401k Plan data: VISITING NURSE ASSOCIATION OF THE MIDLANDS GROUP LIFE, AD&D, AND MAJOR MEDICAL PLAN plan

VISITING NURSE ASSOCIATION OF THE MIDLANDS GROUP LIFE, AD&D, AND MAJOR MEDICAL PLAN 401k Plan overview

Plan Name	VISITING NURSE ASSOCIATION OF THE MIDLANDS GROUP LIFE, AD&D, AND MAJOR MEDICAL PLAN
Plan identification number	503

VISITING NURSE ASSOCIATION OF THE MIDLANDS GROUP LIFE, AD&D, AND MAJOR MEDICAL PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Long-term disability cover Other welfare benefit cover Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

VISITING NURSE ASSOCIATION OF THE MIDLANDS has sponsored the creation of one or more 401k plans.

Company Name: VISITING NURSE ASSOCIATION OF THE MIDLANDS

Employer identification number (EIN): 470690207

NAIC Classification: 621610
NAIC Description: Home Health Care Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan VISITING NURSE ASSOCIATION OF THE MIDLANDS GROUP LIFE, AD&D, AND MAJOR MEDICAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2021-01-01 DAVID VANLANDINGHAM 2022-08-01
503 2021-01-01 DAVID VANLANDINGHAM 2024-02-05
503 2020-01-01 DAVID VANLANDINGHAM 2021-07-14
503 2019-01-01 DAVID VANLANDINGHAM 2020-06-11
503 2018-01-01
503 2017-01-01
503 2016-01-01
503 2015-01-01
503 2014-01-01
503 2013-01-01
503 2012-01-01 DAVID VANLANDINGHAM
503 2011-01-01 DAVID VANLANDINGHAM
503 2010-01-01 DAVE VANLANDINGHAM
503 2009-01-01 DAVID VANLANDINGHAM

Plan Statistics for VISITING NURSE ASSOCIATION OF THE MIDLANDS GROUP LIFE, AD&D, AND MAJOR MEDICAL PLAN

401k plan membership statisitcs for VISITING NURSE ASSOCIATION OF THE MIDLANDS GROUP LIFE, AD&D, AND MAJOR MEDICAL PLAN

Measure Date Value
2021: VISITING NURSE ASSOCIATION OF THE MIDLANDS GROUP LIFE, AD&D, AND MAJOR MEDICAL PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 194
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 58
Number of retired or separated participants receiving benefits 2021-01-01 3
Total of all active and inactive participants 2021-01-01 61
2020: VISITING NURSE ASSOCIATION OF THE MIDLANDS GROUP LIFE, AD&D, AND MAJOR MEDICAL PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 206
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 194
Total of all active and inactive participants 2020-01-01 194
2019: VISITING NURSE ASSOCIATION OF THE MIDLANDS GROUP LIFE, AD&D, AND MAJOR MEDICAL PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 232
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 206
Total of all active and inactive participants 2019-01-01 206
2018: VISITING NURSE ASSOCIATION OF THE MIDLANDS GROUP LIFE, AD&D, AND MAJOR MEDICAL PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 216
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 231
Number of retired or separated participants receiving benefits 2018-01-01 1
Total of all active and inactive participants 2018-01-01 232
2017: VISITING NURSE ASSOCIATION OF THE MIDLANDS GROUP LIFE, AD&D, AND MAJOR MEDICAL PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 256
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 214
Number of retired or separated participants receiving benefits 2017-01-01 2
Total of all active and inactive participants 2017-01-01 216
2016: VISITING NURSE ASSOCIATION OF THE MIDLANDS GROUP LIFE, AD&D, AND MAJOR MEDICAL PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 239
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 256
Total of all active and inactive participants 2016-01-01 256
2015: VISITING NURSE ASSOCIATION OF THE MIDLANDS GROUP LIFE, AD&D, AND MAJOR MEDICAL PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 373
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 239
Total of all active and inactive participants 2015-01-01 239
2014: VISITING NURSE ASSOCIATION OF THE MIDLANDS GROUP LIFE, AD&D, AND MAJOR MEDICAL PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 352
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 373
Total of all active and inactive participants 2014-01-01 373
2013: VISITING NURSE ASSOCIATION OF THE MIDLANDS GROUP LIFE, AD&D, AND MAJOR MEDICAL PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 322
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 352
Total of all active and inactive participants 2013-01-01 352
2012: VISITING NURSE ASSOCIATION OF THE MIDLANDS GROUP LIFE, AD&D, AND MAJOR MEDICAL PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 290
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 322
Total of all active and inactive participants 2012-01-01 322
2011: VISITING NURSE ASSOCIATION OF THE MIDLANDS GROUP LIFE, AD&D, AND MAJOR MEDICAL PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 274
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 290
Total of all active and inactive participants 2011-01-01 290
2010: VISITING NURSE ASSOCIATION OF THE MIDLANDS GROUP LIFE, AD&D, AND MAJOR MEDICAL PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 291
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 274
Total of all active and inactive participants 2010-01-01 274
2009: VISITING NURSE ASSOCIATION OF THE MIDLANDS GROUP LIFE, AD&D, AND MAJOR MEDICAL PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 324
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 291
Total of all active and inactive participants 2009-01-01 291

