ONEWORLD COMMUNITY HEALTH CENTERS, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan GROUP LIFE, DISABILITY AND MEDICAL PLAN
Measure | Date | Value |
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2022: GROUP LIFE, DISABILITY AND MEDICAL PLAN 2022 401k membership |
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Total participants, beginning-of-year | 2022-01-01 | 598 |
Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 611 |
Number of retired or separated participants receiving benefits | 2022-01-01 | 1 |
Total of all active and inactive participants | 2022-01-01 | 612 |
2021: GROUP LIFE, DISABILITY AND MEDICAL PLAN 2021 401k membership |
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Total participants, beginning-of-year | 2021-01-01 | 562 |
Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 598 |
Total of all active and inactive participants | 2021-01-01 | 598 |
2020: GROUP LIFE, DISABILITY AND MEDICAL PLAN 2020 401k membership |
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Total participants, beginning-of-year | 2020-01-01 | 515 |
Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 562 |
Total of all active and inactive participants | 2020-01-01 | 562 |
2019: GROUP LIFE, DISABILITY AND MEDICAL PLAN 2019 401k membership |
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Total participants, beginning-of-year | 2019-01-01 | 509 |
Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 513 |
Number of retired or separated participants receiving benefits | 2019-01-01 | 2 |
Total of all active and inactive participants | 2019-01-01 | 515 |
2018: GROUP LIFE, DISABILITY AND MEDICAL PLAN 2018 401k membership |
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Total participants, beginning-of-year | 2018-01-01 | 465 |
Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 507 |
Number of retired or separated participants receiving benefits | 2018-01-01 | 2 |
Total of all active and inactive participants | 2018-01-01 | 509 |
2017: GROUP LIFE, DISABILITY AND MEDICAL PLAN 2017 401k membership |
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Total participants, beginning-of-year | 2017-01-01 | 390 |
Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 463 |
Number of retired or separated participants receiving benefits | 2017-01-01 | 2 |
Total of all active and inactive participants | 2017-01-01 | 465 |
2016: GROUP LIFE, DISABILITY AND MEDICAL PLAN 2016 401k membership |
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Total participants, beginning-of-year | 2016-01-01 | 440 |
Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 506 |
Number of retired or separated participants receiving benefits | 2016-01-01 | 3 |
Total of all active and inactive participants | 2016-01-01 | 509 |
2015: GROUP LIFE, DISABILITY AND MEDICAL PLAN 2015 401k membership |
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Total participants, beginning-of-year | 2015-01-01 | 415 |
Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 439 |
Number of retired or separated participants receiving benefits | 2015-01-01 | 1 |
Total of all active and inactive participants | 2015-01-01 | 440 |
2014: GROUP LIFE, DISABILITY AND MEDICAL PLAN 2014 401k membership |
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Total participants, beginning-of-year | 2014-01-01 | 326 |
Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 413 |
Number of retired or separated participants receiving benefits | 2014-01-01 | 2 |
Total of all active and inactive participants | 2014-01-01 | 415 |
2013: GROUP LIFE, DISABILITY AND MEDICAL PLAN 2013 401k membership |
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Total participants, beginning-of-year | 2013-01-01 | 248 |
Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 326 |
Total of all active and inactive participants | 2013-01-01 | 326 |
2012: GROUP LIFE, DISABILITY AND MEDICAL PLAN 2012 401k membership |
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Total participants, beginning-of-year | 2012-07-01 | 220 |
Total number of active participants reported on line 7a of the Form 5500 | 2012-07-01 | 248 |
Total of all active and inactive participants | 2012-07-01 | 248 |
Total participants | 2012-07-01 | 248 |
2011: GROUP LIFE, DISABILITY AND MEDICAL PLAN 2011 401k membership |
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Total participants, beginning-of-year | 2011-07-01 | 177 |
Total number of active participants reported on line 7a of the Form 5500 | 2011-07-01 | 220 |
Total of all active and inactive participants | 2011-07-01 | 220 |
Total participants | 2011-07-01 | 220 |
2009: GROUP LIFE, DISABILITY AND MEDICAL PLAN 2009 401k membership |
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Total participants, beginning-of-year | 2009-07-01 | 131 |
Total number of active participants reported on line 7a of the Form 5500 | 2009-07-01 | 159 |
Total of all active and inactive participants | 2009-07-01 | 159 |
Total participants | 2009-07-01 | 159 |
2022: GROUP LIFE, DISABILITY AND MEDICAL PLAN 2022 form 5500 responses |
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2022-01-01 | Type of plan entity | Single employer plan |
2022-01-01 | Plan funding arrangement – Insurance | Yes |
2022-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2022-01-01 | Plan benefit arrangement – Insurance | Yes |
2022-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2021: GROUP LIFE, DISABILITY AND MEDICAL PLAN 2021 form 5500 responses |
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2021-01-01 | Type of plan entity | Single employer plan |
2021-01-01 | Plan funding arrangement – Insurance | Yes |
2021-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2021-01-01 | Plan benefit arrangement – Insurance | Yes |
