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ARAMARK SERVICES, INC. LIFE & ACCIDENT PLAN 401k Plan overview

Plan NameARAMARK SERVICES, INC. LIFE & ACCIDENT PLAN
Plan identification number 517

ARAMARK SERVICES, INC. LIFE & ACCIDENT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Life insurance
  • Death benefits (include travel accident but not life insurance)
  • Other welfare benefit cover

401k Sponsoring company profile

ARAMARK SERVICES, INC. RETIREMENT BENEFITS has sponsored the creation of one or more 401k plans.

Company Name:ARAMARK SERVICES, INC. RETIREMENT BENEFITS
Employer identification number (EIN):952051630
NAIC Classification:722300
NAIC Description: Special Food Services

Additional information about ARAMARK SERVICES, INC. RETIREMENT BENEFITS

Jurisdiction of Incorporation: Texas Secretary of State
Incorporation Date: 1960-11-03
Company Identification Number: 0002076106
Legal Registered Office Address: PO BOX 7548

PHILADELPHIA
United States of America (USA)
19101

More information about ARAMARK SERVICES, INC. RETIREMENT BENEFITS

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ARAMARK SERVICES, INC. LIFE & ACCIDENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5172022-01-01TODD LOMBARDI2023-10-13
5172021-01-01TODD LOMBARDI2022-10-13
5172020-01-01TODD LOMBARDI2021-10-12
5172019-01-01TODD LOMBARDI2020-10-13
5172018-01-01TODD LOMBARDI2019-10-11
5172017-01-01
5172016-01-01
5172015-01-01
5172014-01-01
5172013-01-01
5172012-01-01JILL K. MALILA
5172011-01-01CATHERINE PALMER
5172010-01-01VALERIE WANDLER
5172009-01-01JOHN MATEKOVIC

Plan Statistics for ARAMARK SERVICES, INC. LIFE & ACCIDENT PLAN

401k plan membership statisitcs for ARAMARK SERVICES, INC. LIFE & ACCIDENT PLAN

Measure Date Value
2022: ARAMARK SERVICES, INC. LIFE & ACCIDENT PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-0168,667
Total number of active participants reported on line 7a of the Form 55002022-01-0163,690
Number of retired or separated participants receiving benefits2022-01-0120
Total of all active and inactive participants2022-01-0163,710
2021: ARAMARK SERVICES, INC. LIFE & ACCIDENT PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-0154,122
Total number of active participants reported on line 7a of the Form 55002021-01-0168,662
Number of retired or separated participants receiving benefits2021-01-015
Total of all active and inactive participants2021-01-0168,667
2020: ARAMARK SERVICES, INC. LIFE & ACCIDENT PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-0170,416
Total number of active participants reported on line 7a of the Form 55002020-01-0154,115
Number of retired or separated participants receiving benefits2020-01-017
Total of all active and inactive participants2020-01-0154,122
2019: ARAMARK SERVICES, INC. LIFE & ACCIDENT PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-0172,656
Total number of active participants reported on line 7a of the Form 55002019-01-0170,409
Number of retired or separated participants receiving benefits2019-01-017
Total of all active and inactive participants2019-01-0170,416
2018: ARAMARK SERVICES, INC. LIFE & ACCIDENT PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-0168,855
Total number of active participants reported on line 7a of the Form 55002018-01-0172,649
Number of retired or separated participants receiving benefits2018-01-017
Total of all active and inactive participants2018-01-0172,656
2017: ARAMARK SERVICES, INC. LIFE & ACCIDENT PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-0169,830
Total number of active participants reported on line 7a of the Form 55002017-01-0168,818
Number of retired or separated participants receiving benefits2017-01-0137
Total of all active and inactive participants2017-01-0168,855
2016: ARAMARK SERVICES, INC. LIFE & ACCIDENT PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-0170,854
Total number of active participants reported on line 7a of the Form 55002016-01-0169,793
Number of retired or separated participants receiving benefits2016-01-0137
Total of all active and inactive participants2016-01-0169,830
2015: ARAMARK SERVICES, INC. LIFE & ACCIDENT PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-0167,584
Total number of active participants reported on line 7a of the Form 55002015-01-0170,817
Number of retired or separated participants receiving benefits2015-01-0137
Total of all active and inactive participants2015-01-0170,854
2014: ARAMARK SERVICES, INC. LIFE & ACCIDENT PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-0166,558
Total number of active participants reported on line 7a of the Form 55002014-01-0167,547
Number of retired or separated participants receiving benefits2014-01-0137
Total of all active and inactive participants2014-01-0167,584
2013: ARAMARK SERVICES, INC. LIFE & ACCIDENT PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-0165,235
Total number of active participants reported on line 7a of the Form 55002013-01-0166,521
Number of retired or separated participants receiving benefits2013-01-0137
Number of other retired or separated participants entitled to future benefits2013-01-010
Total of all active and inactive participants2013-01-0166,558
2012: ARAMARK SERVICES, INC. LIFE & ACCIDENT PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-0162,791
Total number of active participants reported on line 7a of the Form 55002012-01-0165,197
Number of retired or separated participants receiving benefits2012-01-0138
Number of other retired or separated participants entitled to future benefits2012-01-010
Total of all active and inactive participants2012-01-0165,235
2011: ARAMARK SERVICES, INC. LIFE & ACCIDENT PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-0165,424
Total number of active participants reported on line 7a of the Form 55002011-01-0162,751
Number of retired or separated participants receiving benefits2011-01-0140
Total of all active and inactive participants2011-01-0162,791
2010: ARAMARK SERVICES, INC. LIFE & ACCIDENT PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-0172,558
Total number of active participants reported on line 7a of the Form 55002010-01-0165,386
Number of retired or separated participants receiving benefits2010-01-010
Number of other retired or separated participants entitled to future benefits2010-01-0138
Total of all active and inactive participants2010-01-0165,424
Total participants2010-01-0165,424
2009: ARAMARK SERVICES, INC. LIFE & ACCIDENT PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-0166,132
Total number of active participants reported on line 7a of the Form 55002009-01-0172,514
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-0144
Total of all active and inactive participants2009-01-0172,558