Measure	Date	Value
2021: VISITING NURSE ASSOCIATION OF THE MIDLANDS GROUP LIFE, AD&D, AND MAJOR MEDICAL PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	194
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	58
Number of retired or separated participants receiving benefits	2021-01-01	3
Total of all active and inactive participants	2021-01-01	61
2020: VISITING NURSE ASSOCIATION OF THE MIDLANDS GROUP LIFE, AD&D, AND MAJOR MEDICAL PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	206
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	194
Total of all active and inactive participants	2020-01-01	194
2019: VISITING NURSE ASSOCIATION OF THE MIDLANDS GROUP LIFE, AD&D, AND MAJOR MEDICAL PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	232
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	206
Total of all active and inactive participants	2019-01-01	206
2018: VISITING NURSE ASSOCIATION OF THE MIDLANDS GROUP LIFE, AD&D, AND MAJOR MEDICAL PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	216
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	231
Number of retired or separated participants receiving benefits	2018-01-01	1
Total of all active and inactive participants	2018-01-01	232
2017: VISITING NURSE ASSOCIATION OF THE MIDLANDS GROUP LIFE, AD&D, AND MAJOR MEDICAL PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	256
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	214
Number of retired or separated participants receiving benefits	2017-01-01	2
Total of all active and inactive participants	2017-01-01	216
2016: VISITING NURSE ASSOCIATION OF THE MIDLANDS GROUP LIFE, AD&D, AND MAJOR MEDICAL PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	239
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	256
Total of all active and inactive participants	2016-01-01	256
2015: VISITING NURSE ASSOCIATION OF THE MIDLANDS GROUP LIFE, AD&D, AND MAJOR MEDICAL PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	373
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	239
Total of all active and inactive participants	2015-01-01	239
2014: VISITING NURSE ASSOCIATION OF THE MIDLANDS GROUP LIFE, AD&D, AND MAJOR MEDICAL PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	352
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	373
Total of all active and inactive participants	2014-01-01	373
2013: VISITING NURSE ASSOCIATION OF THE MIDLANDS GROUP LIFE, AD&D, AND MAJOR MEDICAL PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	322
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	352
Total of all active and inactive participants	2013-01-01	352
2012: VISITING NURSE ASSOCIATION OF THE MIDLANDS GROUP LIFE, AD&D, AND MAJOR MEDICAL PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	290
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	322
Total of all active and inactive participants	2012-01-01	322
2011: VISITING NURSE ASSOCIATION OF THE MIDLANDS GROUP LIFE, AD&D, AND MAJOR MEDICAL PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	274
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	290
Total of all active and inactive participants	2011-01-01	290
2010: VISITING NURSE ASSOCIATION OF THE MIDLANDS GROUP LIFE, AD&D, AND MAJOR MEDICAL PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	291
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	274
Total of all active and inactive participants	2010-01-01	274
2009: VISITING NURSE ASSOCIATION OF THE MIDLANDS GROUP LIFE, AD&D, AND MAJOR MEDICAL PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	324
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	291
Total of all active and inactive participants	2009-01-01	291

