G & G OUTFITTERS, INC. has sponsored the creation of one or more 401k plans.
Additional information about G & G OUTFITTERS, INC.
Submission information for form 5500 for 401k plan G & G OUTFITTERS, INC. LIFE INSURANCE PLAN
401k plan membership statisitcs for G & G OUTFITTERS, INC. LIFE INSURANCE PLAN
Measure | Date | Value |
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2022: G & G OUTFITTERS, INC. LIFE INSURANCE PLAN 2022 401k membership |
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Total participants, beginning-of-year | 2022-10-01 | 278 |
Total number of active participants reported on line 7a of the Form 5500 | 2022-10-01 | 280 |
Number of retired or separated participants receiving benefits | 2022-10-01 | 2 |
Number of other retired or separated participants entitled to future benefits | 2022-10-01 | 0 |
Total of all active and inactive participants | 2022-10-01 | 282 |
2021: G & G OUTFITTERS, INC. LIFE INSURANCE PLAN 2021 401k membership |
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Total participants, beginning-of-year | 2021-10-01 | 292 |
Total number of active participants reported on line 7a of the Form 5500 | 2021-10-01 | 278 |
Number of retired or separated participants receiving benefits | 2021-10-01 | 2 |
Number of other retired or separated participants entitled to future benefits | 2021-10-01 | 0 |
Total of all active and inactive participants | 2021-10-01 | 280 |
2020: G & G OUTFITTERS, INC. LIFE INSURANCE PLAN 2020 401k membership |
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Total participants, beginning-of-year | 2020-10-01 | 273 |
Total number of active participants reported on line 7a of the Form 5500 | 2020-10-01 | 292 |
Number of retired or separated participants receiving benefits | 2020-10-01 | 2 |
Number of other retired or separated participants entitled to future benefits | 2020-10-01 | 0 |
Total of all active and inactive participants | 2020-10-01 | 294 |
2019: G & G OUTFITTERS, INC. LIFE INSURANCE PLAN 2019 401k membership |
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Total participants, beginning-of-year | 2019-10-01 | 280 |
Total number of active participants reported on line 7a of the Form 5500 | 2019-10-01 | 273 |
Number of retired or separated participants receiving benefits | 2019-10-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2019-10-01 | 0 |
Total of all active and inactive participants | 2019-10-01 | 273 |
2018: G & G OUTFITTERS, INC. LIFE INSURANCE PLAN 2018 401k membership |
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Total participants, beginning-of-year | 2018-10-01 | 270 |
Total number of active participants reported on line 7a of the Form 5500 | 2018-10-01 | 280 |
Number of retired or separated participants receiving benefits | 2018-10-01 | 2 |
Number of other retired or separated participants entitled to future benefits | 2018-10-01 | 0 |
Total of all active and inactive participants | 2018-10-01 | 282 |
2017: G & G OUTFITTERS, INC. LIFE INSURANCE PLAN 2017 401k membership |
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Total participants, beginning-of-year | 2017-10-01 | 312 |
Total number of active participants reported on line 7a of the Form 5500 | 2017-10-01 | 270 |
Number of retired or separated participants receiving benefits | 2017-10-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2017-10-01 | 0 |
Total of all active and inactive participants | 2017-10-01 | 270 |
2016: G & G OUTFITTERS, INC. LIFE INSURANCE PLAN 2016 401k membership |
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Total participants, beginning-of-year | 2016-10-01 | 312 |
Total number of active participants reported on line 7a of the Form 5500 | 2016-10-01 | 267 |
Number of retired or separated participants receiving benefits | 2016-10-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2016-10-01 | 0 |
Total of all active and inactive participants | 2016-10-01 | 267 |
2015: G & G OUTFITTERS, INC. LIFE INSURANCE PLAN 2015 401k membership |
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Total participants, beginning-of-year | 2015-10-01 | 126 |
Total number of active participants reported on line 7a of the Form 5500 | 2015-10-01 | 312 |
Number of retired or separated participants receiving benefits | 2015-10-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2015-10-01 | 0 |
Total of all active and inactive participants | 2015-10-01 | 312 |
2014: G & G OUTFITTERS, INC. LIFE INSURANCE PLAN 2014 401k membership |
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Total participants, beginning-of-year | 2014-10-01 | 113 |
Total number of active participants reported on line 7a of the Form 5500 | 2014-10-01 | 108 |
Number of retired or separated participants receiving benefits | 2014-10-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2014-10-01 | 0 |
Total of all active and inactive participants | 2014-10-01 | 108 |
2013: G & G OUTFITTERS, INC. LIFE INSURANCE PLAN 2013 401k membership |
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Total participants, beginning-of-year | 2013-10-01 | 102 |
Total number of active participants reported on line 7a of the Form 5500 | 2013-10-01 | 96 |
Number of retired or separated participants receiving benefits | 2013-10-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2013-10-01 | 0 |
Total of all active and inactive participants | 2013-10-01 | 96 |
2012: G & G OUTFITTERS, INC. LIFE INSURANCE PLAN 2012 401k membership |