Form 5500 Responses for ARAMARK SERVICES, INC. LIFE & ACCIDENT PLAN

2022: ARAMARK SERVICES, INC. LIFE & ACCIDENT PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – InsuranceYes
2021: ARAMARK SERVICES, INC. LIFE & ACCIDENT PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – InsuranceYes
2020: ARAMARK SERVICES, INC. LIFE & ACCIDENT PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – InsuranceYes
2019: ARAMARK SERVICES, INC. LIFE & ACCIDENT PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – InsuranceYes
2018: ARAMARK SERVICES, INC. LIFE & ACCIDENT PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – InsuranceYes
2017: ARAMARK SERVICES, INC. LIFE & ACCIDENT PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – InsuranceYes
2016: ARAMARK SERVICES, INC. LIFE & ACCIDENT PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – InsuranceYes
2015: ARAMARK SERVICES, INC. LIFE & ACCIDENT PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: ARAMARK SERVICES, INC. LIFE & ACCIDENT PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: ARAMARK SERVICES, INC. LIFE & ACCIDENT PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: ARAMARK SERVICES, INC. LIFE & ACCIDENT PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: ARAMARK SERVICES, INC. LIFE & ACCIDENT PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – InsuranceYes
2010: ARAMARK SERVICES, INC. LIFE & ACCIDENT PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedNo
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan benefit arrangement – InsuranceYes
2009: ARAMARK SERVICES, INC. LIFE & ACCIDENT PLAN 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 benefit arrangement – InsuranceYes