2021-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2020: GROUP LIFE, DISABILITY AND MEDICAL PLAN 2020 form 5500 responses |
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2020-01-01 | Type of plan entity | Single employer plan |
2020-01-01 | Plan funding arrangement – Insurance | Yes |
2020-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2020-01-01 | Plan benefit arrangement – Insurance | Yes |
2020-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2019: GROUP LIFE, DISABILITY AND MEDICAL PLAN 2019 form 5500 responses |
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2019-01-01 | Type of plan entity | Single employer plan |
2019-01-01 | Plan funding arrangement – Insurance | Yes |
2019-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2019-01-01 | Plan benefit arrangement – Insurance | Yes |
2019-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2018: GROUP LIFE, DISABILITY AND MEDICAL PLAN 2018 form 5500 responses |
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2018-01-01 | Type of plan entity | Single employer plan |
2018-01-01 | Plan funding arrangement – Insurance | Yes |
2018-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2018-01-01 | Plan benefit arrangement – Insurance | Yes |
2018-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2017: GROUP LIFE, DISABILITY AND MEDICAL PLAN 2017 form 5500 responses |
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2017-01-01 | Type of plan entity | Single employer plan |
2017-01-01 | Plan funding arrangement – Insurance | Yes |
2017-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2017-01-01 | Plan benefit arrangement – Insurance | Yes |
2017-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2016: GROUP LIFE, DISABILITY AND MEDICAL PLAN 2016 form 5500 responses |
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2016-01-01 | Type of plan entity | Single employer plan |
2016-01-01 | Plan funding arrangement – Insurance | Yes |
2016-01-01 | Plan benefit arrangement – Insurance | Yes |
2015: GROUP LIFE, DISABILITY AND MEDICAL PLAN 2015 form 5500 responses |
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2015-01-01 | Type of plan entity | Single employer plan |
2015-01-01 | Plan funding arrangement – Insurance | Yes |
2015-01-01 | Plan benefit arrangement – Insurance | Yes |
2014: GROUP LIFE, DISABILITY AND MEDICAL PLAN 2014 form 5500 responses |
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2014-01-01 | Type of plan entity | Single employer plan |
2014-01-01 | Plan funding arrangement – Insurance | Yes |
2014-01-01 | Plan benefit arrangement – Insurance | Yes |
2013: GROUP LIFE, DISABILITY AND MEDICAL PLAN 2013 form 5500 responses |
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2013-01-01 | Type of plan entity | Single employer plan |
2013-01-01 | Plan funding arrangement – Insurance | Yes |
2013-01-01 | Plan benefit arrangement – Insurance | Yes |
2012: GROUP LIFE, DISABILITY AND MEDICAL PLAN 2012 form 5500 responses |
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2012-07-01 | Type of plan entity | Single employer plan |
2012-07-01 | Submission has been amended | No |
2012-07-01 | This submission is the final filing | No |
2012-07-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
2012-07-01 | Plan is a collectively bargained plan | No |
2012-07-01 | Plan funding arrangement – Insurance | Yes |
2012-07-01 | Plan benefit arrangement – Insurance | Yes |
2011: GROUP LIFE, DISABILITY AND MEDICAL PLAN 2011 form 5500 responses |
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2011-07-01 | Type of plan entity | Single employer plan |
2011-07-01 | Submission has been amended | No |
2011-07-01 | This submission is the final filing | No |
2011-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2011-07-01 | Plan is a collectively bargained plan | No |
2011-07-01 | Plan funding arrangement – Insurance | Yes |
2011-07-01 | Plan benefit arrangement – Insurance | Yes |
2009: GROUP LIFE, DISABILITY AND MEDICAL PLAN 2009 form 5500 responses |
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2009-07-01 | Type of plan entity | Single employer plan |
2009-07-01 | Submission has been amended | No |
2009-07-01 | This submission is the final filing | No |
2009-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2009-07-01 | Plan is a collectively bargained plan | No |
2009-07-01 | Plan funding arrangement – Insurance | Yes |
2009-07-01 | Plan benefit arrangement – Insurance | Yes |
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 10164541001 |
Policy instance | 9 |
Insurance contract or identification number | 10164541001 | Number of Individuals Covered | 1 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $4 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $41 | 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 | Insurance broker organization code? | 3 |
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LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | FLX968648 |
Policy instance | 1 |
Insurance contract or identification number | FLX968648 | Number of Individuals Covered | 506 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $51,181 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 0869634 |
Policy instance | 2 |
Insurance contract or identification number | 0869634 | Number of Individuals Covered | 612 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $7,261 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $184,293 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,261 | Insurance broker organization code? | 3 |
|
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 98678961001 |
Policy instance | 3 |