Form 5500 Responses for VISITING NURSE ASSOCIATION OF THE MIDLANDS GROUP LIFE, AD&D, AND MAJOR MEDICAL PLAN

2021: VISITING NURSE ASSOCIATION OF THE MIDLANDS GROUP LIFE, AD&D, AND MAJOR MEDICAL PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Submission has been amended	Yes
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: VISITING NURSE ASSOCIATION OF THE MIDLANDS GROUP LIFE, AD&D, AND MAJOR MEDICAL PLAN 2020 form 5500 responses
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: VISITING NURSE ASSOCIATION OF THE MIDLANDS GROUP LIFE, AD&D, AND MAJOR MEDICAL PLAN 2019 form 5500 responses
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: VISITING NURSE ASSOCIATION OF THE MIDLANDS GROUP LIFE, AD&D, AND MAJOR MEDICAL PLAN 2018 form 5500 responses
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: VISITING NURSE ASSOCIATION OF THE MIDLANDS GROUP LIFE, AD&D, AND MAJOR MEDICAL PLAN 2017 form 5500 responses
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: VISITING NURSE ASSOCIATION OF THE MIDLANDS GROUP LIFE, AD&D, AND MAJOR MEDICAL PLAN 2016 form 5500 responses
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: VISITING NURSE ASSOCIATION OF THE MIDLANDS GROUP LIFE, AD&D, AND MAJOR MEDICAL PLAN 2015 form 5500 responses
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: VISITING NURSE ASSOCIATION OF THE MIDLANDS GROUP LIFE, AD&D, AND MAJOR MEDICAL PLAN 2014 form 5500 responses
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: VISITING NURSE ASSOCIATION OF THE MIDLANDS GROUP LIFE, AD&D, AND MAJOR MEDICAL PLAN 2013 form 5500 responses
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: VISITING NURSE ASSOCIATION OF THE MIDLANDS GROUP LIFE, AD&D, AND MAJOR MEDICAL PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: VISITING NURSE ASSOCIATION OF THE MIDLANDS GROUP LIFE, AD&D, AND MAJOR MEDICAL PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2010: VISITING NURSE ASSOCIATION OF THE MIDLANDS GROUP LIFE, AD&D, AND MAJOR MEDICAL PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2009: VISITING NURSE ASSOCIATION OF THE MIDLANDS GROUP LIFE, AD&D, AND MAJOR MEDICAL PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	This submission is the final filing	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

010211000 00000

Policy instance

Insurance contract or identification number	010211000 00000
Number of Individuals Covered	61
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $3,868
Total amount of fees paid to insurance company	USD $1,059
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $37,360
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,868
Insurance broker organization code?	3
Amount paid for insurance broker fees	1059
Additional information about fees paid to insurance broker	OTHER FEES

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

400001000 20507

Policy instance

Insurance contract or identification number	400001000 20507
Number of Individuals Covered	37
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $1,297
Total amount of fees paid to insurance company	USD $736
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $25,948
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,297
Insurance broker organization code?	3
Amount paid for insurance broker fees	736
Additional information about fees paid to insurance broker	OTHER FEES

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

010210999 00000

Policy instance

Insurance contract or identification number	010210999 00000
Number of Individuals Covered	61
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $457
Total amount of fees paid to insurance company	USD $261
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $9,136
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $457
Insurance broker organization code?	3
Amount paid for insurance broker fees	261
Additional information about fees paid to insurance broker	OTHER FEES

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

010211001 00000

Policy instance

Insurance contract or identification number	010211001 00000
Number of Individuals Covered	36
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $1,482
Total amount of fees paid to insurance company	USD $1,100
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $35,426
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,482
Insurance broker organization code?	3
Amount paid for insurance broker fees	1100
Additional information about fees paid to insurance broker	OTHER FEES

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

010-031070

Policy instance

Insurance contract or identification number	010-031070
Number of Individuals Covered	92
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 $6,284
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $91,897
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	6284
Additional information about fees paid to insurance broker	OTHER FEES
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF NEBRASKA (National Association of Insurance Commissioners NAIC id number: 77780 )

Policy contract number

105814

Policy instance

Insurance contract or identification number	105814
Number of Individuals Covered	75
Insurance policy start date	2021-07-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $7,904
Total amount of fees paid to insurance company	USD $1,825
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $225,167
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,904
Amount paid for insurance broker fees	1825
Additional information about fees paid to insurance broker	OTHER FEES
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

010211001 00000

Policy instance

Insurance contract or identification number	010211001 00000
Number of Individuals Covered	116
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $1,667
Total amount of fees paid to insurance company	USD $1,199
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $54,994
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,667
Insurance broker organization code?	3
Amount paid for insurance broker fees	1199
Additional information about fees paid to insurance broker	BROKER BONUS

