J H INDUSTRY, INC has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan J H INDUSTRY, INC. D/B/A WOOSHIN USA
401k plan membership statisitcs for J H INDUSTRY, INC. D/B/A WOOSHIN USA
Measure | Date | Value |
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2022: J H INDUSTRY, INC. D/B/A WOOSHIN USA 2022 401k membership |
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Total participants, beginning-of-year | 2022-03-01 | 86 |
Total number of active participants reported on line 7a of the Form 5500 | 2022-03-01 | 80 |
Number of retired or separated participants receiving benefits | 2022-03-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2022-03-01 | 0 |
Total of all active and inactive participants | 2022-03-01 | 80 |
2021: J H INDUSTRY, INC. D/B/A WOOSHIN USA 2021 401k membership |
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Total participants, beginning-of-year | 2021-03-01 | 116 |
Total number of active participants reported on line 7a of the Form 5500 | 2021-03-01 | 86 |
Number of retired or separated participants receiving benefits | 2021-03-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2021-03-01 | 0 |
Total of all active and inactive participants | 2021-03-01 | 86 |
2020: J H INDUSTRY, INC. D/B/A WOOSHIN USA 2020 401k membership |
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Total participants, beginning-of-year | 2020-03-01 | 107 |
Total number of active participants reported on line 7a of the Form 5500 | 2020-03-01 | 116 |
Number of retired or separated participants receiving benefits | 2020-03-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2020-03-01 | 0 |
Total of all active and inactive participants | 2020-03-01 | 116 |
2019: J H INDUSTRY, INC. D/B/A WOOSHIN USA 2019 401k membership |
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Total participants, beginning-of-year | 2019-10-01 | 110 |
Total number of active participants reported on line 7a of the Form 5500 | 2019-10-01 | 107 |
Number of retired or separated participants receiving benefits | 2019-10-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2019-10-01 | 0 |
Total of all active and inactive participants | 2019-10-01 | 107 |
Total participants | 2019-10-01 | 107 |
2018: J H INDUSTRY, INC. D/B/A WOOSHIN USA 2018 401k membership |
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Total participants, beginning-of-year | 2018-10-01 | 675 |
Total number of active participants reported on line 7a of the Form 5500 | 2018-10-01 | 620 |
Number of retired or separated participants receiving benefits | 2018-10-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2018-10-01 | 0 |
Total of all active and inactive participants | 2018-10-01 | 620 |
Total participants | 2018-10-01 | 620 |
2017: J H INDUSTRY, INC. D/B/A WOOSHIN USA 2017 401k membership |
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Total participants, beginning-of-year | 2017-10-01 | 675 |
Total number of active participants reported on line 7a of the Form 5500 | 2017-10-01 | 620 |
Number of retired or separated participants receiving benefits | 2017-10-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2017-10-01 | 0 |
Total of all active and inactive participants | 2017-10-01 | 620 |
2016: J H INDUSTRY, INC. D/B/A WOOSHIN USA 2016 401k membership |
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Total participants, beginning-of-year | 2016-10-01 | 573 |
Total number of active participants reported on line 7a of the Form 5500 | 2016-10-01 | 675 |
Number of retired or separated participants receiving benefits | 2016-10-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2016-10-01 | 0 |
Total of all active and inactive participants | 2016-10-01 | 675 |
2015: J H INDUSTRY, INC. D/B/A WOOSHIN USA 2015 401k membership |
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Total participants, beginning-of-year | 2015-10-01 | 199 |
Total number of active participants reported on line 7a of the Form 5500 | 2015-10-01 | 573 |
Number of retired or separated participants receiving benefits | 2015-10-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2015-10-01 | 0 |
Total of all active and inactive participants | 2015-10-01 | 573 |
2014: J H INDUSTRY, INC. D/B/A WOOSHIN USA 2014 401k membership |
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Total participants, beginning-of-year | 2014-10-01 | 135 |
Total number of active participants reported on line 7a of the Form 5500 | 2014-10-01 | 199 |
Number of retired or separated participants receiving benefits | 2014-10-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2014-10-01 | 0 |
Total of all active and inactive participants | 2014-10-01 | 199 |
2013: J H INDUSTRY, INC. D/B/A WOOSHIN USA 2013 401k membership |
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Total participants, beginning-of-year | 2013-10-01 | 135 |
Total number of active participants reported on line 7a of the Form 5500 | 2013-10-01 | 135 |
Number of retired or separated participants receiving benefits | 2013-10-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2013-10-01 | 0 |
Total of all active and inactive participants | 2013-10-01 | 135 |
2012: J H INDUSTRY, INC. D/B/A WOOSHIN USA 2012 401k membership |
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Total participants, beginning-of-year | 2012-10-01 | 154 |
Total number of active participants reported on line 7a of the Form 5500 | 2012-10-01 | 533 |
Number of retired or separated participants receiving benefits | 2012-10-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2012-10-01 | 0 |
