021 form 5500 responses |
---|
2021-09-01 | Type of plan entity | Single employer plan |
2021-09-01 | Plan funding arrangement – Insurance | Yes |
2021-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2021-09-01 | Plan benefit arrangement – Insurance | Yes |
2021-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2020: BROWN & RIDING INSURANCE SERVICES HEALTH AND WELFARE PLAN 2020 form 5500 responses |
---|
2020-09-01 | Type of plan entity | Single employer plan |
2020-09-01 | Plan funding arrangement – Insurance | Yes |
2020-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2020-09-01 | Plan benefit arrangement – Insurance | Yes |
2020-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2019: BROWN & RIDING INSURANCE SERVICES HEALTH AND WELFARE PLAN 2019 form 5500 responses |
---|
2019-09-01 | Type of plan entity | Single employer plan |
2019-09-01 | Plan funding arrangement – Insurance | Yes |
2019-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2019-09-01 | Plan benefit arrangement – Insurance | Yes |
2019-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2018: BROWN & RIDING INSURANCE SERVICES HEALTH AND WELFARE PLAN 2018 form 5500 responses |
---|
2018-09-01 | Type of plan entity | Single employer plan |
2018-09-01 | Submission has been amended | No |
2018-09-01 | This submission is the final filing | No |
2018-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2018-09-01 | Plan is a collectively bargained plan | No |
2018-09-01 | Plan funding arrangement – Insurance | Yes |
2018-09-01 | Plan benefit arrangement – Insurance | Yes |
2017: BROWN & RIDING INSURANCE SERVICES HEALTH AND WELFARE PLAN 2017 form 5500 responses |
---|
2017-09-01 | Type of plan entity | Single employer plan |
2017-09-01 | Submission has been amended | No |
2017-09-01 | This submission is the final filing | No |
2017-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2017-09-01 | Plan is a collectively bargained plan | No |
2017-09-01 | Plan funding arrangement – Insurance | Yes |
2017-09-01 | Plan benefit arrangement – Insurance | Yes |
2016: BROWN & RIDING INSURANCE SERVICES HEALTH AND WELFARE PLAN 2016 form 5500 responses |
---|
2016-09-01 | Type of plan entity | Single employer plan |
2016-09-01 | Submission has been amended | No |
2016-09-01 | This submission is the final filing | No |
2016-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2016-09-01 | Plan is a collectively bargained plan | No |
2016-09-01 | Plan funding arrangement – Insurance | Yes |
2016-09-01 | Plan benefit arrangement – Insurance | Yes |
2015: BROWN & RIDING INSURANCE SERVICES HEALTH AND WELFARE PLAN 2015 form 5500 responses |
---|
2015-09-01 | Type of plan entity | Single employer plan |
2015-09-01 | Submission has been amended | No |
2015-09-01 | This submission is the final filing | No |
2015-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2015-09-01 | Plan is a collectively bargained plan | No |
2015-09-01 | Plan funding arrangement – Insurance | Yes |
2015-09-01 | Plan benefit arrangement – Insurance | Yes |
2014: BROWN & RIDING INSURANCE SERVICES HEALTH AND WELFARE PLAN 2014 form 5500 responses |
---|
2014-09-01 | Type of plan entity | Single employer plan |
2014-09-01 | Submission has been amended | No |
2014-09-01 | This submission is the final filing | No |
2014-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2014-09-01 | Plan is a collectively bargained plan | No |
2014-09-01 | Plan funding arrangement – Insurance | Yes |
2014-09-01 | Plan benefit arrangement – Insurance | Yes |
2013: BROWN & RIDING INSURANCE SERVICES HEALTH AND WELFARE PLAN 2013 form 5500 responses |
---|
2013-09-01 | Type of plan entity | Single employer plan |
2013-09-01 | Submission has been amended | No |
2013-09-01 | This submission is the final filing | No |
2013-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2013-09-01 | Plan is a collectively bargained plan | No |
2013-09-01 | Plan funding arrangement – Insurance | Yes |
2013-09-01 | Plan benefit arrangement – Insurance | Yes |
2012: BROWN & RIDING INSURANCE SERVICES HEALTH AND WELFARE PLAN 2012 form 5500 responses |
---|
2012-09-01 | Type of plan entity | Single employer plan |
2012-09-01 | Submission has been amended | No |
2012-09-01 | This submission is the final filing | No |
2012-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2012-09-01 | Plan is a collectively bargained plan | No |
2012-09-01 | Plan funding arrangement – Insurance | Yes |
2012-09-01 | Plan benefit arrangement – Insurance | Yes |
2011: BROWN & RIDING INSURANCE SERVICES HEALTH AND WELFARE PLAN 2011 form 5500 responses |
---|
2011-09-01 | Type of plan entity | Single employer plan |
2011-09-01 | First time form 5500 has been submitted | Yes |
2011-09-01 | Submission has been amended | No |
2011-09-01 | This submission is the final filing | No |
2011-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2011-09-01 | Plan is a collectively bargained plan | No |
2011-09-01 | Plan funding arrangement – Insurance | Yes |
2011-09-01 | Plan benefit arrangement – Insurance | Yes |
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | SOK605623 |
Policy instance | 7 |
