LANDMARK AUTOMOTIVE GROUP, LLC has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan LANDMARK AUTOMOTIVE GROUP, LLC WELFARE BENEFIT PLAN
401k plan membership statisitcs for LANDMARK AUTOMOTIVE GROUP, LLC WELFARE BENEFIT PLAN
| Measure | Date | Value |
|---|
| 2023: LANDMARK AUTOMOTIVE GROUP, LLC WELFARE BENEFIT PLAN 2023 401k membership |
|---|
| Total participants, beginning-of-year | 2023-01-01 | 191 |
| Total number of active participants reported on line 7a of the Form 5500 | 2023-01-01 | 195 |
| Number of retired or separated participants receiving benefits | 2023-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2023-01-01 | 0 |
| Total of all active and inactive participants | 2023-01-01 | 195 |
| Number of employers contributing to the scheme | 2023-01-01 | 0 |
| 2022: LANDMARK AUTOMOTIVE GROUP, LLC WELFARE BENEFIT PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 242 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 207 |
| Number of retired or separated participants receiving benefits | 2022-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2022-01-01 | 0 |
| Total of all active and inactive participants | 2022-01-01 | 207 |
| Number of employers contributing to the scheme | 2022-01-01 | 0 |
| 2021: LANDMARK AUTOMOTIVE GROUP, LLC WELFARE BENEFIT PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 242 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 227 |
| Number of retired or separated participants receiving benefits | 2021-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-01-01 | 0 |
| Total of all active and inactive participants | 2021-01-01 | 227 |
| Number of employers contributing to the scheme | 2021-01-01 | 0 |
| 2020: LANDMARK AUTOMOTIVE GROUP, LLC WELFARE BENEFIT PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 275 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 275 |
| Number of retired or separated participants receiving benefits | 2020-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2020-01-01 | 0 |
| Total of all active and inactive participants | 2020-01-01 | 275 |
| Number of employers contributing to the scheme | 2020-01-01 | 0 |
| 2019: LANDMARK AUTOMOTIVE GROUP, LLC WELFARE BENEFIT PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 169 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 190 |
| Number of retired or separated participants receiving benefits | 2019-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-01-01 | 0 |
| Total of all active and inactive participants | 2019-01-01 | 190 |
| Number of employers contributing to the scheme | 2019-01-01 | 0 |
| 2018: LANDMARK AUTOMOTIVE GROUP, LLC WELFARE BENEFIT PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 230 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 243 |
| Number of retired or separated participants receiving benefits | 2018-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-01-01 | 0 |
| Total of all active and inactive participants | 2018-01-01 | 243 |
| Number of employers contributing to the scheme | 2018-01-01 | 0 |
| 2017: LANDMARK AUTOMOTIVE GROUP, LLC WELFARE BENEFIT PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 276 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 230 |
| Number of retired or separated participants receiving benefits | 2017-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-01-01 | 0 |
| Total of all active and inactive participants | 2017-01-01 | 230 |
| 2016: LANDMARK AUTOMOTIVE GROUP, LLC WELFARE BENEFIT PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 266 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 276 |
| Total of all active and inactive participants | 2016-01-01 | 276 |
| Total participants | 2016-01-01 | 276 |
| 2015: LANDMARK AUTOMOTIVE GROUP, LLC WELFARE BENEFIT PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 255 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 266 |
| Total of all active and inactive participants | 2015-01-01 | 266 |
| Total participants | 2015-01-01 | 0 |
| 2014: LANDMARK AUTOMOTIVE GROUP, LLC WELFARE BENEFIT PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 137 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 255 |
| Total of all active and inactive participants | 2014-01-01 | 255 |
| Total participants | 2014-01-01 | 0 |
| 2013: LANDMARK AUTOMOTIVE GROUP, LLC WELFARE BENEFIT PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 139 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 137 |
| Total of all active and inactive participants | 2013-01-01 | 137 |
| Total participants | 2013-01-01 | 0 |
| 2012: LANDMARK AUTOMOTIVE GROUP, LLC WELFARE BENEFIT PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 139 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 88 |
| Total of all active and inactive participants | 2012-01-01 | 88 |
| Total participants | 2012-01-01 | 0 |
| 2011: LANDMARK AUTOMOTIVE GROUP, LLC WELFARE BENEFIT PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-01-01 | 128 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 139 |
| Total of all active and inactive participants | 2011-01-01 | 139 |
| Total participants | 2011-01-01 | 139 |
| 2010: LANDMARK AUTOMOTIVE GROUP, LLC WELFARE BENEFIT PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-01-01 | 100 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-01-01 | 128 |