Total of all active and inactive participants | 2012-10-01 | 533 |
2011: J H INDUSTRY, INC. D/B/A WOOSHIN USA 2011 401k membership |
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Total participants, beginning-of-year | 2011-10-01 | 0 |
Total number of active participants reported on line 7a of the Form 5500 | 2011-10-01 | 154 |
Number of retired or separated participants receiving benefits | 2011-10-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2011-10-01 | 0 |
Total of all active and inactive participants | 2011-10-01 | 154 |
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E5773353 |
Policy instance | 8 |
Insurance contract or identification number | E5773353 | Number of Individuals Covered | 43 | Insurance policy start date | 2022-03-01 | Insurance policy end date | 2023-02-28 | Total amount of commissions paid to insurance broker | USD $10,154 | Total amount of fees paid to insurance company | USD $6,932 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $26,205 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,968 | Amount paid for insurance broker fees | 1410 | Additional information about fees paid to insurance broker | AGENT/PRODUCER | Insurance broker organization code? | 3 |
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BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 ) |
Policy contract number | 0087003 |
Policy instance | 1 |
Insurance contract or identification number | 0087003 | Number of Individuals Covered | 80 | Insurance policy start date | 2022-03-01 | Insurance policy end date | 2023-02-28 | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Other welfare benefits provided | BABY YOURSELF, AIR MEDICAL SERVICES | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000BBLQ |
Policy instance | 2 |
Insurance contract or identification number | G000BBLQ | Number of Individuals Covered | 77 | Insurance policy start date | 2022-03-01 | Insurance policy end date | 2023-02-28 | Total amount of commissions paid to insurance broker | USD $1,020 | Total amount of fees paid to insurance company | USD $615 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $10,198 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,020 | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 615 |
|
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000BBLQ |
Policy instance | 3 |
Insurance contract or identification number | G000BBLQ | Number of Individuals Covered | 77 | Insurance policy start date | 2022-03-01 | Insurance policy end date | 2023-02-28 | Total amount of commissions paid to insurance broker | USD $2,132 | Total amount of fees paid to insurance company | USD $852 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERENT | Welfare Benefit Premiums Paid to Carrier | USD $14,212 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,132 | Additional information about fees paid to insurance broker | AGENT OR BROKER OF THE RECORD | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 852 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000BBLQ |
Policy instance | 4 |
Insurance contract or identification number | G000BBLQ | Number of Individuals Covered | 38 | Insurance policy start date | 2022-03-01 | Insurance policy end date | 2023-02-28 | Total amount of commissions paid to insurance broker | USD $4,810 | Total amount of fees paid to insurance company | USD $1,755 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $32,067 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,810 | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 1755 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000BBLQ |
Policy instance | 5 |
Insurance contract or identification number | G000BBLQ | Insurance policy start date | 2022-03-01 | Insurance policy end date | 2023-02-28 | Total amount of fees paid to insurance company | USD $545 | Other welfare benefits provided | CRITICAL ILLNESS VOLUNTARY | Welfare Benefit Premiums Paid to Carrier | USD $-2 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 545 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000BBLQ |
Policy instance | 6 |
Insurance contract or identification number | G000BBLQ | Number of Individuals Covered | 37 | Insurance policy start date | 2022-03-01 | Insurance policy end date | 2023-02-28 | Total amount of commissions paid to insurance broker | USD $2,070 | Total amount of fees paid to insurance company | USD $891 | Other welfare benefits provided | TERM LIFE - VOLUNTARY | Welfare Benefit Premiums Paid to Carrier | USD $13,798 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,070 | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 891 |
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SHELTERPOINT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 89958 ) |
Policy contract number | 81001 |
Policy instance | 7 |
Insurance contract or identification number | 81001 | Number of Individuals Covered | 142 | Insurance policy start date | 2022-03-01 | Insurance policy end date | 2023-02-28 | Total amount of commissions paid to insurance broker | USD $37,942 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $161,453 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $22,603 | Additional information about fees paid to insurance broker | AGENT | Insurance broker organization code? | 3 |
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BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 ) |
Policy contract number | 0087003 |
Policy instance | 1 |