Insurance contract or identification number | SOK605623 | Number of Individuals Covered | 324 | Insurance policy start date | 2021-09-01 | Insurance policy end date | 2022-08-31 | Total amount of commissions paid to insurance broker | USD $330 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $3,301 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $330 | Amount paid for insurance broker fees | 0 | Additional information about fees paid to insurance broker | FEES | Insurance broker organization code? | 3 |
|
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 503492 |
Policy instance | 1 |
Insurance contract or identification number | 503492 | Number of Individuals Covered | 283 | Insurance policy start date | 2021-09-01 | Insurance policy end date | 2022-08-31 | Total amount of commissions paid to insurance broker | USD $31,953 | Total amount of fees paid to insurance company | USD $15,011 | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENT, CRITICAL ILLNESS, HOSPITAL | Welfare Benefit Premiums Paid to Carrier | USD $279,501 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $31,953 | Amount paid for insurance broker fees | 15011 | Additional information about fees paid to insurance broker | FEES | Insurance broker organization code? | 3 |
|
CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 ) |
Policy contract number | W0001116 |
Policy instance | 2 |
Insurance contract or identification number | W0001116 | Number of Individuals Covered | 426 | Insurance policy start date | 2021-09-01 | Insurance policy end date | 2022-08-31 | Total amount of commissions paid to insurance broker | USD $118,796 | Total amount of fees paid to insurance company | USD $114,884 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $2,520,563 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $66,085 | Amount paid for insurance broker fees | 114884 | Additional information about fees paid to insurance broker | PRODUCER SERVICE FEES | Insurance broker organization code? | 3 |
|
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | SGM607725 |
Policy instance | 3 |
Insurance contract or identification number | SGM607725 | Number of Individuals Covered | 324 | Insurance policy start date | 2021-09-01 | Insurance policy end date | 2022-08-31 | Total amount of commissions paid to insurance broker | USD $1,122 | Total amount of fees paid to insurance company | USD $162 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $11,223 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,122 | Amount paid for insurance broker fees | 127 | Additional information about fees paid to insurance broker | OVERRIDE | Insurance broker organization code? | 3 |
|
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | SGD608147 |
Policy instance | 4 |
Insurance contract or identification number | SGD608147 | Number of Individuals Covered | 324 | Insurance policy start date | 2021-09-01 | Insurance policy end date | 2022-08-31 | Total amount of commissions paid to insurance broker | USD $4,153 | Total amount of fees paid to insurance company | USD $581 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $41,534 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,153 | Amount paid for insurance broker fees | 454 | Additional information about fees paid to insurance broker | OVERRIDE | Insurance broker organization code? | 3 |
|
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | VDT601845 |
Policy instance | 5 |
Insurance contract or identification number | VDT601845 | Number of Individuals Covered | 63 | Insurance policy start date | 2021-09-01 | Insurance policy end date | 2022-08-31 | Total amount of commissions paid to insurance broker | USD $1,538 | Total amount of fees paid to insurance company | USD $0 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $17,085 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,538 | Amount paid for insurance broker fees | 0 | Additional information about fees paid to insurance broker | FEES | Insurance broker organization code? | 3 |
|
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | SGM607726 |
Policy instance | 6 |
Insurance contract or identification number | SGM607726 | Number of Individuals Covered | 324 | Insurance policy start date | 2021-09-01 | Insurance policy end date | 2022-08-31 | Total amount of commissions paid to insurance broker | USD $7,239 | Total amount of fees paid to insurance company | USD $668 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $48,263 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,239 | Amount paid for insurance broker fees | 526 | Additional information about fees paid to insurance broker | OVERRIDE | Insurance broker organization code? | 3 |
|
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | SGM607725 |
Policy instance | 3 |
Insurance contract or identification number | SGM607725 | Number of Individuals Covered | 299 | Insurance policy start date | 2020-09-01 | Insurance policy end date | 2021-08-31 | Total amount of commissions paid to insurance broker | USD $16,387 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $138,253 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $16,387 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