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

010-031070

Policy instance

Insurance contract or identification number	010-031070
Number of Individuals Covered	141
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 $2,003
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $155,432
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	2003
Additional information about fees paid to insurance broker	OTHER FEES
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

010210999 00000

Policy instance

Insurance contract or identification number	010210999 00000
Number of Individuals Covered	194
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $651
Total amount of fees paid to insurance company	USD $281
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $13,029
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $651
Insurance broker organization code?	3
Amount paid for insurance broker fees	281
Additional information about fees paid to insurance broker	BROKER BONUS

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

400001000 20507

Policy instance

Insurance contract or identification number	400001000 20507
Number of Individuals Covered	98
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $1,841
Total amount of fees paid to insurance company	USD $892
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $36,821
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,841
Insurance broker organization code?	3
Amount paid for insurance broker fees	892
Additional information about fees paid to insurance broker	BROKER BONUS

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

010211000 00000

Policy instance

Insurance contract or identification number	010211000 00000
Number of Individuals Covered	194
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $4,648
Total amount of fees paid to insurance company	USD $1,127
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $52,969
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,648
Insurance broker organization code?	3
Amount paid for insurance broker fees	1127
Additional information about fees paid to insurance broker	BROKER BONUS

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

010-031070

Policy instance

Insurance contract or identification number	010-031070
Number of Individuals Covered	156
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 $2,984
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $157,129
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	2984
Additional information about fees paid to insurance broker	OTHER FEES
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

010211001 00000

Policy instance

Insurance contract or identification number	010211001 00000
Number of Individuals Covered	126
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $1,617
Total amount of fees paid to insurance company	USD $1,850
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $48,979
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,617
Amount paid for insurance broker fees	1850
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

400001000 20507

Policy instance

Insurance contract or identification number	400001000 20507
Number of Individuals Covered	110
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $1,822
Total amount of fees paid to insurance company	USD $1,191
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $36,440
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,822
Amount paid for insurance broker fees	1191
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

010211000 00000

Policy instance

Insurance contract or identification number	010211000 00000
Number of Individuals Covered	206
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $4,301
Total amount of fees paid to insurance company	USD $1,625
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $46,010
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,301
Amount paid for insurance broker fees	1625
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

010210999 00000

Policy instance

Insurance contract or identification number	010210999 00000
Number of Individuals Covered	206
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $573
Total amount of fees paid to insurance company	USD $407
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $11,459
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $573
Amount paid for insurance broker fees	407
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

010-031070

Policy instance

Insurance contract or identification number	010-031070
Number of Individuals Covered	174
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $2,677
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $177,598
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	2677
Additional information about fees paid to insurance broker	OTHER FEES
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

010211001 00000

Policy instance

Insurance contract or identification number	010211001 00000
Number of Individuals Covered	134
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $1,715
Total amount of fees paid to insurance company	USD $1,784
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $61,682
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,715
Amount paid for insurance broker fees	1784
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

010210999 00000

Policy instance

Insurance contract or identification number	010210999 00000
Number of Individuals Covered	231
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $679
Total amount of fees paid to insurance company	USD $370
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $13,581
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $679
Amount paid for insurance broker fees	370
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

400001000 20507

Policy instance

Insurance contract or identification number	400001000 20507
Number of Individuals Covered	121
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $1,932
Total amount of fees paid to insurance company	USD $1,146
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $38,633
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,932
Amount paid for insurance broker fees	1146
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

010211000 00000

Policy instance

Insurance contract or identification number	010211000 00000
Number of Individuals Covered	231
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $4,700
Total amount of fees paid to insurance company	USD $1,482
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $54,167
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,700
Amount paid for insurance broker fees	1482
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

010211000 00000

Policy instance

Insurance contract or identification number	010211000 00000
Number of Individuals Covered	214
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $4,435
Total amount of fees paid to insurance company	USD $928
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $49,415
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,435
Amount paid for insurance broker fees	928
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	SILVERSTONE GRP INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

400001000 20507

Policy instance

Insurance contract or identification number	400001000 20507
Number of Individuals Covered	110
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $1,911
Total amount of fees paid to insurance company	USD $721
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $38,216
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,911
Amount paid for insurance broker fees	721
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	SILVERSTONE GRP INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