Insurance contract or identification number | 0087003 | Number of Individuals Covered | 86 | Insurance policy start date | 2021-03-01 | Insurance policy end date | 2022-02-28 | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Other welfare benefits provided | BABY YOURSELF, AIR MEDICAL SERVICES | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000BBLQ |
Policy instance | 2 |
Insurance contract or identification number | G000BBLQ | Number of Individuals Covered | 84 | Insurance policy start date | 2021-03-01 | Insurance policy end date | 2022-02-28 | Total amount of commissions paid to insurance broker | USD $997 | Total amount of fees paid to insurance company | USD $972 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $9,971 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $997 | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 648 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000BBLQ |
Policy instance | 3 |
Insurance contract or identification number | G000BBLQ | Number of Individuals Covered | 84 | Insurance policy start date | 2021-03-01 | Insurance policy end date | 2022-02-28 | Total amount of commissions paid to insurance broker | USD $2,072 | Total amount of fees paid to insurance company | USD $1,348 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERENT | Welfare Benefit Premiums Paid to Carrier | USD $13,814 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,072 | Additional information about fees paid to insurance broker | AGENT OR BROKER OF THE RECORD | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 899 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000BBLQ |
Policy instance | 4 |
Insurance contract or identification number | G000BBLQ | Number of Individuals Covered | 37 | Insurance policy start date | 2021-03-01 | Insurance policy end date | 2022-02-28 | Total amount of commissions paid to insurance broker | USD $4,304 | Total amount of fees paid to insurance company | USD $2,807 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $28,692 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,304 | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 1871 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000BBLQ |
Policy instance | 5 |
Insurance contract or identification number | G000BBLQ | Number of Individuals Covered | 20 | Insurance policy start date | 2021-03-01 | Insurance policy end date | 2022-02-28 | Total amount of commissions paid to insurance broker | USD $2,234 | Total amount of fees paid to insurance company | USD $872 | Other welfare benefits provided | CRITICAL ILLNESS VOLUNTARY | Welfare Benefit Premiums Paid to Carrier | USD $8,936 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,234 | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 581 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000BBLQ |
Policy instance | 6 |
Insurance contract or identification number | G000BBLQ | Number of Individuals Covered | 28 | Insurance policy start date | 2021-03-01 | Insurance policy end date | 2022-02-28 | Total amount of commissions paid to insurance broker | USD $1,348 | Total amount of fees paid to insurance company | USD $961 | Other welfare benefits provided | ACCIDENT ONLY VOLUNTARY | Welfare Benefit Premiums Paid to Carrier | USD $8,989 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,348 | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 641 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000BBLQ |
Policy instance | 7 |
Insurance contract or identification number | G000BBLQ | Number of Individuals Covered | 39 | Insurance policy start date | 2021-03-01 | Insurance policy end date | 2022-02-28 | Total amount of commissions paid to insurance broker | USD $2,203 | Total amount of fees paid to insurance company | USD $1,380 | Other welfare benefits provided | TERM LIFE - VOLUNTARY | Welfare Benefit Premiums Paid to Carrier | USD $14,684 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,203 | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 920 |
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ACE AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 22667 ) |
Policy contract number | 40041 |
Policy instance | 8 |
Insurance contract or identification number | 40041 | Number of Individuals Covered | 159 | Insurance policy start date | 2021-03-01 | Insurance policy end date | 2022-02-28 | Total amount of commissions paid to insurance broker | USD $3,204 | Health Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,602 | Additional information about fees paid to insurance broker | AGENT | Insurance broker organization code? | 3 |
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BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 ) |
Policy contract number | 0087003 |
Policy instance | 1 |
Insurance contract or identification number | 0087003 | Number of Individuals Covered | 116 | Insurance policy start date | 2020-03-01 | Insurance policy end date | 2021-02-28 | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Other welfare benefits provided | BABY YOURSELF, AIR MEDICAL SERVICES | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000BBLQ |
Policy instance | 2 |
Insurance contract or identification number | G000BBLQ | Number of Individuals Covered | 114 | Insurance policy start date | 2020-03-01 | Insurance policy end date | 2021-02-28 | Total amount of commissions paid to insurance broker | USD $1,192 | Total amount of fees paid to insurance company | USD $1,011 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $11,922 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,192 | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 674 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000BBLQ |