Insurance Providers Used on plan

NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )
Policy contract numberBSC9035261-D
Policy instance 4
Insurance contract or identification numberBSC9035261-D
Number of Individuals Covered58569
Insurance policy start date2022-01-01
Insurance policy end date2023-01-01
Total amount of commissions paid to insurance brokerUSD $9,864
Total amount of fees paid to insurance companyUSD $19,727
Other welfare benefits providedAD&D AND PARALYSIS
Welfare Benefit Premiums Paid to CarrierUSD $197,273
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,864
Amount paid for insurance broker fees19727
Additional information about fees paid to insurance brokerADMIN/ACCOUNT MANAGEMENT
Insurance broker organization code?3
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )
Policy contract numberGTP0009124022-A
Policy instance 3
Insurance contract or identification numberGTP0009124022-A
Number of Individuals Covered15530
Insurance policy start date2022-01-01
Insurance policy end date2023-01-01
Total amount of commissions paid to insurance brokerUSD $9,054
Total amount of fees paid to insurance companyUSD $13,581
Other welfare benefits providedAD&D AND PARALYSIS
Welfare Benefit Premiums Paid to CarrierUSD $90,535
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,054
Amount paid for insurance broker fees13581
Additional information about fees paid to insurance brokerADMIN/ACCOUNT MANAGEMENT
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0116424
Policy instance 2
Insurance contract or identification number0116424
Number of Individuals Covered71958
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $327,471
Total amount of fees paid to insurance companyUSD $13
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,802,319
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $327,471
Amount paid for insurance broker fees13
Additional information about fees paid to insurance brokerNON-MONETARY COMPENSATION
Insurance broker organization code?3
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )
Policy contract numberPAI0009052772-C
Policy instance 5
Insurance contract or identification numberPAI0009052772-C
Number of Individuals Covered15106
Insurance policy start date2022-01-01
Insurance policy end date2023-01-01
Total amount of commissions paid to insurance brokerUSD $28,691
Total amount of fees paid to insurance companyUSD $28,691
Other welfare benefits providedAD&D AND PARALYSIS
Welfare Benefit Premiums Paid to CarrierUSD $286,906
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $28,691
Amount paid for insurance broker fees28691
Additional information about fees paid to insurance brokerADMIN/ACCOUNT MANAGEMENT
Insurance broker organization code?3
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number164400
Policy instance 6
Insurance contract or identification number164400
Number of Individuals Covered7
Insurance policy start date2022-01-01
Insurance policy end date2023-01-01
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedDISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $18,758
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE4961751
Policy instance 7
Insurance contract or identification numberE4961751
Number of Individuals Covered11
Insurance policy start date2022-03-01
Insurance policy end date2023-02-28
Total amount of commissions paid to insurance brokerUSD $9,927
Total amount of fees paid to insurance companyUSD $1,172
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $52,887
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,755
Amount paid for insurance broker fees885
Additional information about fees paid to insurance brokerBONUS, NON-CASH INCENTIVES
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number444121
Policy instance 1
Insurance contract or identification number444121
Number of Individuals Covered20
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $273
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $2,310
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $270
Insurance broker organization code?3
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )
Policy contract numberPAI0009052772-C
Policy instance 5
Insurance contract or identification numberPAI0009052772-C
Number of Individuals Covered15106
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $30,071
Total amount of fees paid to insurance companyUSD $30,071
Other welfare benefits providedAD&D AND PARALYSIS
Welfare Benefit Premiums Paid to CarrierUSD $300,711
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $30,071
Amount paid for insurance broker fees30071
Additional information about fees paid to insurance brokerUNDERWRITING/ACCOUNT MANAGEMENT FEE
Insurance broker organization code?3
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number41553
Policy instance 6
Insurance contract or identification number41553
Number of Individuals Covered8
Insurance policy start date2021-01-01
Insurance policy end date2022-01-01
Total amount of commissions paid to insurance brokerUSD $298
Total amount of fees paid to insurance companyUSD $102
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $10,741
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $199
Amount paid for insurance broker fees102
Additional information about fees paid to insurance brokerADDTIONAL FEES
Insurance broker organization code?3
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )
Policy contract numberBSC9035261-D
Policy instance 4
Insurance contract or identification numberBSC9035261-D
Number of Individuals Covered58569
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $8,813
Total amount of fees paid to insurance companyUSD $17,626
Other welfare benefits providedAD&D AND PARALYSIS
Welfare Benefit Premiums Paid to CarrierUSD $176,265
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,813
Amount paid for insurance broker fees17626
Additional information about fees paid to insurance brokerUNDERWRITING/ACCOUNT MANAGEMENT FEE
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number444121
Policy instance 1
Insurance contract or identification number444121
Number of Individuals Covered16
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $352
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $3,167
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $296
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0116424
Policy instance 2
Insurance contract or identification number0116424
Number of Individuals Covered67576
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $310,184
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,475,648
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $310,184
Insurance broker organization code?3
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )
Policy contract numberGTP0009124022-A
Policy instance 3
Insurance contract or identification numberGTP0009124022-A
Number of Individuals Covered15106
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $7,771
Total amount of fees paid to insurance companyUSD $11,656
Other welfare benefits providedAD&D AND PARALYSIS
Welfare Benefit Premiums Paid to CarrierUSD $77,705
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,771
Amount paid for insurance broker fees11656
Additional information about fees paid to insurance brokerADMIN/ACCOUNT MANAGEMENT
Insurance broker organization code?3
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number164400
Policy instance 7
Insurance contract or identification number164400
Number of Individuals Covered9
Insurance policy start date2021-01-01
Insurance policy end date2022-01-01
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedDISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $26,259
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 number444121
Policy instance 1
Insurance contract or identification number444121
Number of Individuals Covered15
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $544
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $5,163
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $544
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number10080792
Policy instance 2
Insurance contract or identification number10080792
Number of Individuals Covered12
Insurance policy start date2020-01-01
Insurance policy end date2020-05-31
Total amount of commissions paid to insurance brokerUSD $69