|
CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 ) |
Policy contract number | W0001116 |
Policy instance | 2 |
Insurance contract or identification number | W0001116 | Number of Individuals Covered | 412 | Insurance policy start date | 2020-09-01 | Insurance policy end date | 2021-08-31 | Total amount of commissions paid to insurance broker | USD $166,227 | Total amount of fees paid to insurance company | USD $107,993 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $2,374,541 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $116,578 | Amount paid for insurance broker fees | 107993 | Additional information about fees paid to insurance broker | PRODUCER SERVICE FEES | Insurance broker organization code? | 3 |
|
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 503492 |
Policy instance | 1 |
Insurance contract or identification number | 503492 | Number of Individuals Covered | 253 | Insurance policy start date | 2020-09-01 | Insurance policy end date | 2021-08-31 | Total amount of commissions paid to insurance broker | USD $30,801 | Total amount of fees paid to insurance company | USD $5,193 | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENT, CRITICAL ILLNESS, HOSPITAL | Welfare Benefit Premiums Paid to Carrier | USD $281,141 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $30,801 | Amount paid for insurance broker fees | 5193 | Additional information about fees paid to insurance broker | FEES | Insurance broker organization code? | 3 |
|
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 503492 |
Policy instance | 1 |
Insurance contract or identification number | 503492 | Number of Individuals Covered | 232 | Insurance policy start date | 2019-09-01 | Insurance policy end date | 2020-08-31 | Total amount of commissions paid to insurance broker | USD $24,354 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $242,637 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $18,104 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
|
CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 ) |
Policy contract number | W0001116 |
Policy instance | 2 |
Insurance contract or identification number | W0001116 | Number of Individuals Covered | 392 | Insurance policy start date | 2019-09-01 | Insurance policy end date | 2020-08-31 | Total amount of commissions paid to insurance broker | USD $107,659 | Total amount of fees paid to insurance company | USD $100,562 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,903,990 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $41,734 | Amount paid for insurance broker fees | 74998 | Additional information about fees paid to insurance broker | PRODUCER SERVICE FEES | Insurance broker organization code? | 3 |
|
CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 ) |
Policy contract number | 23034 |
Policy instance | 3 |
Insurance contract or identification number | 23034 | Number of Individuals Covered | 86 | Insurance policy start date | 2019-09-01 | Insurance policy end date | 2020-08-31 | Total amount of commissions paid to insurance broker | USD $6,656 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | ACCIDENT, CRITICAL ILLNESS, HOSPITAL | Welfare Benefit Premiums Paid to Carrier | USD $34,453 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,656 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
|
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | SGM607725 |
Policy instance | 4 |
Insurance contract or identification number | SGM607725 | Number of Individuals Covered | 232 | Insurance policy start date | 2019-09-01 | Insurance policy end date | 2020-08-31 | Total amount of commissions paid to insurance broker | USD $12,310 | Total amount of fees paid to insurance company | USD $2,482 | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $109,796 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $11,106 | Amount paid for insurance broker fees | 2482 | Additional information about fees paid to insurance broker | OVERRIDE | Insurance broker organization code? | 3 |
|
CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 ) |
Policy contract number | 0000023034 |
Policy instance | 8 |
Insurance contract or identification number | 0000023034 | Number of Individuals Covered | 84 | Insurance policy start date | 2018-09-01 | Insurance policy end date | 2019-08-31 | Total amount of commissions paid to insurance broker | USD $7,893 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENT, CRITICAL ILLNESS, HOSPITAL INDEMNITY | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $31,530 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,893 | Insurance broker organization code? | 3 |
|
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | SGM607726 |
Policy instance | 7 |
Insurance contract or identification number | SGM607726 | Number of Individuals Covered | 113 | Insurance policy start date | 2018-09-01 | Insurance policy end date | 2019-08-31 | Total amount of commissions paid to insurance broker | USD $6,767 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $45,115 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,767 | Insurance broker organization code? | 3 |