| Total of all active and inactive participants | 2010-01-01 | 128 |
| Total participants | 2010-01-01 | 128 |
| 2009: LANDMARK AUTOMOTIVE GROUP, LLC WELFARE BENEFIT PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-01-01 | 115 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 100 |
| Total of all active and inactive participants | 2009-01-01 | 100 |
| Total participants | 2009-01-01 | 100 |
| AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 ) |
| Policy contract number | 69411 |
| Policy instance | 4 |
| Insurance contract or identification number | 69411 | | Number of Individuals Covered | 72 | | Insurance policy start date | 2022-11-01 | | Insurance policy end date | 2023-10-31 | | Total amount of commissions paid to insurance broker | USD $16,193 | | Total amount of fees paid to insurance company | USD $0 | | 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 | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENT, HOSPITAL, CANCER | | Welfare Benefit Premiums Paid to Carrier | USD $207,155 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC. (National Association of Insurance Commissioners NAIC id number: 95519 ) |
| Policy contract number | 403722 |
| Policy instance | 3 |
| Insurance contract or identification number | 403722 | | Number of Individuals Covered | 63 | | Insurance policy start date | 2022-11-01 | | Insurance policy end date | 2023-10-31 | | Total amount of commissions paid to insurance broker | USD $53,434 | | Total amount of fees paid to insurance company | USD $8,000 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,074,510 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| GREATER GEORGIA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97217 ) |
| Policy contract number | GB0517 |
| Policy instance | 2 |
| Insurance contract or identification number | GB0517 | | Number of Individuals Covered | 74 | | Insurance policy start date | 2022-11-01 | | Insurance policy end date | 2023-10-31 | | Total amount of commissions paid to insurance broker | USD $2,098 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $13,362 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 ) |
| Policy contract number | 403722 |
| Policy instance | 1 |
| Insurance contract or identification number | 403722 | | Number of Individuals Covered | 169 | | Insurance policy start date | 2022-11-01 | | Insurance policy end date | 2023-10-31 | | Total amount of commissions paid to insurance broker | USD $12,300 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $119,016 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 ) |
| Policy contract number | GB0517 |
| Policy instance | 1 |
| Insurance contract or identification number | GB0517 | | Number of Individuals Covered | 263 | | Insurance policy start date | 2021-11-01 | | Insurance policy end date | 2022-10-31 | | Total amount of commissions paid to insurance broker | USD $65,983 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,381,227 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $65,983 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| GREATER GEORGIA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97217 ) |
| Policy contract number | GB0517 |
| Policy instance | 2 |
| Insurance contract or identification number | GB0517 | | Number of Individuals Covered | 176 | | Insurance policy start date | 2021-11-01 | | Insurance policy end date | 2022-10-31 | | Total amount of commissions paid to insurance broker | USD $3,389 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $26,507 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,389 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 ) |
| Policy contract number | 69411 |
| Policy instance | 3 |
| Insurance contract or identification number | 69411 | | Number of Individuals Covered | 79 | | Insurance policy start date | 2021-11-01 | | Insurance policy end date | 2022-10-31 | | Total amount of commissions paid to insurance broker | USD $15,154 | | Total amount of fees paid to insurance company | USD $0 | | 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 | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENT, HOSPITAL, CANCER | | Welfare Benefit Premiums Paid to Carrier | USD $194,206 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $15,154 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 ) |
| Policy contract number | 69411 |
| Policy instance | 3 |
| Insurance contract or identification number | 69411 | | Number of Individuals Covered | 86 | | Insurance policy start date | 2020-11-01 | | Insurance policy end date | 2021-10-31 | | Total amount of commissions paid to insurance broker | USD $16,993 | | Total amount of fees paid to insurance company | USD $0 | | 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 | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENT, HOSPITAL, CANCER | | Welfare Benefit Premiums Paid to Carrier | USD $217,202 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $16,993 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| GREATER GEORGIA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97217 ) |
| Policy contract number | GB0517 |
| Policy instance | 2 |