Insurance contract or identification number | 98678961001 | Number of Individuals Covered | 514 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $2,646 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $29,138 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,646 | 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 | E7653454 |
Policy instance | 4 |
Insurance contract or identification number | E7653454 | Number of Individuals Covered | 23 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $5,146 | Total amount of fees paid to insurance company | USD $927 | Other welfare benefits provided | VOL CANCER/ACCIDENT/HOSPITAL INDEM. | Welfare Benefit Premiums Paid to Carrier | USD $26,425 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,826 | Amount paid for insurance broker fees | 527 | Additional information about fees paid to insurance broker | OTHER FEES | Insurance broker organization code? | 3 |
|
NEBRASKA METHODIST HEALTH SYSTEM D/B/A BESTCARE EAP (National Association of Insurance Commissioners NAIC id number: 00 ) |
Policy contract number | 0001 |
Policy instance | 5 |
Insurance contract or identification number | 0001 | Number of Individuals Covered | 530 | Insurance policy start date | 2021-03-01 | Insurance policy end date | 2022-02-28 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | EMPLOYEE ASSISTANCE PLAN | Welfare Benefit Premiums Paid to Carrier | USD $11,157 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | LK752399 |
Policy instance | 6 |
Insurance contract or identification number | LK752399 | Number of Individuals Covered | 506 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $187,455 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | LK965812 |
Policy instance | 7 |
Insurance contract or identification number | LK965812 | Number of Individuals Covered | 140 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $74,101 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | OK970129 |
Policy instance | 8 |
Insurance contract or identification number | OK970129 | Number of Individuals Covered | 506 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $5,551 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | FLX968648 |
Policy instance | 1 |
Insurance contract or identification number | FLX968648 | Number of Individuals Covered | 461 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $707 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $44,220 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 707 | Additional information about fees paid to insurance broker | OTHER FEES | Insurance broker organization code? | 3 |
|
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 0869634 |
Policy instance | 2 |
Insurance contract or identification number | 0869634 | Number of Individuals Covered | 598 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $7,171 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $178,747 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,171 | Insurance broker organization code? | 3 |
|
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 98678961001 |
Policy instance | 3 |
Insurance contract or identification number | 98678961001 | Number of Individuals Covered | 477 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $2,938 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $27,166 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,938 | Insurance broker organization code? | 3 |
|
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E7653454 |
Policy instance | 4 |
Insurance contract or identification number | E7653454 | Number of Individuals Covered | 21 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $3,159 | Total amount of fees paid to insurance company | USD $481 | Other welfare benefits provided | VOL CANCER/ACCIDENT/HOSPITAL INDEM. | Welfare Benefit Premiums Paid to Carrier | USD $20,724 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,198 | Amount paid for insurance broker fees | 363 | Additional information about fees paid to insurance broker | OTHER FEES | Insurance broker organization code? | 3 |
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NEBRASKA METHODIST HEALTH SYSTEM D/B/A BESTCARE EAP (National Association of Insurance Commissioners NAIC id number: 00 ) |
Policy contract number | 0001 |
Policy instance | 5 |
Insurance contract or identification number | 0001 | Number of Individuals Covered | 508 | Insurance policy start date | 2020-03-01 | Insurance policy end date | 2021-02-28 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | EMPLOYEE ASSISTANCE PLAN | Welfare Benefit Premiums Paid to Carrier | USD $9,373 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | LK752399 |
Policy instance | 6 |
Insurance contract or identification number | LK752399 | Number of Individuals Covered | 464 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $2,623 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $166,885 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 2623 | Additional information about fees paid to insurance broker | OTHER FEES | Insurance broker organization code? | 3 |
|
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | LK965812 |
Policy instance | 7 |
Insurance contract or identification number | LK965812 | Number of Individuals Covered | 135 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $977 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $62,268 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 977 | Additional information about fees paid to insurance broker | OTHER FEES | Insurance broker organization code? | 3 |
|
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | OK970129 |
Policy instance | 8 |