|
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | SGD608147 |
Policy instance | 5 |
Insurance contract or identification number | SGD608147 | Number of Individuals Covered | 241 | Insurance policy start date | 2018-09-01 | Insurance policy end date | 2019-08-31 | Total amount of commissions paid to insurance broker | USD $4,144 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $41,442 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,144 | Insurance broker organization code? | 3 |
|
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | VDT601845 |
Policy instance | 4 |
Insurance contract or identification number | VDT601845 | Number of Individuals Covered | 87 | Insurance policy start date | 2018-09-01 | Insurance policy end date | 2019-08-31 | Total amount of commissions paid to insurance broker | USD $2,921 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $37,614 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,921 | Insurance broker organization code? | 3 |
|
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | SOK605623 |
Policy instance | 3 |
Insurance contract or identification number | SOK605623 | Number of Individuals Covered | 241 | Insurance policy start date | 2018-09-01 | Insurance policy end date | 2019-08-31 | Total amount of commissions paid to insurance broker | USD $337 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $3,372 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $337 | Insurance broker organization code? | 3 |
|
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00503492 |
Policy instance | 2 |
Insurance contract or identification number | 00503492 | Number of Individuals Covered | 213 | Insurance policy start date | 2018-09-01 | Insurance policy end date | 2019-08-31 | Total amount of commissions paid to insurance broker | USD $22,484 | Total amount of fees paid to insurance company | USD $5,661 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $223,718 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $22,372 | Amount paid for insurance broker fees | 5661 | Additional information about fees paid to insurance broker | FEES | Insurance broker organization code? | 3 |
|
CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 ) |
Policy contract number | W0001116 |
Policy instance | 1 |
Insurance contract or identification number | W0001116 | Number of Individuals Covered | 366 | Insurance policy start date | 2018-09-01 | Insurance policy end date | 2019-08-31 | Total amount of commissions paid to insurance broker | USD $90,842 | Total amount of fees paid to insurance company | USD $37,777 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $1,885,802 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $90,842 | Amount paid for insurance broker fees | 61 | Additional information about fees paid to insurance broker | MISC. GIFTS, MEALS & ENTERTAINMENT ALLOCATION | Insurance broker organization code? | 3 |
|
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | SGM607725 |
Policy instance | 6 |
Insurance contract or identification number | SGM607725 | Number of Individuals Covered | 241 | Insurance policy start date | 2018-09-01 | Insurance policy end date | 2019-08-31 | Total amount of commissions paid to insurance broker | USD $1,147 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $11,474 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,147 | Insurance broker organization code? | 3 |
|
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | SGM607726 |
Policy instance | 7 |
Insurance contract or identification number | SGM607726 | Number of Individuals Covered | 102 | Insurance policy start date | 2017-09-01 | Insurance policy end date | 2018-08-31 | Total amount of commissions paid to insurance broker | USD $4,519 | Total amount of fees paid to insurance company | USD $602 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $30,126 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 ) |
Policy contract number | W0001116 |
Policy instance | 1 |
Insurance contract or identification number | W0001116 | Number of Individuals Covered | 354 | Insurance policy start date | 2017-09-01 | Insurance policy end date | 2018-08-31 | Total amount of commissions paid to insurance broker | USD $121,084 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $1,833,108 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | SOK605623 |
Policy instance | 3 |
Insurance contract or identification number | SOK605623 | Number of Individuals Covered | 241 | Insurance policy start date | 2017-09-01 | Insurance policy end date | 2018-08-31 | Total amount of commissions paid to insurance broker | USD $240 | Total amount of fees paid to insurance company | USD $49 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $2,397 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00503492 |
Policy instance | 2 |
Insurance contract or identification number | 00503492 | Number of Individuals Covered | 199 | Insurance policy start date | 2017-09-01 | Insurance policy end date | 2018-08-31 | Total amount of commissions paid to insurance broker | USD $23,067 | Total amount of fees paid to insurance company | USD $4,825 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $230,134 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | VDT601845 |