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Total participants, beginning-of-year | 2012-10-01 | 102 |
Total number of active participants reported on line 7a of the Form 5500 | 2012-10-01 | 99 |
Number of retired or separated participants receiving benefits | 2012-10-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2012-10-01 | 0 |
Total of all active and inactive participants | 2012-10-01 | 99 |
2022: G & G OUTFITTERS, INC. LIFE INSURANCE PLAN 2022 form 5500 responses |
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2022-10-01 | Type of plan entity | Single employer plan |
2022-10-01 | Submission has been amended | No |
2022-10-01 | This submission is the final filing | No |
2022-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2022-10-01 | Plan is a collectively bargained plan | No |
2022-10-01 | Plan funding arrangement – Insurance | Yes |
2022-10-01 | Plan benefit arrangement – Insurance | Yes |
2021: G & G OUTFITTERS, INC. LIFE INSURANCE PLAN 2021 form 5500 responses |
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2021-10-01 | Type of plan entity | Single employer plan |
2021-10-01 | Submission has been amended | No |
2021-10-01 | This submission is the final filing | No |
2021-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2021-10-01 | Plan is a collectively bargained plan | No |
2021-10-01 | Plan funding arrangement – Insurance | Yes |
2021-10-01 | Plan benefit arrangement – Insurance | Yes |
2020: G & G OUTFITTERS, INC. LIFE INSURANCE PLAN 2020 form 5500 responses |
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2020-10-01 | Type of plan entity | Single employer plan |
2020-10-01 | Submission has been amended | No |
2020-10-01 | This submission is the final filing | No |
2020-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2020-10-01 | Plan is a collectively bargained plan | No |
2020-10-01 | Plan funding arrangement – Insurance | Yes |
2020-10-01 | Plan benefit arrangement – Insurance | Yes |
2019: G & G OUTFITTERS, INC. LIFE INSURANCE PLAN 2019 form 5500 responses |
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2019-10-01 | Type of plan entity | Single employer plan |
2019-10-01 | Submission has been amended | No |
2019-10-01 | This submission is the final filing | No |
2019-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2019-10-01 | Plan is a collectively bargained plan | No |
2019-10-01 | Plan funding arrangement – Insurance | Yes |
2019-10-01 | Plan benefit arrangement – Insurance | Yes |
2018: G & G OUTFITTERS, INC. LIFE INSURANCE PLAN 2018 form 5500 responses |
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2018-10-01 | Type of plan entity | Single employer plan |
2018-10-01 | Submission has been amended | No |
2018-10-01 | This submission is the final filing | No |
2018-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2018-10-01 | Plan is a collectively bargained plan | No |
2018-10-01 | Plan funding arrangement – Insurance | Yes |
2018-10-01 | Plan benefit arrangement – Insurance | Yes |
2017: G & G OUTFITTERS, INC. LIFE INSURANCE PLAN 2017 form 5500 responses |
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2017-10-01 | Type of plan entity | Single employer plan |
2017-10-01 | Submission has been amended | No |
2017-10-01 | This submission is the final filing | No |
2017-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2017-10-01 | Plan is a collectively bargained plan | No |
2017-10-01 | Plan funding arrangement – Insurance | Yes |
2017-10-01 | Plan benefit arrangement – Insurance | Yes |
2016: G & G OUTFITTERS, INC. LIFE INSURANCE PLAN 2016 form 5500 responses |
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2016-10-01 | Type of plan entity | Single employer plan |
2016-10-01 | Submission has been amended | No |
2016-10-01 | This submission is the final filing | No |
2016-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2016-10-01 | Plan is a collectively bargained plan | No |
2016-10-01 | Plan funding arrangement – Insurance | Yes |
2016-10-01 | Plan benefit arrangement – Insurance | Yes |
2015: G & G OUTFITTERS, INC. LIFE INSURANCE PLAN 2015 form 5500 responses |
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2015-10-01 | Type of plan entity | Single employer plan |
2015-10-01 | Submission has been amended | No |
2015-10-01 | This submission is the final filing | No |
2015-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2015-10-01 | Plan is a collectively bargained plan | No |
2015-10-01 | Plan funding arrangement – Insurance | Yes |
2015-10-01 | Plan benefit arrangement – Insurance | Yes |
2014: G & G OUTFITTERS, INC. LIFE INSURANCE PLAN 2014 form 5500 responses |
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2014-10-01 | Type of plan entity | Single employer plan |
2014-10-01 | Submission has been amended | No |
2014-10-01 | This submission is the final filing | No |
2014-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2014-10-01 | Plan is a collectively bargained plan | No |
2014-10-01 | Plan funding arrangement – Insurance | Yes |
2014-10-01 | Plan benefit arrangement – Insurance | Yes |
2013: G & G OUTFITTERS, INC. LIFE INSURANCE PLAN 2013 form 5500 responses |
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2013-10-01 | Type of plan entity | Single employer plan |
2013-10-01 | Submission has been amended | No |
2013-10-01 | This submission is the final filing | No |
2013-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2013-10-01 | Plan is a collectively bargained plan | No |