Insurance contract or identification number | OK970129 | Number of Individuals Covered | 572 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $82 | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $4,997 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 82 | Additional information about fees paid to insurance broker | OTHER FEES | Insurance broker organization code? | 3 |
|
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 10164541001 |
Policy instance | 9 |
Insurance contract or identification number | 10164541001 | Number of Individuals Covered | 0 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $1 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $18 | 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 | Insurance broker organization code? | 3 |
|
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | FLX968648 |
Policy instance | 1 |
Insurance contract or identification number | FLX968648 | Number of Individuals Covered | 449 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $395 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $38,012 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $0 | Amount paid for insurance broker fees | 395 | Additional information about fees paid to insurance broker | OTHER FEES | Insurance broker organization code? | 3 |
|
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 0869634 |
Policy instance | 2 |
Insurance contract or identification number | 0869634 | Number of Individuals Covered | 562 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $7,251 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $178,844 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,251 | Insurance broker organization code? | 3 |
|
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E7653454 |
Policy instance | 4 |
Insurance contract or identification number | E7653454 | Number of Individuals Covered | 26 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $2,307 | Total amount of fees paid to insurance company | USD $111 | Other welfare benefits provided | VOL CANCER/ACCIDENT/HOSPITAL INDEM. | Welfare Benefit Premiums Paid to Carrier | USD $22,908 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $941 | Amount paid for insurance broker fees | 71 | Additional information about fees paid to insurance broker | OTHER FEES | Insurance broker organization code? | 3 |
|
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 98678961001 |
Policy instance | 3 |
Insurance contract or identification number | 98678961001 | Number of Individuals Covered | 450 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $2,712 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $25,021 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,712 | Insurance broker organization code? | 3 |
|
NEBRASKA METHODIST HEALTH SYSTEM D/B/A BESTCARE EAP (National Association of Insurance Commissioners NAIC id number: 00 ) |
Policy contract number | 0001 |
Policy instance | 5 |
Insurance contract or identification number | 0001 | Number of Individuals Covered | 450 | Insurance policy start date | 2019-03-01 | Insurance policy end date | 2020-02-29 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | EMPLOYEE ASSISTANCE PLAN | Welfare Benefit Premiums Paid to Carrier | USD $8,303 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | LK752399 |
Policy instance | 6 |
Insurance contract or identification number | LK752399 | Number of Individuals Covered | 449 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $1,564 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $140,566 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $0 | Amount paid for insurance broker fees | 1564 | Additional information about fees paid to insurance broker | OTHER FEES | Insurance broker organization code? | 3 |
|
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | LK965812 |
Policy instance | 7 |
Insurance contract or identification number | LK965812 | Number of Individuals Covered | 130 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $581 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $52,488 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $0 | Amount paid for insurance broker fees | 581 | Additional information about fees paid to insurance broker | OTHER FEES | Insurance broker organization code? | 3 |
|
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | OK970129 |
Policy instance | 8 |
Insurance contract or identification number | OK970129 | Number of Individuals Covered | 449 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $51 | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $4,399 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $0 | Amount paid for insurance broker fees | 51 | Additional information about fees paid to insurance broker | OTHER FEES | Insurance broker organization code? | 3 |
|
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E7653454 |
Policy instance | 4 |
Insurance contract or identification number | E7653454 | Number of Individuals Covered | 29 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $4,161 | Total amount of fees paid to insurance company | USD $391 | Other welfare benefits provided | VOL CANCER/ACCIDENT/HOSPITAL INDEM. | Welfare Benefit Premiums Paid to Carrier | USD $29,045 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,606 | Amount paid for insurance broker fees | 232 | Additional information about fees paid to insurance broker | OTHER FEES | Insurance broker organization code? | 3 |
|
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 10164541001 |
Policy instance | 9 |
Insurance contract or identification number | 10164541001 | Number of Individuals Covered | 1 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $23 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $223 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $23 | Insurance broker organization code? | 3 |