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $459
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $69
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0116424
Policy instance 3
Insurance contract or identification number0116424
Number of Individuals Covered63406
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $331,289
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,839,837
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $331,289
Insurance broker organization code?3
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )
Policy contract numberGTP0009124022-A
Policy instance 4
Insurance contract or identification numberGTP0009124022-A
Number of Individuals Covered17068
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $10,023
Total amount of fees paid to insurance companyUSD $15,034
Other welfare benefits providedAD&D AND PARALYSIS
Welfare Benefit Premiums Paid to CarrierUSD $100,225
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,023
Amount paid for insurance broker fees15034
Additional information about fees paid to insurance brokerADMIN/ACCOUNT MANAGEMENT
Insurance broker organization code?3
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )
Policy contract numberBSC9035261-D
Policy instance 5
Insurance contract or identification numberBSC9035261-D
Number of Individuals Covered53099
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $9,684
Total amount of fees paid to insurance companyUSD $19,367
Other welfare benefits providedAD&D AND PARALYSIS
Welfare Benefit Premiums Paid to CarrierUSD $193,671
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,684
Amount paid for insurance broker fees19367
Additional information about fees paid to insurance brokerUNDERWRITING/ACCOUNT MANAGEMENT FEE
Insurance broker organization code?3
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )
Policy contract numberPAI0009052772-C
Policy instance 6
Insurance contract or identification numberPAI0009052772-C
Number of Individuals Covered13871
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $33,277
Total amount of fees paid to insurance companyUSD $33,277
Other welfare benefits providedAD&D AND PARALYSIS
Welfare Benefit Premiums Paid to CarrierUSD $332,773
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $33,277
Amount paid for insurance broker fees33277
Additional information about fees paid to insurance brokerUNDERWRITING/ACCOUNT MANAGEMENT FEE
Insurance broker organization code?3
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number41553
Policy instance 7
Insurance contract or identification number41553
Number of Individuals Covered41
Insurance policy start date2020-01-01
Insurance policy end date2021-01-01
Total amount of commissions paid to insurance brokerUSD $383
Total amount of fees paid to insurance companyUSD $135
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $12,273
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $258
Amount paid for insurance broker fees135
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number164400
Policy instance 8
Insurance contract or identification number164400
Number of Individuals Covered10
Insurance policy start date2020-01-01
Insurance policy end date2021-01-01
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedDISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $26,735
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 number41553
Policy instance 7
Insurance contract or identification number41553
Number of Individuals Covered31
Insurance policy start date2019-01-01
Insurance policy end date2020-01-01
Total amount of commissions paid to insurance brokerUSD $593
Total amount of fees paid to insurance companyUSD $241
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $16,485
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $405
Amount paid for insurance broker fees241
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )
Policy contract numberPAI0009052772-C
Policy instance 6
Insurance contract or identification numberPAI0009052772-C
Number of Individuals Covered16678
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $34,022
Total amount of fees paid to insurance companyUSD $34,022
Other welfare benefits providedAD&D AND PARALYSIS
Welfare Benefit Premiums Paid to CarrierUSD $340,217
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $34,022
Amount paid for insurance broker fees34022
Additional information about fees paid to insurance brokerUNDERWRITING ACCOUNTING MANAGEMENT FEE
Insurance broker organization code?3
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )
Policy contract numberBSC9035261-D
Policy instance 5
Insurance contract or identification numberBSC9035261-D
Number of Individuals Covered70239
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $10,055
Total amount of fees paid to insurance companyUSD $20,111
Other welfare benefits providedAD&D AND PARALYSIS
Welfare Benefit Premiums Paid to CarrierUSD $201,108
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,055
Amount paid for insurance broker fees20111
Additional information about fees paid to insurance brokerUNDERWRITING ACCOUNTING MANAGEMENT FEE
Insurance broker organization code?3
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )
Policy contract numberGTP0009124022-A
Policy instance 4
Insurance contract or identification numberGTP0009124022-A
Number of Individuals Covered17068
Insurance policy start date2019-01-01
Insurance policy end date2020-01-01
Total amount of commissions paid to insurance brokerUSD $10,023
Total amount of fees paid to insurance companyUSD $15,034
Other welfare benefits providedAD&D AND PARALYSIS
Welfare Benefit Premiums Paid to CarrierUSD $100,225
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,023
Amount paid for insurance broker fees15034
Additional information about fees paid to insurance brokerADMIN/ACCOUNT MANAGEMENT
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number10080792
Policy instance 2
Insurance contract or identification number10080792
Number of Individuals Covered8
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $213
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $1,422
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $213
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0116424
Policy instance 3
Insurance contract or identification number0116424
Number of Individuals Covered80149
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $361,672
Total amount of fees paid to insurance companyUSD $8,712
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,861,204
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $361,672
Amount paid for insurance broker fees8712
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number444121
Policy instance 1
Insurance contract or identification number444121
Number of Individuals Covered15
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $1,256
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $9,414
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,256
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number444121
Policy instance 1
Insurance contract or identification number444121
Number of Individuals Covered75
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $2,513
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $16,755
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,513
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number10080792
Policy instance 2
Insurance contract or identification number10080792
Number of Individuals Covered14
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $161
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $1,076
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $161
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK968779
Policy instance 9
Insurance contract or identification numberOK968779
Number of Individuals Covered425
Insurance policy start date2018-01-01
Insurance policy end date2019-01-01
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $1,130
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 numberFLX967269
Policy instance 8
Insurance contract or identification numberFLX967269
Number of Individuals Covered425
Insurance policy start date2018-01-01
Insurance policy end date2018-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $8,980
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 number41553