Policy instance | 4 |
Insurance contract or identification number | G000BBLQ | Number of Individuals Covered | 52 | Insurance policy start date | 2020-03-01 | Insurance policy end date | 2021-02-28 | Total amount of commissions paid to insurance broker | USD $6,817 | Total amount of fees paid to insurance company | USD $3,076 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $34,083 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,817 | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 2051 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000BBLQ |
Policy instance | 3 |
Insurance contract or identification number | G000BBLQ | Number of Individuals Covered | 114 | Insurance policy start date | 2020-03-01 | Insurance policy end date | 2021-02-28 | Total amount of commissions paid to insurance broker | USD $2,481 | Total amount of fees paid to insurance company | USD $1,407 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERENT | Welfare Benefit Premiums Paid to Carrier | USD $16,537 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,481 | Additional information about fees paid to insurance broker | AGENT OR BROKER OF THE RECORD | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 938 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000BBLQ |
Policy instance | 5 |
Insurance contract or identification number | G000BBLQ | Number of Individuals Covered | 27 | Insurance policy start date | 2020-03-01 | Insurance policy end date | 2021-02-28 | Total amount of commissions paid to insurance broker | USD $2,661 | Total amount of fees paid to insurance company | USD $951 | Other welfare benefits provided | CRITICAL ILLNESS VOLUNTARY | Welfare Benefit Premiums Paid to Carrier | USD $10,643 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,661 | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 634 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000BBLQ |
Policy instance | 6 |
Insurance contract or identification number | G000BBLQ | Number of Individuals Covered | 38 | Insurance policy start date | 2020-03-01 | Insurance policy end date | 2021-02-28 | Total amount of commissions paid to insurance broker | USD $1,740 | Total amount of fees paid to insurance company | USD $1,078 | Other welfare benefits provided | ACCIDENT ONLY VOLUNTARY | Welfare Benefit Premiums Paid to Carrier | USD $11,600 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,740 | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 719 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000BBLQ |
Policy instance | 7 |
Insurance contract or identification number | G000BBLQ | Number of Individuals Covered | 51 | Insurance policy start date | 2020-03-01 | Insurance policy end date | 2021-02-28 | Total amount of commissions paid to insurance broker | USD $3,384 | Total amount of fees paid to insurance company | USD $1,457 | Other welfare benefits provided | TERM LIFE - VOLUNTARY | Welfare Benefit Premiums Paid to Carrier | USD $16,920 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,384 | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 971 |
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ACE AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 22667 ) |
Policy contract number | |
Policy instance | 8 |
Number of Individuals Covered | 207 | Insurance policy start date | 2020-03-01 | Insurance policy end date | 2021-02-28 | Total amount of commissions paid to insurance broker | USD $50,088 | Health Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $25,044 | Additional information about fees paid to insurance broker | AGENT | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000BBLQ |
Policy instance | 3 |
Insurance contract or identification number | G000BBLQ | Number of Individuals Covered | 107 | Insurance policy start date | 2019-10-01 | Insurance policy end date | 2020-02-29 | Total amount of commissions paid to insurance broker | USD $2,394 | Total amount of fees paid to insurance company | USD $1,144 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERENT | Welfare Benefit Premiums Paid to Carrier | USD $15,041 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,394 | Additional information about fees paid to insurance broker | AGENT OR BROKER OF THE RECORD | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 616 |
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ACE AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 22667 ) |
Policy contract number | |
Policy instance | 8 |
Number of Individuals Covered | 201 | Insurance policy start date | 2019-10-01 | Insurance policy end date | 2020-02-29 | Total amount of commissions paid to insurance broker | USD $50,906 | Health Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $25,453 | Additional information about fees paid to insurance broker | AGENT | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000BBLQ |
Policy instance | 7 |
Insurance contract or identification number | G000BBLQ | Number of Individuals Covered | 61 | Insurance policy start date | 2019-10-01 | Insurance policy end date | 2020-02-29 | Total amount of commissions paid to insurance broker | USD $3,278 | Total amount of fees paid to insurance company | USD $1,102 | Other welfare benefits provided | TERM LIFE - VOLUNTARY | Welfare Benefit Premiums Paid to Carrier | USD $14,662 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,278 | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 593 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000BBLQ |