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LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | OK970129 |
Policy instance | 8 |
Insurance contract or identification number | OK970129 | Number of Individuals Covered | 419 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $89 | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $4,688 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $0 | Amount paid for insurance broker fees | 89 | Additional information about fees paid to insurance broker | OTHER FEES | Insurance broker organization code? | 3 |
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LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | FLX968648 |
Policy instance | 1 |
Insurance contract or identification number | FLX968648 | Number of Individuals Covered | 419 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $662 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $39,475 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $0 | Amount paid for insurance broker fees | 662 | Additional information about fees paid to insurance broker | OTHER FEES | Insurance broker organization code? | 3 |
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AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 0869634 |
Policy instance | 2 |
Insurance contract or identification number | 0869634 | Number of Individuals Covered | 515 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $7,679 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $157,181 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,679 | Insurance broker organization code? | 3 |
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EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 98678961001 |
Policy instance | 3 |
Insurance contract or identification number | 98678961001 | Number of Individuals Covered | 411 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $2,092 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $21,023 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,092 | Insurance broker organization code? | 3 |
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NEBRASKA METHODIST HEALTH SYSTEM D/B/A BESTCARE EAP (National Association of Insurance Commissioners NAIC id number: 00 ) |
Policy contract number | 0001 |
Policy instance | 5 |
Insurance contract or identification number | 0001 | Number of Individuals Covered | 450 | Insurance policy start date | 2018-03-01 | Insurance policy end date | 2019-02-28 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | EMPLOYEE ASSISTANCE PLAN | Welfare Benefit Premiums Paid to Carrier | USD $8,303 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | LK752399 |
Policy instance | 6 |
Insurance contract or identification number | LK752399 | Number of Individuals Covered | 419 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $2,253 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $144,206 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $0 | Amount paid for insurance broker fees | 2253 | Additional information about fees paid to insurance broker | OTHER FEES | Insurance broker organization code? | 3 |
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LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | LK965812 |
Policy instance | 7 |
Insurance contract or identification number | LK965812 | Number of Individuals Covered | 121 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $1,033 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $53,501 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $0 | Amount paid for insurance broker fees | 1033 | Additional information about fees paid to insurance broker | OTHER FEES | Insurance broker organization code? | 3 |
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NEBRASKA METHODIST HEALTH SYSTEM D/B/A BESTCARE EAP (National Association of Insurance Commissioners NAIC id number: 00 ) |
Policy contract number | 0001 |
Policy instance | 5 |
Insurance contract or identification number | 0001 | Number of Individuals Covered | 450 | Insurance policy start date | 2017-03-01 | Insurance policy end date | 2018-02-28 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | EMPLOYEE ASSISTANCE PLAN | Welfare Benefit Premiums Paid to Carrier | USD $8,190 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E7653454 |
Policy instance | 4 |
Insurance contract or identification number | E7653454 | Number of Individuals Covered | 32 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $4,350 | Total amount of fees paid to insurance company | USD $597 | Other welfare benefits provided | VOL CANCER/ACCIDENT/HOSPITAL INDEM. | Welfare Benefit Premiums Paid to Carrier | USD $29,196 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,629 | Amount paid for insurance broker fees | 422 | Additional information about fees paid to insurance broker | OTHER FEES | Insurance broker organization code? | 3 |
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EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 98678961001 |
Policy instance | 3 |
Insurance contract or identification number | 98678961001 | Number of Individuals Covered | 374 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $2,077 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $20,875 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,077 | Insurance broker organization code? | 3 |
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AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 0869634 |
Policy instance | 2 |