Policy instance 7
Insurance contract or identification number41553
Number of Individuals Covered47
Insurance policy start date2018-01-01
Insurance policy end date2019-01-01
Total amount of commissions paid to insurance brokerUSD $897
Total amount of fees paid to insurance companyUSD $121
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $19,828
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $609
Amount paid for insurance broker fees121
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )
Policy contract numberPAI0009052772-C
Policy instance 6
Insurance contract or identification numberPAI0009052772-C
Number of Individuals Covered17940
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $35,617
Total amount of fees paid to insurance companyUSD $35,617
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $356,166
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $35,617
Amount paid for insurance broker fees35617
Additional information about fees paid to insurance brokerUNDERWRITING, ACCOUNTING, MANAGEMENT FEE
Insurance broker organization code?3
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )
Policy contract numberBSC9035261-C
Policy instance 5
Insurance contract or identification numberBSC9035261-C
Number of Individuals Covered72349
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $10,263
Total amount of fees paid to insurance companyUSD $20,527
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $205,267
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,263
Amount paid for insurance broker fees20527
Additional information about fees paid to insurance brokerUNDERWRITING, ACCOUNTING, MANAGEMENT FEE
Insurance broker organization code?3
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )
Policy contract numberGTP0009124022-A
Policy instance 4
Insurance contract or identification numberGTP0009124022-A
Number of Individuals Covered17429
Insurance policy start date2018-01-01
Insurance policy end date2019-01-01
Total amount of commissions paid to insurance brokerUSD $10,629
Total amount of fees paid to insurance companyUSD $15,943
Other welfare benefits providedTRAVEL POLICY, ALL ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $106,289
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,629
Amount paid for insurance broker fees15943
Additional information about fees paid to insurance brokerADMIN/ACCOUNT MANAGEMENT
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0116424
Policy instance 3
Insurance contract or identification number0116424
Number of Individuals Covered83732
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $357,879
Total amount of fees paid to insurance companyUSD $64,740
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $6,233,641
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $357,879
Amount paid for insurance broker fees64740
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number10080792
Policy instance 2
Insurance contract or identification number10080792
Number of Individuals Covered10
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $276
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $1,843
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $276
Insurance broker organization code?3
Insurance broker nameGROUP ASSOCIATES
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0116424
Policy instance 3
Insurance contract or identification number0116424
Number of Individuals Covered80069
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $378,113
Total amount of fees paid to insurance companyUSD $107,259
Life Insurance Welfare BenefitYes
Other welfare benefits providedOPT, GF LIFE
Welfare Benefit Premiums Paid to CarrierUSD $6,650,389
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $378,113
Amount paid for insurance broker fees107259
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
Insurance broker nameSPECIAL RISK INSURANCE SERVICES INC
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )
Policy contract numberGTP0009124022-A
Policy instance 4
Insurance contract or identification numberGTP0009124022-A
Number of Individuals Covered18147
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $10,629
Total amount of fees paid to insurance companyUSD $15,943
Other welfare benefits providedTRAVEL POLICY, ALL ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $106,289
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,629
Amount paid for insurance broker fees15943
Additional information about fees paid to insurance brokerADMIN/ACCOUNT MANAGEMENT FEE
Insurance broker organization code?3
Insurance broker nameSPECIAL RISK INSURANCE SERVICES INC
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )
Policy contract numberBSC9035261-C
Policy instance 5
Insurance contract or identification numberBSC9035261-C
Number of Individuals Covered68504
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $20,953
Total amount of fees paid to insurance companyUSD $48,890
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $279,373
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $20,953
Amount paid for insurance broker fees48890
Additional information about fees paid to insurance brokerUNDERWRITING, ACCOUNTING, AND MANAGEMENT FEE
Insurance broker organization code?3
Insurance broker nameSPECIAL RISK INSURANCE SERVICES INC
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )
Policy contract numberPAI0009052772-C
Policy instance 6
Insurance contract or identification numberPAI0009052772-C
Number of Individuals Covered18352
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $48,627
Total amount of fees paid to insurance companyUSD $72,940
Other welfare benefits providedPERSONAL ACCIDENT INSURANCE
Welfare Benefit Premiums Paid to CarrierUSD $486,268
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $48,627
Amount paid for insurance broker fees72940
Additional information about fees paid to insurance brokerUNDERWRITING, ACCOUNTING, AND MANAGEMENT FEE
Insurance broker organization code?4
Insurance broker nameSPECIAL RISK INSURANCE SERVICES INC
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number41553
Policy instance 7
Insurance contract or identification number41553
Number of Individuals Covered59
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $1,486
Total amount of fees paid to insurance companyUSD $283
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $27,172
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,486
Amount paid for insurance broker fees283
Insurance broker organization code?3
Insurance broker nameMERCER HEALTH & BENEFITS ADMIN LLC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX967269
Policy instance 8
Insurance contract or identification numberFLX967269
Number of Individuals Covered309
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $12,348
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 numberOK968779
Policy instance 9
Insurance contract or identification numberOK968779
Number of Individuals Covered309
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $1,553
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 number444121
Policy instance 1
Insurance contract or identification number444121
Number of Individuals Covered80
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $2,575
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $17,147
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,575
Insurance broker organization code?3
Insurance broker nameGROUP ASSOCIATES
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0116424
Policy instance 3
Insurance contract or identification number0116424
Number of Individuals Covered82792
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $403,450
Total amount of fees paid to insurance companyUSD $110,168
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $6,618,102
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $403,450
Amount paid for insurance broker fees110168
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
Insurance broker nameSPECIAL RISK INSURANCE SERVICES INC
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number10080792
Policy instance 2
Insurance contract or identification number10080792
Number of Individuals Covered38
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $474
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $3,158
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $436