2013-10-01 | Plan funding arrangement – Insurance | Yes |
2013-10-01 | Plan benefit arrangement – Insurance | Yes |
2012: G & G OUTFITTERS, INC. LIFE INSURANCE PLAN 2012 form 5500 responses |
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2012-10-01 | Type of plan entity | Single employer plan |
2012-10-01 | First time form 5500 has been submitted | Yes |
2012-10-01 | Submission has been amended | No |
2012-10-01 | This submission is the final filing | No |
2012-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2012-10-01 | Plan is a collectively bargained plan | No |
2012-10-01 | Plan funding arrangement – Insurance | Yes |
2012-10-01 | Plan benefit arrangement – Insurance | Yes |
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 925453 |
Policy instance | 2 |
Insurance contract or identification number | 925453 | Number of Individuals Covered | 84 | Insurance policy start date | 2022-10-01 | Insurance policy end date | 2023-09-30 | Total amount of commissions paid to insurance broker | USD $12,893 | Total amount of fees paid to insurance company | USD $35,387 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $737,051 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 35387 | Additional information about fees paid to insurance broker | FEES PAID | Insurance broker organization code? | 3 | Commission paid to Insurance Broker | USD $12,893 |
|
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GLUG0AJUQ |
Policy instance | 1 |
Insurance contract or identification number | GLUG0AJUQ | Number of Individuals Covered | 278 | Insurance policy start date | 2022-10-01 | Insurance policy end date | 2023-09-30 | Total amount of commissions paid to insurance broker | USD $1,099 | Total amount of fees paid to insurance company | USD $549 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $10,977 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,099 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 549 | Additional information about fees paid to insurance broker | ADMINISTRATION |
|
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GVTL0AJUQ |
Policy instance | 3 |
Insurance contract or identification number | GVTL0AJUQ | Number of Individuals Covered | 32 | Insurance policy start date | 2022-10-01 | Insurance policy end date | 2023-09-30 | Total amount of commissions paid to insurance broker | USD $2,286 | Total amount of fees paid to insurance company | USD $761 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | VOLUNTARY LIFE AND VOLUNTARY ACCIDENTAL DEATH & DISMEMBERMENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $15,229 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,286 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 761 | Additional information about fees paid to insurance broker | ADMINISTRATION |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GUPROAJUQ |
Policy instance | 4 |
Insurance contract or identification number | GUPROAJUQ | Number of Individuals Covered | 40 | Insurance policy start date | 2022-10-01 | Insurance policy end date | 2023-09-30 | Total amount of commissions paid to insurance broker | USD $4,289 | Total amount of fees paid to insurance company | USD $2,289 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | VOLUNTARY LONG TERM DISABILITY | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $45,773 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,289 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 2289 | Additional information about fees paid to insurance broker | ADMINISTRATION |
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PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
Policy contract number | 1131399 |
Policy instance | 5 |
Insurance contract or identification number | 1131399 | Number of Individuals Covered | 153 | Insurance policy start date | 2022-10-01 | Insurance policy end date | 2023-09-30 | Total amount of commissions paid to insurance broker | USD $4,848 | Total amount of fees paid to insurance company | USD $1,064 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $53,202 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,188 | Amount paid for insurance broker fees | 1064 | Additional information about fees paid to insurance broker | SERVICE FEE | Insurance broker organization code? | 3 |
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PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
Policy contract number | 1131399 |
Policy instance | 5 |
Insurance contract or identification number | 1131399 | Number of Individuals Covered | 150 | Insurance policy start date | 2021-10-01 | Insurance policy end date | 2022-09-30 | Total amount of commissions paid to insurance broker | USD $5,330 | Total amount of fees paid to insurance company | USD $1,168 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $58,386 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,411 | Amount paid for insurance broker fees | 1168 | Additional information about fees paid to insurance broker | SERVICE FEE | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GLUG0AJUQ |
Policy instance | 1 |
Insurance contract or identification number | GLUG0AJUQ | Number of Individuals Covered | 254 | Insurance policy start date | 2021-10-01 | Insurance policy end date | 2022-09-30 | Total amount of commissions paid to insurance broker | USD $939 | Total amount of fees paid to insurance company | USD $509 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $10,171 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $939 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 509 | Additional information about fees paid to insurance broker | ADMINISTRATION |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 925453 |