Policy instance | 6 |
Insurance contract or identification number | G000BBLQ | Number of Individuals Covered | 36 | Insurance policy start date | 2019-10-01 | Insurance policy end date | 2020-02-29 | Total amount of commissions paid to insurance broker | USD $1,802 | Total amount of fees paid to insurance company | USD $905 | Other welfare benefits provided | ACCIDENT ONLY VOLUNTARY | Welfare Benefit Premiums Paid to Carrier | USD $9,603 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,802 | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 487 |
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BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 ) |
Policy contract number | 0087003 |
Policy instance | 1 |
Insurance contract or identification number | 0087003 | Number of Individuals Covered | 107 | Insurance policy start date | 2019-10-01 | Insurance policy end date | 2020-02-29 | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Other welfare benefits provided | BABY YOURSELF, AIR MEDICAL SERVICES | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000BBLQ |
Policy instance | 5 |
Insurance contract or identification number | G000BBLQ | Number of Individuals Covered | 22 | Insurance policy start date | 2019-10-01 | Insurance policy end date | 2020-02-29 | Total amount of commissions paid to insurance broker | USD $2,636 | Total amount of fees paid to insurance company | USD $783 | Other welfare benefits provided | CRITICAL ILLNESS VOLUNTARY | Welfare Benefit Premiums Paid to Carrier | USD $6,204 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,636 | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 422 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000BBLQ |
Policy instance | 4 |
Insurance contract or identification number | G000BBLQ | Number of Individuals Covered | 65 | Insurance policy start date | 2019-10-01 | Insurance policy end date | 2020-02-29 | Total amount of commissions paid to insurance broker | USD $6,883 | Total amount of fees paid to insurance company | USD $2,703 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $39,952 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,883 | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 1455 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000BBLQ |
Policy instance | 2 |
Insurance contract or identification number | G000BBLQ | Number of Individuals Covered | 107 | Insurance policy start date | 2019-10-01 | Insurance policy end date | 2020-02-29 | Total amount of commissions paid to insurance broker | USD $1,147 | Total amount of fees paid to insurance company | USD $822 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $11,017 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,147 | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 443 |
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BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 ) |
Policy contract number | 0087003 |
Policy instance | 1 |
Insurance contract or identification number | 0087003 | Number of Individuals Covered | 470 | Insurance policy start date | 2018-10-01 | Insurance policy end date | 2019-09-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AIR MEDICAL SERVICES (AIRMED) | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000BBLQ |
Policy instance | 3 |
Insurance contract or identification number | G000BBLQ | Number of Individuals Covered | 182 | Insurance policy start date | 2018-10-01 | Insurance policy end date | 2019-09-30 | Total amount of commissions paid to insurance broker | USD $8,877 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $59,178 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8,877 | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000BBLQ |
Policy instance | 2 |
Insurance contract or identification number | G000BBLQ | Number of Individuals Covered | 461 | Insurance policy start date | 2018-10-01 | Insurance policy end date | 2019-09-30 | Total amount of commissions paid to insurance broker | USD $5,437 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $54,372 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,437 | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD | Insurance broker organization code? | 3 |
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COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E3838901 |
Policy instance | 4 |
Insurance contract or identification number | E3838901 | Number of Individuals Covered | 126 | Insurance policy start date | 2017-10-01 | Insurance policy end date | 2018-09-30 | Total amount of commissions paid to insurance broker | USD $7,442 | Total amount of fees paid to insurance company | USD $513 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,943 | Additional information about fees paid to insurance broker | INS. COMMISSION | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 174 | Insurance broker name | KELLIE WELLS |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 000010179941 |
Policy instance | 3 |