Insurance broker organization code?3
Insurance broker nameSTACY V. HARRIS
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number444121
Policy instance 1
Insurance contract or identification number444121
Number of Individuals Covered411
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $8,769
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $60,210
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,769
Insurance broker organization code?3
Insurance broker nameGROUP ASSOCIATES
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number41553
Policy instance 7
Insurance contract or identification number41553
Number of Individuals Covered92
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $1,531
Total amount of fees paid to insurance companyUSD $349
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $30,593
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,071
Amount paid for insurance broker fees349
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION PAID
Insurance broker organization code?3
Insurance broker nameMERCER HEALTH & BENEFITS ADMIN LLC
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )
Policy contract numberPAI0009052772-A
Policy instance 6
Insurance contract or identification numberPAI0009052772-A
Number of Individuals Covered18540
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $48,488
Total amount of fees paid to insurance companyUSD $72,132
Other welfare benefits providedPERSONAL ACCIDENT INSURANCE
Welfare Benefit Premiums Paid to CarrierUSD $484,878
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $48,488
Amount paid for insurance broker fees72132
Additional information about fees paid to insurance brokerADMIN/ACCOUNT MANAGEMENT
Insurance broker organization code?3
Insurance broker nameSPECIAL RISK INSURANCE SERVICES INC
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )
Policy contract numberBSC9035261-B
Policy instance 5
Insurance contract or identification numberBSC9035261-B
Number of Individuals Covered69694
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $20,909
Total amount of fees paid to insurance companyUSD $48,787
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $278,785
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $20,909
Amount paid for insurance broker fees48787
Additional information about fees paid to insurance brokerADMIN/ACCOUNT MANAGEMENTADMIN/ACCOUNT MANAGEMENT
Insurance broker organization code?3
Insurance broker nameSPECIAL RISK INSURANCE SERVICES INC
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )
Policy contract numberGTP0009124022-A
Policy instance 4
Insurance contract or identification numberGTP0009124022-A
Number of Individuals Covered18503
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $11,188
Total amount of fees paid to insurance companyUSD $16,782
Other welfare benefits providedTRAVEL POLICY, ALL ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $111,883
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,188
Amount paid for insurance broker fees16782
Additional information about fees paid to insurance brokerADMIN/ACCOUNT MANAGEMENT
Insurance broker organization code?3
Insurance broker nameSPECIAL RISK INSURANCE SERVICES INC
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )
Policy contract numberPAI9052772
Policy instance 6
Insurance contract or identification numberPAI9052772
Number of Individuals Covered18881
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $49,327
Total amount of fees paid to insurance companyUSD $73,991
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedPERSONAL ACCIDENT INSURANCE
Welfare Benefit Premiums Paid to CarrierUSD $493,270
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $49,327
Amount paid for insurance broker fees73991
Additional information about fees paid to insurance brokerADMIN/ ACCOUNT MANAGEMENT
Insurance broker organization code?3
Insurance broker nameSPECIAL RISK INSURANCE SERVICES INC
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )
Policy contract numberBSC9035261-A
Policy instance 5
Insurance contract or identification numberBSC9035261-A
Number of Individuals Covered66534
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $20,064
Total amount of fees paid to insurance companyUSD $46,817
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $267,527
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $20,064
Amount paid for insurance broker fees46817
Additional information about fees paid to insurance brokerADMIN/ ACCOUNT MANAGEMENT
Insurance broker organization code?3
Insurance broker nameSPECIAL RISK INSURANCE SERVICES INC
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )
Policy contract numberGTP9124022
Policy instance 4
Insurance contract or identification numberGTP9124022
Number of Individuals Covered18670
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $12,088
Total amount of fees paid to insurance companyUSD $18,131
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedTRAVEL POLICY, ALL ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $120,876
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,088
Amount paid for insurance broker fees18131
Additional information about fees paid to insurance brokerADMIN/ ACCOUNT MANAGEMENT
Insurance broker organization code?3
Insurance broker nameSPECIAL RISK INSURANCE SERVICES INC
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0116424
Policy instance 3
Insurance contract or identification number0116424
Number of Individuals Covered79491
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $325,176
Total amount of fees paid to insurance companyUSD $50,088
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $6,752,660
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $325,176
Amount paid for insurance broker fees50088
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
Insurance broker nameSPECIAL RISK INSURANCE SERVICES INC
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number10080792
Policy instance 2
Insurance contract or identification number10080792
Number of Individuals Covered41
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $470
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $3,133
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $470
Insurance broker organization code?3
Insurance broker nameGROUP ASSOCIATES
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number444121
Policy instance 1
Insurance contract or identification number444121
Number of Individuals Covered339
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $8,104
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $55,925
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,104
Insurance broker organization code?3
Insurance broker nameGROUP ASSOCIATES
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number41553
Policy instance 7
Insurance contract or identification number41553
Number of Individuals Covered103
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $1,832
Total amount of fees paid to insurance companyUSD $404
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $36,618
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,282
Amount paid for insurance broker fees404
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION PAID
Insurance broker organization code?3
Insurance broker nameMERCER HEALTH & BENEFITS ADMIN LLC
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0116424
Policy instance 3
Insurance contract or identification number0116424
Number of Individuals Covered74398
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $431,685
Total amount of fees paid to insurance companyUSD $70,463
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $7,543,395
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $431,685
Amount paid for insurance broker fees70463
Additional information about fees paid to insurance brokerSUPPLEMENTAL & NON-MONETARY COMPENSATION
Insurance broker organization code?3
Insurance broker nameSPECIAL RISK INSURANCE SERVICES INC
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )
Policy contract numberGTP9124022
Policy instance 4
Insurance contract or identification numberGTP9124022
Number of Individuals Covered16851
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $12,574
Total amount of fees paid to insurance companyUSD $18,860