Insurance contract or identification number | 0869634 | Number of Individuals Covered | 509 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $6,045 | Total amount of fees paid to insurance company | USD $711 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $143,811 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,045 | Amount paid for insurance broker fees | 711 | Additional information about fees paid to insurance broker | 2017 PPP ENGAGEMENT CREDIT MEDICAL RETENTION | Insurance broker organization code? | 3 |
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AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 0865167 |
Policy instance | 1 |
Insurance contract or identification number | 0865167 | Number of Individuals Covered | 398 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $14,827 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $235,327 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $14,827 | Insurance broker organization code? | 3 |
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AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 0865167 |
Policy instance | 1 |
Insurance contract or identification number | 0865167 | Number of Individuals Covered | 387 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $14,118 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $219,777 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $14,118 | Insurance broker organization code? | 3 | Insurance broker name | GALLAGHER BENEFIT SERVICES INC |
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AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 0869634 |
Policy instance | 2 |
Insurance contract or identification number | 0869634 | Number of Individuals Covered | 465 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $5,311 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $119,903 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,311 | Insurance broker organization code? | 3 | Insurance broker name | GALLAGHER BENEFIT SERVICES INC |
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EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 98678961001 |
Policy instance | 3 |
Insurance contract or identification number | 98678961001 | Number of Individuals Covered | 340 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $1,892 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $20,583 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,892 | Insurance broker organization code? | 3 | Insurance broker name | GALLAGHER BENEFIT SERVICES INC |
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AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 0865167 |
Policy instance | 1 |
Insurance contract or identification number | 0865167 | Number of Individuals Covered | 318 | Insurance policy start date | 2015-01-01 | Insurance policy end date | 2015-12-31 | Total amount of commissions paid to insurance broker | USD $22,318 | Total amount of fees paid to insurance company | USD $914 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $154,232 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $22,318 | Amount paid for insurance broker fees | 914 | Additional information about fees paid to insurance broker | 2014/2015 PPP ENGAGEMENT CREDIT | Insurance broker organization code? | 3 | Insurance broker name | GALLAGHER BENEFIT SERVICES INC |
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EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 9867896 |
Policy instance | 4 |
Insurance contract or identification number | 9867896 | Number of Individuals Covered | 205 | Insurance policy start date | 2015-01-01 | Insurance policy end date | 2015-12-31 | Total amount of commissions paid to insurance broker | USD $1,123 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $11,423 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,123 | Insurance broker organization code? | 3 | Insurance broker name | GALLAGHER BENEFIT SERVICES |
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DELTA DENTAL OF NEBRASKA (National Association of Insurance Commissioners NAIC id number: 47091 ) |
Policy contract number | 472866 |
Policy instance | 3 |
Insurance contract or identification number | 472866 | Number of Individuals Covered | 180 | Insurance policy start date | 2015-01-01 | Insurance policy end date | 2015-12-31 | Total amount of commissions paid to insurance broker | USD $8,387 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $71,923 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,173 | Insurance broker organization code? | 3 | Insurance broker name | GALLAGHER BENEFIT SERVICES |
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COVENTRY HEALTH CARE OF NEBRASKA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 8040930000 |
Policy instance | 2 |
Insurance contract or identification number | 8040930000 | Number of Individuals Covered | 440 | Insurance policy start date | 2015-01-01 | Insurance policy end date | 2015-12-31 | Total amount of commissions paid to insurance broker | USD $53,852 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,485,036 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $53,852 | Insurance broker organization code? | 3 | Insurance broker name | GALLAGHER BENEFITS SERVICES, INC. |
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COVENTRY HEALTH CARE OF NEBRASKA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 8040930000 |
Policy instance | 2 |
Insurance contract or identification number | 8040930000 | Number of Individuals Covered | 415 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,445,240 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 0865167 |
Policy instance | 1 |
Insurance contract or identification number | 0865167 | Number of Individuals Covered | 285 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-12-31 | Total amount of commissions paid to insurance broker | USD $61 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $127,780 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $61 | Insurance broker organization code? | 3 | Insurance broker name | GALLAGHER BENEFIT SERVICES |