010211001 00000

Policy instance

Insurance contract or identification number	010211001 00000
Number of Individuals Covered	136
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $1,699
Total amount of fees paid to insurance company	USD $1,194
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $59,466
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,699
Amount paid for insurance broker fees	1194
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	SILVERSTONE GRP INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

010210999 00000

Policy instance

Insurance contract or identification number	010210999 00000
Number of Individuals Covered	214
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $616
Total amount of fees paid to insurance company	USD $234
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $12,323
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $616
Amount paid for insurance broker fees	234
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	SILVERSTONE GRP INC

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

010-031070

Policy instance

Insurance contract or identification number	010-031070
Number of Individuals Covered	162
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $2,367
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $139,175
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	2367
Additional information about fees paid to insurance broker	OTHER FEES
Insurance broker organization code?	3
Insurance broker name	SILVERSTONE GROUP INCORPORATED

BLUE CROSS BLUE SHIELD OF NEBRASKA (National Association of Insurance Commissioners NAIC id number: 77780 )

Policy contract number

305178

Policy instance

Insurance contract or identification number	305178
Number of Individuals Covered	180
Insurance policy start date	2015-11-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $9,537
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $221,613
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,537
Insurance broker organization code?	3
Insurance broker name	GALLAGHER BENEFIT SERVICES INC

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

010-031070

Policy instance

Insurance contract or identification number	010-031070
Number of Individuals Covered	178
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $681
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $136,580
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	681
Additional information about fees paid to insurance broker	OTHER FEES
Insurance broker organization code?	3
Insurance broker name	GALLAGHER BENEFIT SERVICES INC

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

VDT600643

Policy instance

Insurance contract or identification number	VDT600643
Number of Individuals Covered	156
Insurance policy start date	2014-02-01
Insurance policy end date	2015-01-31
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 $63,354
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

SDK601680

Policy instance

Insurance contract or identification number	SDK601680
Number of Individuals Covered	175
Insurance policy start date	2014-11-01
Insurance policy end date	2015-10-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $31
Other welfare benefits provided	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $3,002
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	31
Additional information about fees paid to insurance broker	OVERRIDE FEES
Insurance broker organization code?	3
Insurance broker name	GALLAGHER BENEFIT SERVICES INC

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

FLX962042

Policy instance

Insurance contract or identification number	FLX962042
Number of Individuals Covered	239
Insurance policy start date	2014-11-01
Insurance policy end date	2015-10-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $453
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $45,746
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	453
Additional information about fees paid to insurance broker	OVERRIDE FEES
Insurance broker organization code?	3
Insurance broker name	GALLAGHER BENEFIT SERVICES INC

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

DIV #313

Policy instance

Insurance contract or identification number	DIV #313
Number of Individuals Covered	6
Insurance policy start date	2014-03-01
Insurance policy end date	2015-02-28
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 $12,625
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

VDT600643

Policy instance

Insurance contract or identification number	VDT600643
Number of Individuals Covered	156
Insurance policy start date	2015-02-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $633
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $62,801
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	633
Additional information about fees paid to insurance broker	OVERRIDE FEES
Insurance broker organization code?	3
Insurance broker name	GALLAGHER BENEFIT SERVICES INC

BLUE CROSS BLUE SHIELD OF NEBRASKA (National Association of Insurance Commissioners NAIC id number: 77780 )

Policy contract number

305178

Policy instance

Insurance contract or identification number	305178
Number of Individuals Covered	179
Insurance policy start date	2014-11-01
Insurance policy end date	2015-10-31
Total amount of commissions paid to insurance broker	USD $70,474
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,337,759
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $70,474
Insurance broker organization code?	3
Insurance broker name	GALLAGHER BENEFIT SERVICES INC

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

SDK601680

Policy instance

Insurance contract or identification number	SDK601680
Number of Individuals Covered	91
Insurance policy start date	2013-11-01
Insurance policy end date	2014-10-31
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
Other welfare benefits provided	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $3,027
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

DIV #313

Policy instance

Insurance contract or identification number	DIV #313
Number of Individuals Covered	7
Insurance policy start date	2013-03-01
Insurance policy end date	2014-02-28
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
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $13,597
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

COVENTRY HEALTH CARE OF NEBRASKA (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