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedTRAVEL POLICY, ALL ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $125,736
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,574
Amount paid for insurance broker fees18860
Additional information about fees paid to insurance brokerADMINISTRATION & ACCOUNT MANAGEMENT
Insurance broker organization code?3
Insurance broker nameSPECIAL RISK INSURANCE SERVICES INC
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )
Policy contract numberBSC9035261
Policy instance 5
Insurance contract or identification numberBSC9035261
Number of Individuals Covered65520
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $20,682
Total amount of fees paid to insurance companyUSD $48,257
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $275,754
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $20,682
Amount paid for insurance broker fees48257
Additional information about fees paid to insurance brokerADMINISTRATION & ACCOUNT MANAGEMENT
Insurance broker organization code?3
Insurance broker nameSPECIAL RISK INSURANCE SERVICES INC
PROVIDENT LIFE AND CASUALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68209 )
Policy contract number41553
Policy instance 7
Insurance contract or identification number41553
Number of Individuals Covered1
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $26
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,073
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17
Insurance broker organization code?3
Insurance broker nameSEABURY & SMITH
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number41553
Policy instance 8
Insurance contract or identification number41553
Number of Individuals Covered119
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $2,764
Total amount of fees paid to insurance companyUSD $432
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $43,158
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,934
Amount paid for insurance broker fees432
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
Insurance broker nameSEABURY & SMITH
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )
Policy contract numberPAI9052772
Policy instance 6
Insurance contract or identification numberPAI9052772
Number of Individuals Covered18289
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $53,510
Total amount of fees paid to insurance companyUSD $80,265
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedPERSONAL ACCIDENT INSURANCE
Welfare Benefit Premiums Paid to CarrierUSD $535,100
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $53,510
Amount paid for insurance broker fees80265
Additional information about fees paid to insurance brokerADMINISTRATION & ACCOUNT MANAGEMENT
Insurance broker organization code?3
Insurance broker nameSPECIAL RISK INSURANCE SERVICES INC
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number444121
Policy instance 1
Insurance contract or identification number444121
Number of Individuals Covered389
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $7,543
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $52,198
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,543
Insurance broker organization code?3
Insurance broker nameGROUP ASSOCIATES
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number10080792
Policy instance 2
Insurance contract or identification number10080792
Number of Individuals Covered40
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $427
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $2,848
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $427
Insurance broker organization code?3
Insurance broker nameGROUP ASSOCIATES
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0116424
Policy instance 3
Insurance contract or identification number0116424
Number of Individuals Covered73988
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $451,524
Total amount of fees paid to insurance companyUSD $116,352
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $7,979,951
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $451,524
Amount paid for insurance broker fees116352
Additional information about fees paid to insurance brokerSUPPLEMENTAL & NON-MONETARY COMPENSATION
Insurance broker organization code?3
Insurance broker nameSPECIAL RISK INSURANCE SERVICES INC
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number444121
Policy instance 1
Insurance contract or identification number444121
Number of Individuals Covered324
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $10,262
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $46,149
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,262
Insurance broker organization code?3
Insurance broker nameGROUP ASSOCIATES
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number10080792
Policy instance 2
Insurance contract or identification number10080792
Number of Individuals Covered36
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $465
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $2,728
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $465
Insurance broker organization code?3
Insurance broker nameGROUP ASSOCIATES
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )
Policy contract numberBSC9035261
Policy instance 5
Insurance contract or identification numberBSC9035261
Number of Individuals Covered64893
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $20,800
Total amount of fees paid to insurance companyUSD $48,533
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $277,333
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $20,800
Amount paid for insurance broker fees48533
Additional information about fees paid to insurance brokerADMINISTRATION & ACCOUNT MANAGEMENT
Insurance broker organization code?3
Insurance broker nameSPECIAL RISK INSURANCE SERVICES INC
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )
Policy contract numberPAI9052772
Policy instance 6
Insurance contract or identification numberPAI9052772
Number of Individuals Covered18059
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $55,019
Total amount of fees paid to insurance companyUSD $82,528
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedPERSONAL ACCIDENT INSURANCE
Welfare Benefit Premiums Paid to CarrierUSD $550,186
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $55,019
Amount paid for insurance broker fees82528
Additional information about fees paid to insurance brokerADMINISTRATION & ACCOUNT MANAGEMENT
Insurance broker organization code?3
Insurance broker nameSPECIAL RISK INSURANCE SERVICES INC
PROVIDENT LIFE AND CASUALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68209 )
Policy contract number41553
Policy instance 7
Insurance contract or identification number41553
Number of Individuals Covered1
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $54
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,184
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $38
Insurance broker organization code?3
Insurance broker nameSEABURY & SMITH
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number41553
Policy instance 8
Insurance contract or identification number41553
Number of Individuals Covered305
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $6,651
Total amount of fees paid to insurance companyUSD $1,352
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $66,130
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,655
Amount paid for insurance broker fees1352
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
Insurance broker nameSEABURY & SMITH
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )
Policy contract numberGTP9124022
Policy instance 4
Insurance contract or identification numberGTP9124022
Number of Individuals Covered18485
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $13,178
Total amount of fees paid to insurance companyUSD $19,768
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedTRAVEL POLICY, ALL ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $131,784
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,178
Amount paid for insurance broker fees19768
Additional information about fees paid to insurance brokerADMINISTRATION & ACCOUNT MANAGEMENT
Insurance broker organization code?3
Insurance broker nameSPECIAL RISK INSURANCE SERVICES INC
PROVIDENT LIFE AND CASUALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68209 )
Policy contract number41553