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EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 9867896 |
Policy instance | 4 |
Insurance contract or identification number | 9867896 | Number of Individuals Covered | 167 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-12-31 | Total amount of commissions paid to insurance broker | USD $853 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $9,330 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $853 | Insurance broker organization code? | 3 | Insurance broker name | GALLAGHER BENEFIT SERVICES |
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DELTA DENTAL OF NEBRASKA (National Association of Insurance Commissioners NAIC id number: 47091 ) |
Policy contract number | 472866 |
Policy instance | 3 |
Insurance contract or identification number | 472866 | Number of Individuals Covered | 164 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-12-31 | Total amount of commissions paid to insurance broker | USD $10,157 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $69,229 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $10,157 | Insurance broker organization code? | 3 | Insurance broker name | GALLAGHER BENEFIT SERVICES |
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DELTA DENTAL OF NEBRASKA (National Association of Insurance Commissioners NAIC id number: 47091 ) |
Policy contract number | 472866 |
Policy instance | 3 |
Insurance contract or identification number | 472866 | Number of Individuals Covered | 114 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $2,715 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $44,482 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,715 | Insurance broker organization code? | 3 | Insurance broker name | SILVERSTONE GROUP |
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PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
Policy contract number | H64596 |
Policy instance | 1 |
Insurance contract or identification number | H64596 | Number of Individuals Covered | 252 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $10,301 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $131,157 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $10,301 | Insurance broker organization code? | 3 | Insurance broker name | GALLAGHER BENEFIT SERVICES |
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COVENTRY HEALTH CARE OF NEBRASKA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 804930000 |
Policy instance | 2 |
Insurance contract or identification number | 804930000 | Number of Individuals Covered | 326 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,038,867 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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COVENTRY HEALTH CARE OF NEBRASKA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 804930000 |
Policy instance | 2 |
Insurance contract or identification number | 804930000 | Number of Individuals Covered | 294 | Insurance policy start date | 2012-07-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $377,242 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
Policy contract number | H64596 |
Policy instance | 1 |
Insurance contract or identification number | H64596 | Number of Individuals Covered | 248 | Insurance policy start date | 2012-07-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $5,344 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $53,584 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,358 | Insurance broker organization code? | 3 | Insurance broker name | GRACE/MAYER INSURANCE AGENCY INC. |
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PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
Policy contract number | H64596 |
Policy instance | 1 |
Insurance contract or identification number | H64596 | Number of Individuals Covered | 220 | Insurance policy start date | 2011-07-01 | Insurance policy end date | 2012-06-30 | Total amount of commissions paid to insurance broker | USD $8,021 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $101,558 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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COVENTRY HEALTH CARE OF NEBRASKA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 8040930000 |
Policy instance | 2 |
Insurance contract or identification number | 8040930000 | Number of Individuals Covered | 266 | Insurance policy start date | 2011-07-01 | Insurance policy end date | 2012-06-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $712,925 | 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 NEBRASKA (National Association of Insurance Commissioners NAIC id number: 77780 ) |
Policy contract number | 04802 |
Policy instance | 2 |
Insurance contract or identification number | 04802 | Number of Individuals Covered | 135 | Insurance policy start date | 2010-07-01 | Insurance policy end date | 2011-06-30 | Total amount of commissions paid to insurance broker | USD $37,129 | Total amount of fees paid to insurance company | USD $8,066 | Health Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
Policy contract number | H64596 |
Policy instance | 1 |
Insurance contract or identification number | H64596 | Number of Individuals Covered | 177 | Insurance policy start date | 2010-07-01 | Insurance policy end date | 2011-06-30 | Total amount of commissions paid to insurance broker | USD $6,935 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $83,193 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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