8038710000

Policy instance

Insurance contract or identification number	8038710000
Number of Individuals Covered	373
Insurance policy start date	2014-01-01
Insurance policy end date	2014-10-31
Total amount of commissions paid to insurance broker	USD $58,362
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 $978,001
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $58,362
Insurance broker organization code?	3
Insurance broker name	FIRST INSURANCE GROUP, LLC

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

VDT600643

Policy instance

Insurance contract or identification number	VDT600643
Number of Individuals Covered	155
Insurance policy start date	2013-02-01
Insurance policy end date	2014-01-31
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
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $67,156
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

010-031070

Policy instance

Insurance contract or identification number	010-031070
Number of Individuals Covered	179
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 $1,537
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
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $118,947
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	1537
Insurance broker organization code?	3
Insurance broker name	GALLAGHER BENEFIT SERVICES INC

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

FLX962042

Policy instance

Insurance contract or identification number	FLX962042
Number of Individuals Covered	222
Insurance policy start date	2013-11-01
Insurance policy end date	2014-10-31
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
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $46,676
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

SDK601680

Policy instance

Insurance contract or identification number	SDK601680
Number of Individuals Covered	158
Insurance policy start date	2012-11-01
Insurance policy end date	2013-10-31
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
Other welfare benefits provided	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $2,675
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

DIV #313

Policy instance

Insurance contract or identification number	DIV #313
Number of Individuals Covered	9
Insurance policy start date	2012-03-01
Insurance policy end date	2013-02-28
Total amount of commissions paid to insurance broker	USD $2,009
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
Welfare Benefit Premiums Paid to Carrier	USD $23,485
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,009
Insurance broker organization code?	3
Insurance broker name	AON CONSULTING INC

COVENTRY HEALTH CARE OF NEBRASKA (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

8038710000

Policy instance

Insurance contract or identification number	8038710000
Number of Individuals Covered	352
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $63,673
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 $1,294,856
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $63,673
Insurance broker organization code?	3
Insurance broker name	FIRST INSURANCE GROUP, LLC

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

VDT600643

Policy instance

Insurance contract or identification number	VDT600643
Number of Individuals Covered	159
Insurance policy start date	2012-02-01
Insurance policy end date	2013-01-31
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
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $48,323
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

010-031070

Policy instance

Insurance contract or identification number	010-031070
Number of Individuals Covered	160
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 $3,000
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 $111,502
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	3000
Additional information about fees paid to insurance broker	BROKER FEES
Insurance broker organization code?	3
Insurance broker name	GALLAGHER BENEFIT SERVICES INC

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

FLX962042

Policy instance

Insurance contract or identification number	FLX962042
Number of Individuals Covered	203
Insurance policy start date	2012-11-01
Insurance policy end date	2013-10-31
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
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $39,393
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

SDK601680

Policy instance

Insurance contract or identification number	SDK601680
Number of Individuals Covered	135
Insurance policy start date	2011-11-01
Insurance policy end date	2012-11-01
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
Other welfare benefits provided	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $1,875
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

FLX962042

Policy instance

Insurance contract or identification number	FLX962042
Number of Individuals Covered	201
Insurance policy start date	2011-11-01
Insurance policy end date	2012-11-01
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
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $28,234
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

010-031070

Policy instance

Insurance contract or identification number	010-031070
Number of Individuals Covered	167
Insurance policy start date	2012-01-01
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 $2,000
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 $104,997
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	2000
Additional information about fees paid to insurance broker	BROKER FEES
Insurance broker organization code?	3
Insurance broker name	GRACE MAYER INSURANCE AGENCY

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

DIV #313

Policy instance

Insurance contract or identification number	DIV #313
Number of Individuals Covered	14
Insurance policy start date	2011-03-01
Insurance policy end date	2012-02-29
Total amount of commissions paid to insurance broker	USD $4,507
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
Welfare Benefit Premiums Paid to Carrier	USD $30,857
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,507
Insurance broker organization code?	3
Insurance broker name	AON CONSULTING

COVENTRY HEALTH CARE OF NEBRASKA (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

8038710000

Policy instance

Insurance contract or identification number	8038710000
Number of Individuals Covered	322
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $59,146
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 $1,197,465
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $59,146
Insurance broker organization code?	3
Insurance broker name	FIRST INSURANCE GROUP, LLC

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

085666

Policy instance

Insurance contract or identification number	085666
Number of Individuals Covered	141
Insurance policy start date	2011-11-01
Insurance policy end date	2012-01-31
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
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $13,433
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