Insurance contract or identification number | 000010179941 | Number of Individuals Covered | 198 | Insurance policy start date | 2017-10-01 | Insurance policy end date | 2018-09-30 | Total amount of commissions paid to insurance broker | USD $1,998 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMB. | Welfare Benefit Premiums Paid to Carrier | USD $19,984 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,998 | Additional information about fees paid to insurance broker | INS COMMISSION | Insurance broker organization code? | 3 | Insurance broker name | HARMON DENNIS BRADSHAW INC |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 000010179942 |
Policy instance | 2 |
Insurance contract or identification number | 000010179942 | Number of Individuals Covered | 195 | Insurance policy start date | 2017-10-01 | Insurance policy end date | 2018-09-30 | Total amount of commissions paid to insurance broker | USD $1,162 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $11,616 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,162 | Additional information about fees paid to insurance broker | INS COMMISSION | Insurance broker organization code? | 3 | Insurance broker name | HARMON DENNIS BRADSHAW INC |
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BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 ) |
Policy contract number | 87003 |
Policy instance | 1 |
Insurance contract or identification number | 87003 | Number of Individuals Covered | 1135 | Insurance policy start date | 2017-10-01 | Insurance policy end date | 2018-09-30 | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | Yes | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Other welfare benefits provided | OTHER-EPS | Welfare Benefit Premiums Paid to Carrier | USD $54,001 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 ) |
Policy contract number | 87003 |
Policy instance | 1 |
Insurance contract or identification number | 87003 | Number of Individuals Covered | 1049 | Insurance policy start date | 2015-10-01 | Insurance policy end date | 2016-09-30 | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | Yes | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Other welfare benefits provided | OTHER-EPS | Welfare Benefit Premiums Paid to Carrier | USD $38,215 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 000010179942 |
Policy instance | 2 |
Insurance contract or identification number | 000010179942 | Number of Individuals Covered | 103 | Insurance policy start date | 2015-10-01 | Insurance policy end date | 2016-09-30 | Total amount of commissions paid to insurance broker | USD $1,468 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $14,684 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,468 | Additional information about fees paid to insurance broker | INS COMMISSION | Insurance broker organization code? | 3 | Insurance broker name | HARMON DENNIS BRADSHAW INC |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 000010179941 |
Policy instance | 3 |
Insurance contract or identification number | 000010179941 | Number of Individuals Covered | 149 | Insurance policy start date | 2015-10-01 | Insurance policy end date | 2016-09-30 | Total amount of commissions paid to insurance broker | USD $2,149 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMB. | Welfare Benefit Premiums Paid to Carrier | USD $21,490 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,149 | Additional information about fees paid to insurance broker | INS COMMISSION | Insurance broker organization code? | 3 | Insurance broker name | HARMON DENNIS BRADSHAW INC |
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COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E3838901 |
Policy instance | 4 |
Insurance contract or identification number | E3838901 | Number of Individuals Covered | 135 | Insurance policy start date | 2015-10-01 | Insurance policy end date | 2016-09-30 | Total amount of commissions paid to insurance broker | USD $21,192 | Total amount of fees paid to insurance company | USD $5,239 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,425 | Amount paid for insurance broker fees | 769 | Additional information about fees paid to insurance broker | INS. COMMISSION | Insurance broker organization code? | 3 | Insurance broker name | TIMOTHY ALLEN WALKER |
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BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 ) |
Policy contract number | 77956 |
Policy instance | 1 |
Insurance contract or identification number | 77956 | Number of Individuals Covered | 154 | Insurance policy start date | 2014-10-01 | Insurance policy end date | 2015-09-30 | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | Yes | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Other welfare benefits provided | OTHER-AIRMED | Welfare Benefit Premiums Paid to Carrier | USD $8,541 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 000010179942 |
Policy instance | 2 |
Insurance contract or identification number | 000010179942 | Number of Individuals Covered | 103 | Insurance policy start date | 2014-10-01 | Insurance policy end date | 2015-09-30 | Total amount of commissions paid to insurance broker | USD $689 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $6,887 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $689 | Additional information about fees paid to insurance broker | INS COMMISSION | Insurance broker organization code? | 3 | Insurance broker name | HARMON DENNIS BRADSHAW INC |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 000010179941 |
Policy instance | 3 |