Policy instance | 2 |
Insurance contract or identification number | 925453 | Number of Individuals Covered | 135 | Insurance policy start date | 2021-10-01 | Insurance policy end date | 2022-09-30 | Total amount of commissions paid to insurance broker | USD $11,489 | Total amount of fees paid to insurance company | USD $29,586 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $647,740 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 29586 | Additional information about fees paid to insurance broker | FEES PAID | Insurance broker organization code? | 3 | Commission paid to Insurance Broker | USD $11,489 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GVTL0AJUQ |
Policy instance | 3 |
Insurance contract or identification number | GVTL0AJUQ | Number of Individuals Covered | 30 | Insurance policy start date | 2021-10-01 | Insurance policy end date | 2022-09-30 | Total amount of commissions paid to insurance broker | USD $1,775 | Total amount of fees paid to insurance company | USD $639 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | VOLUNTARY LIFE AND VOLUNTARY ACCIDENTAL DEATH & DISMEMBERMENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $12,772 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,775 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 639 | Additional information about fees paid to insurance broker | ADMINISTRATION |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GUPROAJUQ |
Policy instance | 4 |
Insurance contract or identification number | GUPROAJUQ | Number of Individuals Covered | 43 | Insurance policy start date | 2021-10-01 | Insurance policy end date | 2022-09-30 | Total amount of commissions paid to insurance broker | USD $4,347 | Total amount of fees paid to insurance company | USD $2,180 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | VOLUNTARY LONG TERM DISABILITY | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $43,599 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,347 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 2180 | Additional information about fees paid to insurance broker | ADMINISTRATION |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GLUG0AJUQ |
Policy instance | 1 |
Insurance contract or identification number | GLUG0AJUQ | Number of Individuals Covered | 246 | Insurance policy start date | 2020-10-01 | Insurance policy end date | 2021-09-30 | Total amount of commissions paid to insurance broker | USD $976 | Total amount of fees paid to insurance company | USD $486 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $9,722 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $976 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 327 | Additional information about fees paid to insurance broker | ADMINISTRATION |
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KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
Policy contract number | 29958 |
Policy instance | 2 |
Insurance contract or identification number | 29958 | Number of Individuals Covered | 123 | Insurance policy start date | 2020-10-01 | Insurance policy end date | 2021-09-30 | Total amount of commissions paid to insurance broker | USD $36,426 | Total amount of fees paid to insurance company | USD $10,842 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $432,184 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $28,934 | Amount paid for insurance broker fees | 10814 | Additional information about fees paid to insurance broker | BONUS & VALUE OF NON-MONETARY COMP | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GVTL0AJUQ |
Policy instance | 3 |
Insurance contract or identification number | GVTL0AJUQ | Number of Individuals Covered | 24 | Insurance policy start date | 2020-10-01 | Insurance policy end date | 2021-09-30 | Total amount of commissions paid to insurance broker | USD $1,698 | Total amount of fees paid to insurance company | USD $566 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | VOLUNTARY LIFE AND VOLUNTARY ACCIDENTAL DEATH & DISMEMBERMENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $11,315 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,698 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 379 | Additional information about fees paid to insurance broker | ADMINISTRATION |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GUPROAJUQ |
Policy instance | 4 |
Insurance contract or identification number | GUPROAJUQ | Number of Individuals Covered | 40 | Insurance policy start date | 2020-10-01 | Insurance policy end date | 2021-09-30 | Total amount of commissions paid to insurance broker | USD $4,525 | Total amount of fees paid to insurance company | USD $2,250 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | VOLUNTARY LONG TERM DISABILITY | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $45,011 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,525 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 1489 | Additional information about fees paid to insurance broker | ADMINISTRATION |
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PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
Policy contract number | 1131399 |
Policy instance | 5 |