| Insurance contract or identification number | GB0517 | | Number of Individuals Covered | 212 | | Insurance policy start date | 2020-11-01 | | Insurance policy end date | 2021-10-31 | | Total amount of commissions paid to insurance broker | USD $3,719 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $26,596 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,719 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 ) |
| Policy contract number | GB0517 |
| Policy instance | 1 |
| Insurance contract or identification number | GB0517 | | Number of Individuals Covered | 285 | | Insurance policy start date | 2020-11-01 | | Insurance policy end date | 2021-10-31 | | Total amount of commissions paid to insurance broker | USD $71,915 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,376,035 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $71,915 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 ) |
| Policy contract number | GB0517 |
| Policy instance | 1 |
| Insurance contract or identification number | GB0517 | | Number of Individuals Covered | 298 | | Insurance policy start date | 2019-11-01 | | Insurance policy end date | 2020-10-31 | | Total amount of commissions paid to insurance broker | USD $72,352 | | Total amount of fees paid to insurance company | USD $2,030 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,409,516 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $72,352 | | Amount paid for insurance broker fees | 2030 | | Additional information about fees paid to insurance broker | FEES | | Insurance broker organization code? | 3 |
|
| GREATER GEORGIA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97217 ) |
| Policy contract number | GB0517 |
| Policy instance | 2 |
| Insurance contract or identification number | GB0517 | | Number of Individuals Covered | 225 | | Insurance policy start date | 2019-11-01 | | Insurance policy end date | 2020-10-31 | | Total amount of commissions paid to insurance broker | USD $3,313 | | Total amount of fees paid to insurance company | USD $743 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $33,697 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,313 | | Amount paid for insurance broker fees | 743 | | Additional information about fees paid to insurance broker | FEES | | Insurance broker organization code? | 3 |
|
| AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 ) |
| Policy contract number | 58386 |
| Policy instance | 3 |
| Insurance contract or identification number | 58386 | | Number of Individuals Covered | 119 | | Insurance policy start date | 2019-11-01 | | Insurance policy end date | 2020-10-31 | | Total amount of commissions paid to insurance broker | USD $16,215 | | Total amount of fees paid to insurance company | USD $0 | | 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 | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENT, HOSPITAL, CANCER | | Welfare Benefit Premiums Paid to Carrier | USD $208,443 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $16,215 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 ) |
| Policy contract number | 69411 |
| Policy instance | 3 |
| Insurance contract or identification number | 69411 | | Number of Individuals Covered | 111 | | Insurance policy start date | 2018-11-01 | | Insurance policy end date | 2019-10-31 | | Total amount of commissions paid to insurance broker | USD $14,786 | | Total amount of fees paid to insurance company | USD $0 | | 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 | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENT, HOSPITAL, CANCER | | Welfare Benefit Premiums Paid to Carrier | USD $185,239 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $14,786 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC. (National Association of Insurance Commissioners NAIC id number: 95519 ) |
| Policy contract number | 789560 |
| Policy instance | 2 |
| Insurance contract or identification number | 789560 | | Number of Individuals Covered | 172 | | Insurance policy start date | 2018-11-01 | | Insurance policy end date | 2019-10-31 | | Total amount of commissions paid to insurance broker | USD $67,800 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,355,990 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $67,800 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 543629 |
| Policy instance | 1 |
| Insurance contract or identification number | 543629 | | Number of Individuals Covered | 238 | | Insurance policy start date | 2018-11-01 | | Insurance policy end date | 2019-10-31 | | Total amount of commissions paid to insurance broker | USD $13,430 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $129,097 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,430 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC. (National Association of Insurance Commissioners NAIC id number: 95519 ) |
| Policy contract number | 789560 |
| Policy instance | 2 |
| Insurance contract or identification number | 789560 | | Number of Individuals Covered | 95 | | Insurance policy start date | 2017-11-01 | | Insurance policy end date | 2018-10-31 | | Total amount of commissions paid to insurance broker | USD $65,374 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,309,367 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $65,374 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 ) |
| Policy contract number | 69411 |
| Policy instance | 3 |