H41658

Policy instance

Insurance contract or identification number	H41658
Number of Individuals Covered	64
Insurance policy start date	2011-01-01
Insurance policy end date	2011-10-31
Total amount of commissions paid to insurance broker	USD $2,342
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
Welfare Benefit Premiums Paid to Carrier	USD $18,731
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

010-031070

Policy instance

Insurance contract or identification number	010-031070
Number of Individuals Covered	152
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
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
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $104,516
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

FLX962042

Policy instance

Insurance contract or identification number	FLX962042
Number of Individuals Covered	173
Insurance policy start date	2010-11-01
Insurance policy end date	2011-11-01
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
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $9,017
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

DIV #313

Policy instance

Insurance contract or identification number	DIV #313
Number of Individuals Covered	14
Insurance policy start date	2010-03-01
Insurance policy end date	2011-02-28
Total amount of commissions paid to insurance broker	USD $4,507
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
Welfare Benefit Premiums Paid to Carrier	USD $30,857
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

COVENTRY HEALTH CARE OF NEBRASKA (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

8038710000

Policy instance

Insurance contract or identification number	8038710000
Number of Individuals Covered	290
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $51,264
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 $1,229,437
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

085666

Policy instance

Insurance contract or identification number	085666
Number of Individuals Covered	143
Insurance policy start date	2010-11-01
Insurance policy end date	2011-10-31
Total amount of commissions paid to insurance broker	USD $2,971
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
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $48,212
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

085666

Policy instance

Insurance contract or identification number	085666
Number of Individuals Covered	143
Insurance policy start date	2009-11-01
Insurance policy end date	2010-10-31
Total amount of commissions paid to insurance broker	USD $3,372
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
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $50,688
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,372
Insurance broker organization code?	3
Insurance broker name	AON RISK SERVICES CENTRAL INC

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

H41658

Policy instance

Insurance contract or identification number	H41658
Number of Individuals Covered	68
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $3,451
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
Welfare Benefit Premiums Paid to Carrier	USD $27,605
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,451
Insurance broker organization code?	3
Insurance broker name	AON CONSULTING

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

FLX962042

Policy instance

Insurance contract or identification number	FLX962042
Number of Individuals Covered	179
Insurance policy start date	2009-11-01
Insurance policy end date	2010-11-01
Total amount of commissions paid to insurance broker	USD $122
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
Welfare Benefit Premiums Paid to Carrier	USD $11,605
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $122
Insurance broker organization code?	3
Insurance broker name	AON CONSULTING

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

DIV #313

Policy instance

Insurance contract or identification number	DIV #313
Number of Individuals Covered	19
Insurance policy start date	2009-03-01
Insurance policy end date	2010-02-28
Total amount of commissions paid to insurance broker	USD $7,651
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
Welfare Benefit Premiums Paid to Carrier	USD $32,693
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,651
Insurance broker organization code?	3
Insurance broker name	AON CONSULTING

COVENTRY HEALTH CARE OF NEBRASKA (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

8038710000

Policy instance

Insurance contract or identification number	8038710000
Number of Individuals Covered	274
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $46,795
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 $1,169,871
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $46,795
Insurance broker organization code?	3
Insurance broker name	FIRST INSURANCE GROUP, LLC

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

010-031070

Policy instance

Insurance contract or identification number	010-031070
Number of Individuals Covered	150
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
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
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $93,712
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	VISITING NURSE ASSOCIATION OF THE MIDLANDS
Employer identification number (EIN):	470690207
NAIC Classification:	621610
NAIC Description:	Home Health Care Services

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
503	2021-01-01	DAVID VANLANDINGHAM	2022-08-01
503	2021-01-01	DAVID VANLANDINGHAM	2024-02-05
503	2020-01-01	DAVID VANLANDINGHAM	2021-07-14
503	2019-01-01	DAVID VANLANDINGHAM	2020-06-11
503	2018-01-01
503	2017-01-01
503	2016-01-01
503	2015-01-01
503	2014-01-01
503	2013-01-01
503	2012-01-01	DAVID VANLANDINGHAM
503	2011-01-01	DAVID VANLANDINGHAM
503	2010-01-01	DAVE VANLANDINGHAM
503	2009-01-01	DAVID VANLANDINGHAM