Insurance contract or identification number | 1131399 | Number of Individuals Covered | 146 | Insurance policy start date | 2020-10-01 | Insurance policy end date | 2021-09-30 | Total amount of commissions paid to insurance broker | USD $4,311 | Total amount of fees paid to insurance company | USD $946 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $47,300 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,946 | Amount paid for insurance broker fees | 946 | Additional information about fees paid to insurance broker | SERVICE FEE | Insurance broker organization code? | 3 |
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THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00530850 |
Policy instance | 5 |
Insurance contract or identification number | 00530850 | Number of Individuals Covered | 73 | Insurance policy start date | 2019-10-01 | Insurance policy end date | 2020-09-30 | Total amount of commissions paid to insurance broker | USD $6,655 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $64,637 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,423 | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GUPROAJUQ |
Policy instance | 4 |
Insurance contract or identification number | GUPROAJUQ | Number of Individuals Covered | 42 | Insurance policy start date | 2019-10-01 | Insurance policy end date | 2020-09-30 | Total amount of commissions paid to insurance broker | USD $4,664 | Total amount of fees paid to insurance company | USD $2,408 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | VOLUNTARY LONG-TERM DISABILITY | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $48,153 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,664 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 2408 | Additional information about fees paid to insurance broker | ADMINISTRATION |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GVTL0AJUQ |
Policy instance | 3 |
Insurance contract or identification number | GVTL0AJUQ | Number of Individuals Covered | 26 | Insurance policy start date | 2019-10-01 | Insurance policy end date | 2020-09-30 | Total amount of commissions paid to insurance broker | USD $1,862 | Total amount of fees paid to insurance company | USD $620 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | VOLUNTARY LIFE & AD&D | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $12,406 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 620 | Additional information about fees paid to insurance broker | AMINISTRATION | Insurance broker organization code? | 5 | Commission paid to Insurance Broker | USD $1,862 |
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GHMSI (National Association of Insurance Commissioners NAIC id number: 53007 ) |
Policy contract number | 1RDT |
Policy instance | 2 |
Insurance contract or identification number | 1RDT | Number of Individuals Covered | 231 | Insurance policy start date | 2019-10-01 | Insurance policy end date | 2020-09-30 | Total amount of commissions paid to insurance broker | USD $288 | Total amount of fees paid to insurance company | USD $44,100 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $671,431 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $288 | Amount paid for insurance broker fees | 33025 | Additional information about fees paid to insurance broker | FEES | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GLUG0AJUQ |
Policy instance | 1 |
Insurance contract or identification number | GLUG0AJUQ | Number of Individuals Covered | 269 | Insurance policy start date | 2019-10-01 | Insurance policy end date | 2020-09-30 | Total amount of commissions paid to insurance broker | USD $1,099 | Total amount of fees paid to insurance company | USD $547 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $10,951 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,099 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 547 | Additional information about fees paid to insurance broker | ADMINISTRATION |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GLUG0AJUQ |
Policy instance | 1 |
Insurance contract or identification number | GLUG0AJUQ | Number of Individuals Covered | 279 | Insurance policy start date | 2018-10-01 | Insurance policy end date | 2019-09-30 | Total amount of commissions paid to insurance broker | USD $1,030 | Total amount of fees paid to insurance company | USD $512 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $10,240 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,030 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 512 | Additional information about fees paid to insurance broker | ADMINISTRATION |
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CAREFIRST BLUECHOICE (National Association of Insurance Commissioners NAIC id number: 96202 ) |
Policy contract number | 1RDT |
Policy instance | 2 |
Insurance contract or identification number | 1RDT | Number of Individuals Covered | 280 | Insurance policy start date | 2018-10-01 | Insurance policy end date | 2019-09-30 | Total amount of commissions paid to insurance broker | USD $28,091 | Total amount of fees paid to insurance company | USD $9,272 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $702,223 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $28,091 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 9272 | Additional information about fees paid to insurance broker | GP/FSP/HDA FEE |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GVTL0AJUQ |
Policy instance | 3 |