| Insurance contract or identification number | 69411 | | Number of Individuals Covered | 99 | | Insurance policy start date | 2017-11-01 | | Insurance policy end date | 2018-10-31 | | Total amount of commissions paid to insurance broker | USD $14,487 | | Total amount of fees paid to insurance company | USD $0 | | 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 | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENT, HOSPITAL, CANCER | | Welfare Benefit Premiums Paid to Carrier | USD $181,831 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $14,487 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 543629 |
| Policy instance | 1 |
| Insurance contract or identification number | 543629 | | Number of Individuals Covered | 243 | | Insurance policy start date | 2017-11-01 | | Insurance policy end date | 2018-10-31 | | Total amount of commissions paid to insurance broker | USD $12,678 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $121,527 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $12,678 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 ) |
| Policy contract number | ACCIDENT ONLY |
| Policy instance | 1 |
| Insurance contract or identification number | ACCIDENT ONLY | | Number of Individuals Covered | 30 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $1,373 | | Welfare Benefit Premiums Paid to Carrier | USD $6,144 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $940 | | Insurance broker organization code? | 3 | | Insurance broker name | AMERICAN FIDELITY ASSURANCE COMPANY |
|
| AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 ) |
| Policy contract number | CANCER |
| Policy instance | 2 |
| Insurance contract or identification number | CANCER | | Number of Individuals Covered | 22 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $811 | | Welfare Benefit Premiums Paid to Carrier | USD $3,996 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $491 | | Insurance broker organization code? | 3 | | Insurance broker name | AMERICAN FIDELITY ASSURANCE COMPANY |
|
| AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 ) |
| Policy contract number | INDIVIDUAL HI |
| Policy instance | 3 |
| Insurance contract or identification number | INDIVIDUAL HI | | Number of Individuals Covered | 1 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $29 | | Welfare Benefit Premiums Paid to Carrier | USD $367 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $29 | | Insurance broker organization code? | 3 | | Insurance broker name | GADA SERVICES INC DBA GADA INS SERV |
|
| AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 ) |
| Policy contract number | LTD |
| Policy instance | 4 |
| Insurance contract or identification number | LTD | | Number of Individuals Covered | 101 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $14,352 | | Welfare Benefit Premiums Paid to Carrier | USD $93,666 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,493 | | Insurance broker organization code? | 3 | | Insurance broker name | AMERICAN FIDELITY ASSURANCE COMPANY |
|
| AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 ) |
| Policy contract number | STD |
| Policy instance | 6 |
| Insurance contract or identification number | STD | | Number of Individuals Covered | 3 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $349 | | Welfare Benefit Premiums Paid to Carrier | USD $2,044 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $186 | | Insurance broker organization code? | 3 | | Insurance broker name | AMERICAN FIDELITY ASSURANCE COMPANY |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00543629 |
| Policy instance | 7 |
| Insurance contract or identification number | 00543629 | | Number of Individuals Covered | 230 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $2,078 | | Welfare Benefit Premiums Paid to Carrier | USD $19,877 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,078 | | Insurance broker organization code? | 3 | | Insurance broker name | GADA SERVICES INC DBA GADA INS SERV |
|
| BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 ) |
| Policy contract number | GA9214 |
| Policy instance | 8 |
| Insurance contract or identification number | GA9214 | | Number of Individuals Covered | 179 | | Insurance policy start date | 2016-11-01 | | Insurance policy end date | 2017-10-31 | | Total amount of commissions paid to insurance broker | USD $62,150 | | Welfare Benefit Premiums Paid to Carrier | USD $1,322,724 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $62,150 | | Insurance broker organization code? | 3 | | Insurance broker name | GADA SERVICES INC DBA GADA INS SERV |
|
| AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 ) |
| Policy contract number | MEDICAL INDIV |
| Policy instance | 5 |
| Insurance contract or identification number | MEDICAL INDIV | | Number of Individuals Covered | 2 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $780 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 ) |
| Policy contract number | AD&D |
| Policy instance | 9 |
| Insurance contract or identification number | AD&D | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $42 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 | | Insurance broker name | AMERICAN FIDELITY ASSURANCE COMPANY |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 00001D029106 |
| Policy instance | 10 |
