Page 13 - INA Program Book 2021

2021 DRAFT INSURANCE NETWORKS STUDY

General Network Information

Name of Network:
Email Address:
Phone Number:
Year network established:

Total agency member count: 2018_____2019_____2020______

Employee Counts
Networks:
Internal network employee count (FTE): _____
Contracted/outsourced employee count (FTE): _____
Members:
Total member employee count including agents: _____
Total number of licensed agents among all member affiliates: _____

How do you describe your organization?
□ Aggregator
□ Cluster
□ Network
□ Wholesaler
□ Other (please specify)

Is your operation a Franchise?
□ Yes
□ No

Network Ownership Structure (select all that apply):
□ Member owned
□ Independent
□ Private Equity Owned
□ Insurer/Wholesaler
□ Bank
□ Other

How is your organization managed?
□ Member-managed
□ Full-time staff dedicated specifically to managing the organization

States network operates in: [drop down box here]

4TH ANNUAL MEETING | 21