Insurance contract or identification number | GVTL0AJUQ | Number of Individuals Covered | 32 | Insurance policy start date | 2018-10-01 | Insurance policy end date | 2019-09-30 | Total amount of commissions paid to insurance broker | USD $1,954 | Total amount of fees paid to insurance company | USD $651 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | VOLUNTARY LIFE & AD&D | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $13,017 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,954 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 651 | Additional information about fees paid to insurance broker | ADMINISTRATION |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GUPROAJUQ |
Policy instance | 4 |
Insurance contract or identification number | GUPROAJUQ | Number of Individuals Covered | 50 | Insurance policy start date | 2018-10-01 | Insurance policy end date | 2019-09-30 | Total amount of commissions paid to insurance broker | USD $4,875 | Total amount of fees paid to insurance company | USD $2,536 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | VOLUNTARY LONG-TERM DISABILITY | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $50,683 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,875 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 2536 | Additional information about fees paid to insurance broker | ADMINISTRATION |
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THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00530850 |
Policy instance | 5 |
Insurance contract or identification number | 00530850 | Number of Individuals Covered | 88 | Insurance policy start date | 2018-10-01 | Insurance policy end date | 2019-09-30 | Total amount of commissions paid to insurance broker | USD $4,074 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $56,836 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,842 | Insurance broker organization code? | 3 |
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DOMINIONNATIONAL DENTAL (National Association of Insurance Commissioners NAIC id number: 95657 ) |
Policy contract number | 214204 |
Policy instance | 6 |
Insurance contract or identification number | 214204 | Number of Individuals Covered | 23 | Insurance policy start date | 2018-10-01 | Insurance policy end date | 2019-09-30 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $5,565 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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DOMINIONNATIONAL DENTAL (National Association of Insurance Commissioners NAIC id number: 95657 ) |
Policy contract number | 214204 |
Policy instance | 6 |
Insurance contract or identification number | 214204 | Number of Individuals Covered | 26 | Insurance policy start date | 2017-10-01 | Insurance policy end date | 2018-09-30 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $5,691 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00530850 |
Policy instance | 5 |
Insurance contract or identification number | 00530850 | Number of Individuals Covered | 87 | Insurance policy start date | 2017-10-01 | Insurance policy end date | 2018-09-30 | Total amount of commissions paid to insurance broker | USD $3,517 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $50,255 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GUPROAJUQ |
Policy instance | 4 |
Insurance contract or identification number | GUPROAJUQ | Number of Individuals Covered | 53 | Insurance policy start date | 2017-10-01 | Insurance policy end date | 2018-09-30 | Total amount of commissions paid to insurance broker | USD $4,591 | Total amount of fees paid to insurance company | USD $2,315 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | VOLUNTARY LONG-TERM DISABILITY | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $46,295 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GVTL0AJUQ |
Policy instance | 3 |
Insurance contract or identification number | GVTL0AJUQ | Number of Individuals Covered | 29 | Insurance policy start date | 2017-10-01 | Insurance policy end date | 2018-09-30 | Total amount of commissions paid to insurance broker | USD $1,985 | Total amount of fees paid to insurance company | USD $661 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | VOLUNTARY LIFE & AD&D | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $13,222 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GLUG0AJUQ |
Policy instance | 1 |
Insurance contract or identification number | GLUG0AJUQ | Number of Individuals Covered | 266 | Insurance policy start date | 2017-10-01 | Insurance policy end date | 2018-09-30 | Total amount of commissions paid to insurance broker | USD $996 | Total amount of fees paid to insurance company | USD $495 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $9,900 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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CAREFIRST BLUECHOICE (National Association of Insurance Commissioners NAIC id number: 96202 ) |
Policy contract number | 1RDT |
Policy instance | 2 |
Insurance contract or identification number | 1RDT | Number of Individuals Covered | 157 | Insurance policy start date | 2017-10-01 | Insurance policy end date | 2018-09-30 | Total amount of commissions paid to insurance broker | USD $27,574 | Total amount of fees paid to insurance company | USD $16,715 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $677,219 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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