| Insurance contract or identification number | 00001D029106 | | Number of Individuals Covered | 157 | | Insurance policy start date | 2014-11-01 | | Insurance policy end date | 2015-10-31 | | Total amount of commissions paid to insurance broker | USD $10,198 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $101,978 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,198 | | Insurance broker organization code? | 3 | | Insurance broker name | GADA SERVICES |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010197089 |
| Policy instance | 11 |
| Insurance contract or identification number | 000010197089 | | Number of Individuals Covered | 224 | | Insurance policy start date | 2014-11-01 | | Insurance policy end date | 2015-10-31 | | Total amount of commissions paid to insurance broker | USD $2,022 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $13,482 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,022 | | Insurance broker organization code? | 3 | | Insurance broker name | GADA SERVICES |
|
| AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 ) |
| Policy contract number | ACCIDENT ONLY |
| Policy instance | 12 |
| Insurance contract or identification number | ACCIDENT ONLY | | Number of Individuals Covered | 6 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $125 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,881 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $138 | | Insurance broker organization code? | 3 | | Insurance broker name | AMERICAN FIDELITY ASSURANCE COMPANY |
|
| AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 ) |
| Policy contract number | CANCER |
| Policy instance | 13 |
| Insurance contract or identification number | CANCER | | Number of Individuals Covered | 10 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $118 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,792 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $143 | | Insurance broker organization code? | 3 | | Insurance broker name | AMERICAN FIDELITY ASSURANCE COMPANY |
|
| AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 ) |
| Policy contract number | LTD |
| Policy instance | 14 |
| Insurance contract or identification number | LTD | | Number of Individuals Covered | 26 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $2,079 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $16,763 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,341 | | Insurance broker organization code? | 3 | | Insurance broker name | AMERICAN FIDELITY ASSURANCE COMPANY |
|
| AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 ) |
| Policy contract number | STD |
| Policy instance | 15 |
| Insurance contract or identification number | STD | | Number of Individuals Covered | 2 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $53 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,349 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $107 | | Insurance broker organization code? | 3 | | Insurance broker name | AMERICAN FIDELITY ASSURANCE COMPANY |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TM05931467 |
| Policy instance | 16 |
| Insurance contract or identification number | TM05931467 | | Number of Individuals Covered | 533 | | Insurance policy start date | 2015-11-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $1,207 | | Total amount of fees paid to insurance company | USD $723 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $25,659 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,207 | | Amount paid for insurance broker fees | 723 | | Insurance broker organization code? | 3 | | Insurance broker name | GADA SERVICES |
|
| COVENTRY HEALTH CARE OF GEORGIA (National Association of Insurance Commissioners NAIC id number: 95282 ) |
| Policy contract number | 6540560000 |
| Policy instance | 8 |
| Insurance contract or identification number | 6540560000 | | Number of Individuals Covered | 266 | | Insurance policy start date | 2014-11-01 | | Insurance policy end date | 2015-10-31 | | Total amount of commissions paid to insurance broker | USD $51,034 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,020,685 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $51,034 | | Insurance broker organization code? | 3 | | Insurance broker name | GADA SERVICES |
|
| AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 ) |
| Policy contract number | MEDICAL INDIV |
| Policy instance | 7 |
| Insurance contract or identification number | MEDICAL INDIV | | Number of Individuals Covered | 2 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $77 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $547 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $77 | | Insurance broker organization code? | 3 | | Insurance broker name | GADA SERVICES |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 ) |
| Policy contract number | 300052453 |
| Policy instance | 6 |
| Insurance contract or identification number | 300052453 | | Number of Individuals Covered | 126 | | Insurance policy start date | 2014-11-01 | | Insurance policy end date | 2015-10-31 | | Total amount of commissions paid to insurance broker | USD $1,541 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $15,406 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,541 | | Insurance broker organization code? | 3 | | Insurance broker name | GADA SERVICES |
|
| AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 ) |
| Policy contract number | ACCIDENT ONLY |