Insurance contract or identification number | 000010179941 | Number of Individuals Covered | 102 | Insurance policy start date | 2014-10-01 | Insurance policy end date | 2015-09-30 | Total amount of commissions paid to insurance broker | USD $1,048 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMB. | Welfare Benefit Premiums Paid to Carrier | USD $10,484 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,048 | Additional information about fees paid to insurance broker | INS COMMISSION | Insurance broker organization code? | 3 | Insurance broker name | HARMON DENNIS BRADSHAW INC |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 000400179943 |
Policy instance | 4 |
Insurance contract or identification number | 000400179943 | Number of Individuals Covered | 27 | Insurance policy start date | 2014-10-01 | Insurance policy end date | 2015-09-30 | Total amount of commissions paid to insurance broker | USD $804 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $5,359 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $804 | Additional information about fees paid to insurance broker | INS COMMISSION | Insurance broker organization code? | 3 | Insurance broker name | HARMON DENNIS BRADSHAW INC |
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COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E3838901 |
Policy instance | 5 |
Insurance contract or identification number | E3838901 | Number of Individuals Covered | 114 | Insurance policy start date | 2014-10-01 | Insurance policy end date | 2015-09-30 | Total amount of commissions paid to insurance broker | USD $11,467 | Total amount of fees paid to insurance company | USD $1,620 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $195 | Amount paid for insurance broker fees | 44 | Additional information about fees paid to insurance broker | INS. COMMISSION | Insurance broker organization code? | 3 | Insurance broker name | HARMON DENNIS BRADSHAW INC |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 000010179941 |
Policy instance | 3 |
Insurance contract or identification number | 000010179941 | Number of Individuals Covered | 98 | Insurance policy start date | 2013-10-01 | Insurance policy end date | 2014-09-30 | Total amount of commissions paid to insurance broker | USD $1,109 | Welfare Benefit Premiums Paid to Carrier | USD $11,095 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,109 | Additional information about fees paid to insurance broker | INS COMMISSION | Insurance broker organization code? | 3 | Insurance broker name | HARMON DENNIS BRADSHAW INC |
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COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E3838901 |
Policy instance | 2 |
Insurance contract or identification number | E3838901 | Number of Individuals Covered | 72 | Insurance policy start date | 2013-10-01 | Insurance policy end date | 2014-09-30 | Total amount of commissions paid to insurance broker | USD $6,461 | Total amount of fees paid to insurance company | USD $333 | Health Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,479 | Amount paid for insurance broker fees | 333 | Additional information about fees paid to insurance broker | INS COMMISSION | Insurance broker organization code? | 3 | Insurance broker name | BRITTANY TINDAL |
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BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 ) |
Policy contract number | 77956 |
Policy instance | 1 |
Insurance contract or identification number | 77956 | Number of Individuals Covered | 154 | Insurance policy start date | 2013-10-01 | Insurance policy end date | 2014-09-30 | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | Yes | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Other welfare benefits provided | OTHER-AIRMED | Welfare Benefit Premiums Paid to Carrier | USD $7,294 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
Policy contract number | 11374 |
Policy instance | 2 |
Insurance contract or identification number | 11374 | Number of Individuals Covered | 390 | Insurance policy start date | 2012-10-01 | Insurance policy end date | 2013-09-30 | Total amount of commissions paid to insurance broker | USD $1,913 | Total amount of fees paid to insurance company | USD $28 | Life Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $27,141 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $195 | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMMISSIONS | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 28 | Insurance broker name | AXA ASSISTANCE USA |
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BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 ) |
Policy contract number | 77956 |
Policy instance | 1 |
Insurance contract or identification number | 77956 | Number of Individuals Covered | 143 | Insurance policy start date | 2012-10-01 | Insurance policy end date | 2013-09-30 | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | Yes | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Other welfare benefits provided | OTHER-AIRMED | Welfare Benefit Premiums Paid to Carrier | USD $1,256 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 ) |
Policy contract number | 77956 |
Policy instance | 1 |
Insurance contract or identification number | 77956 | Number of Individuals Covered | 154 | Insurance policy start date | 2011-10-01 | Insurance policy end date | 2012-09-30 | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | Yes | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Other welfare benefits provided | OTHER SPECIFY | Welfare Benefit Premiums Paid to Carrier | USD $7,613 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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