Policy instance 2
Insurance contract or identification number41553
Number of Individuals Covered2
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $50
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $2,028
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010080792
Policy instance 1
Insurance contract or identification number000010080792
Number of Individuals Covered39
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $597
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & D1SMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $2,798
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )
Policy contract numberPAI9052772
Policy instance 4
Insurance contract or identification numberPAI9052772
Number of Individuals Covered17349
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $53,417
Total amount of fees paid to insurance companyUSD $80,126
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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedPERSONAL ACCIDENT INSURANCE
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $534,173
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )
Policy contract numberGTP9124022
Policy instance 3
Insurance contract or identification numberGTP9124022
Number of Individuals Covered17139
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $15,414
Total amount of fees paid to insurance companyUSD $23,121
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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedTRAVEL POLICY, ALL ACCIDENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $154,140
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 number444121
Policy instance 5
Insurance contract or identification number444121
Number of Individuals Covered313
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $6,295
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $43,452
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 number41553
Policy instance 6
Insurance contract or identification number41553
Number of Individuals Covered468
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $23,864
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedVOLUNTARY BENEFITS-EMPLOYEE PAID
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $86,623
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )
Policy contract numberBSC9035261
Policy instance 7
Insurance contract or identification numberBSC9035261
Number of Individuals Covered61397
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $20,267
Total amount of fees paid to insurance companyUSD $47,289
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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $270,221
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number116424
Policy instance 8
Insurance contract or identification number116424
Number of Individuals Covered61929
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $366,839
Total amount of fees paid to insurance companyUSD $72,622
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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $7,267,982
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )
Policy contract numberPAI 952772
Policy instance 6
Insurance contract or identification numberPAI 952772
Number of Individuals Covered18008
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $51,258
Total amount of fees paid to insurance companyUSD $76,887
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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedPERSONAL ACCIDENT INSURANCE
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $512,579
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $51,258
Amount paid for insurance broker fees76887
Additional information about fees paid to insurance brokerADMIN/ACCOUNT MANAGEMENT
Insurance broker organization code?3
Insurance broker nameSPECIAL RISK INS SERV INC
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number444121
Policy instance 2
Insurance contract or identification number444121
Number of Individuals Covered351
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $7,978
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $55,061
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,978
Insurance broker organization code?3
Insurance broker nameGROUP ASSOCIATES
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number41553
Policy instance 9
Insurance contract or identification number41553
Number of Individuals Covered613
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $32,921
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedVOLUNTARY BENEFITS-EMPLOYEE PAID
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $83,089
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $25,218
Insurance broker organization code?3
Insurance broker nameSEABURY & SMITH MARSH VOLUNTARY BEN
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )
Policy contract number9035261
Policy instance 3
Insurance contract or identification number9035261
Number of Individuals Covered63351
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $20,193
Total amount of fees paid to insurance companyUSD $47,116
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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $269,235
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $20,193
Amount paid for insurance broker fees47116
Additional information about fees paid to insurance brokerADMIN/ACCOUNTING
Insurance broker organization code?3
Insurance broker nameSPECIAL RISK INS SER INC
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract numberAL00002517
Policy instance 4
Insurance contract or identification numberAL00002517
Number of Individuals Covered13
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $117
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $642
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $117
Insurance broker organization code?3
Insurance broker nameGROUP ASSOCIATES INC
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )
Policy contract numberGTP9124022
Policy instance 5
Insurance contract or identification numberGTP9124022
Number of Individuals Covered63739
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $15,548
Total amount of fees paid to insurance companyUSD $23,323
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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedTRAVEL POLICY, ALL ACCIDENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $155,484
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,548
Amount paid for insurance broker fees23323
Additional information about fees paid to insurance brokerACCOUNTING ADMINISTRATOR
Insurance broker organization code?3
Insurance broker nameSPECIAL RISK INSURANCE SERVICES,INC
PROVIDENT LIFE AND CASUALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68209 )
Policy contract number41553
Policy instance 7
Insurance contract or identification number41553
Number of Individuals Covered1
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $54
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $2,184
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $38
Insurance broker organization code?3
Insurance broker nameSEABURY&SMITH MARSH VOLUNTARY BENEF
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010080792
Policy instance 8
Insurance contract or identification number000010080792
Number of Individuals Covered38
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $1,331
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & D1SMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $8,874
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,331
Insurance broker organization code?3
Insurance broker nameGROUP ASSOCIATES
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number116424
Policy instance 1
Insurance contract or identification number116424
Number of Individuals Covered64370
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $435,566
Total amount of fees paid to insurance companyUSD $76,337
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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $7,082,468
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $435,566
Amount paid for insurance broker fees76337
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
Insurance broker nameSPECIAL RISK INSURANCE SERVICES

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