Policy instance | 4 |
Insurance contract or identification number | VDT601845 | Number of Individuals Covered | 73 | Insurance policy start date | 2017-09-01 | Insurance policy end date | 2018-08-31 | Total amount of commissions paid to insurance broker | USD $2,261 | Total amount of fees paid to insurance company | USD $395 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $21,423 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | SGM607725 |
Policy instance | 6 |
Insurance contract or identification number | SGM607725 | Number of Individuals Covered | 241 | Insurance policy start date | 2017-09-01 | Insurance policy end date | 2018-08-31 | Total amount of commissions paid to insurance broker | USD $815 | Total amount of fees paid to insurance company | USD $167 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $8,148 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | SGD608147 |
Policy instance | 5 |
Insurance contract or identification number | SGD608147 | Number of Individuals Covered | 241 | Insurance policy start date | 2017-09-01 | Insurance policy end date | 2018-08-31 | Total amount of commissions paid to insurance broker | USD $2,905 | Total amount of fees paid to insurance company | USD $579 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $29,046 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 ) |
Policy contract number | W0001116 |
Policy instance | 1 |
Insurance contract or identification number | W0001116 | Number of Individuals Covered | 280 | Insurance policy start date | 2015-09-01 | Insurance policy end date | 2016-08-31 | Total amount of commissions paid to insurance broker | USD $72,771 | Total amount of fees paid to insurance company | USD $2,464 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $1,455,416 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $61,022 | Amount paid for insurance broker fees | 57 | Additional information about fees paid to insurance broker | MISCELLANEOUS MEALS, GIFTS & ENTERTAINMENT ALLOCATION | Insurance broker organization code? | 3 | Insurance broker name | CLAREMONT BUSINESS GROUP |
|
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00503492 |
Policy instance | 2 |
Insurance contract or identification number | 00503492 | Number of Individuals Covered | 188 | Insurance policy start date | 2015-09-01 | Insurance policy end date | 2016-08-31 | Total amount of commissions paid to insurance broker | USD $27,988 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $269,350 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $23,479 | Insurance broker organization code? | 3 | Insurance broker name | THE PLEXUS GROUPE LLC |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 415422 |
Policy instance | 3 |
Insurance contract or identification number | 415422 | Number of Individuals Covered | 49 | Insurance policy start date | 2015-09-01 | Insurance policy end date | 2016-08-31 | Total amount of commissions paid to insurance broker | USD $1,764 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | STD | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $16,853 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,528 | Insurance broker organization code? | 3 | Insurance broker name | THE PLEXUS GROUPE LLC |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 415422 |
Policy instance | 3 |
Insurance contract or identification number | 415422 | Number of Individuals Covered | 46 | Insurance policy start date | 2014-09-01 | Insurance policy end date | 2015-08-31 | Total amount of commissions paid to insurance broker | USD $1,417 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | STD | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $14,165 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,417 | Insurance broker organization code? | 3 | Insurance broker name | NAVALI & COMPANY INSURANCE SER |
|
CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 ) |
Policy contract number | W0001116 |
Policy instance | 1 |
Insurance contract or identification number | W0001116 | Number of Individuals Covered | 287 | Insurance policy start date | 2014-09-01 | Insurance policy end date | 2015-08-31 | Total amount of commissions paid to insurance broker | USD $67,209 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $1,344,177 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $67,209 | Insurance broker organization code? | 3 | Insurance broker name | NAVALI & COMPANY INSURANCE SER |
|
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00503492 |
Policy instance | 2 |
Insurance contract or identification number | 00503492 | Number of Individuals Covered | 188 | Insurance policy start date | 2014-09-01 | Insurance policy end date | 2015-08-31 | Total amount of commissions paid to insurance broker | USD $27,665 | Total amount of fees paid to insurance company | USD $2,472 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $267,375 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $27,665 | Amount paid for insurance broker fees | 2472 | Additional information about fees paid to insurance broker | FEES | Insurance broker organization code? | 3 | Insurance broker name | NAVALI & COMPANY INS SVCS INC |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 415422 |
Policy instance | 5 |
Insurance contract or identification number | 415422 | Number of Individuals Covered | 44 | Insurance policy start date | 2013-09-01 | Insurance policy end date | 2014-08-31 | Total amount of commissions paid to insurance broker | USD $1,602 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | STD | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $17,447 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,602 | Insurance broker organization code? | 3 | Insurance broker name | NAVALI & COMPANY INSURANCE SER |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 30021580 |
Policy instance | 3 |
Insurance contract or identification number | 30021580 | Number of Individuals Covered | 0 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-08-31 | Total amount of commissions paid to insurance broker | USD $538 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $14,139 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $538 | Insurance broker organization code? | 3 | Insurance broker name | NAVALI & COMPANY |
|
CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 ) |
Policy contract number | W0001116 |
Policy instance | 1 |
Insurance contract or identification number | W0001116 | Number of Individuals Covered | 290 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $47,121 | Total amount of fees paid to insurance company | USD $17,046 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $946,525 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $44,117 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 17046 | Additional information about fees paid to insurance broker | GENERAL AGENT SERVICES | Insurance broker name | GARY T RODRIGUEZ |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 30021580 |
Policy instance | 2 |
Insurance contract or identification number | 30021580 | Number of Individuals Covered | 112 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $1,104 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $18,767 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,037 | Insurance broker organization code? | 3 | Insurance broker name | PAINE FINANCIAL & INS SVCS |
|
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
Policy contract number | 1013071 |
Policy instance | 4 |
Insurance contract or identification number | 1013071 | Number of Individuals Covered | 339 | Insurance policy start date | 2013-09-01 | Insurance policy end date | 2014-08-31 | Total amount of commissions paid to insurance broker | USD $28,380 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $284,523 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $28,380 | Insurance broker organization code? | 3 | Insurance broker name | NAVALI & CO INC |
|
CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 ) |
Policy contract number | W0001116 |
Policy instance | 1 |
Insurance contract or identification number | W0001116 | Number of Individuals Covered | 194 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $36,024 | Total amount of fees paid to insurance company | USD $13,946 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $697,278 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $18,012 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 13946 | Additional information about fees paid to insurance broker | GENERAL AGENT SERVICES | Insurance broker name | CLAREMONT BUSINESS GROUP |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 30021580 |
Policy instance | 3 |
Insurance contract or identification number | 30021580 | Number of Individuals Covered | 78 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $915 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $13,609 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $915 | Insurance broker organization code? | 3 | Insurance broker name | PAINE FINANCIAL & INS SVCS |
|
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
Policy contract number | 1013071 |
Policy instance | 2 |
Insurance contract or identification number | 1013071 | Number of Individuals Covered | 303 | Insurance policy start date | 2012-09-01 | Insurance policy end date | 2013-08-31 | Total amount of commissions paid to insurance broker | USD $21,820 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $218,256 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $14,223 | Insurance broker organization code? | 3 | Insurance broker name | SCOTT EDWARD PAINE, CLU |
|
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
Policy contract number | 1013071 |
Policy instance | 1 |
Insurance contract or identification number | 1013071 | Number of Individuals Covered | 208 | Insurance policy start date | 2011-09-01 | Insurance policy end date | 2012-08-31 | Total amount of commissions paid to insurance broker | USD $16,091 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $160,728 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|