| Policy instance | 1 |
| Insurance contract or identification number | ACCIDENT ONLY | | Number of Individuals Covered | 26 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $1,134 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,231 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $796 | | Insurance broker organization code? | 3 | | Insurance broker name | GADA SERVICES |
|
| AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 ) |
| Policy contract number | CANCER |
| Policy instance | 2 |
| Insurance contract or identification number | CANCER | | Number of Individuals Covered | 24 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $780 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,223 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $522 | | Insurance broker organization code? | 3 | | Insurance broker name | GADA SERVICES |
|
| AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 ) |
| Policy contract number | LTD |
| Policy instance | 3 |
| Insurance contract or identification number | LTD | | Number of Individuals Covered | 110 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $15,434 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $70,259 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,813 | | Insurance broker organization code? | 3 | | Insurance broker name | GADA SERVICES |
|
| AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 ) |
| Policy contract number | STD |
| Policy instance | 4 |
| Insurance contract or identification number | STD | | Number of Individuals Covered | 4 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $242 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,408 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $193 | | Insurance broker organization code? | 3 | | Insurance broker name | AMERICAN FIDELITY ASSURANCE COMPANY |
|
| AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 ) |
| Policy contract number | INDIVIDUAL HI |
| Policy instance | 5 |
| Insurance contract or identification number | INDIVIDUAL HI | | Number of Individuals Covered | 1 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $27 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $27 | | Insurance broker organization code? | 3 | | Insurance broker name | GADA SERVICES |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 00001D029106 |
| Policy instance | 10 |
| Insurance contract or identification number | 00001D029106 | | Number of Individuals Covered | 150 | | Insurance policy start date | 2014-11-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $1,693 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $16,933 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,693 | | Insurance broker organization code? | 3 | | Insurance broker name | GADA SERVICES |
|
| AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 ) |
| Policy contract number | AD&D |
| Policy instance | 9 |
| Insurance contract or identification number | AD&D | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $17 | | Welfare Benefit Premiums Paid to Carrier | USD $12 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $17 | | Insurance broker organization code? | 3 | | Insurance broker name | AMERICAN FIDELITY ASSURANCE COMPANY |
|
| COVENTRY HEALTH CARE OF GEORGIA (National Association of Insurance Commissioners NAIC id number: 95282 ) |
| Policy contract number | 6540560000 |
| Policy instance | 8 |
| Insurance contract or identification number | 6540560000 | | Number of Individuals Covered | 255 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $44,751 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $895,025 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $44,751 | | Insurance broker organization code? | 3 | | Insurance broker name | GADA SERVICES |
|
| AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 ) |
| Policy contract number | MEDICAL INDIV |
| Policy instance | 7 |
| Insurance contract or identification number | MEDICAL INDIV | | Number of Individuals Covered | 2 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $23 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,367 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $23 | | Insurance broker organization code? | 3 | | Insurance broker name | AMERICAN FIDELITY ASSURANCE COMPANY |
|
| AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 ) |
| Policy contract number | INDIVIDUAL HI |
| Policy instance | 5 |
| Insurance contract or identification number | INDIVIDUAL HI | | Number of Individuals Covered | 1 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $29 | | Welfare Benefit Premiums Paid to Carrier | USD $367 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $29 | | Insurance broker organization code? | 3 | | Insurance broker name | GADA SERVICES |
|
| AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 ) |
| Policy contract number | STD |
| Policy instance | 4 |
| Insurance contract or identification number | STD | | Number of Individuals Covered | 4 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $143 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,794 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $143 | | Insurance broker organization code? | 3 | | Insurance broker name | GADA SERVICES |
|
| AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 ) |
| Policy contract number | CANCER |
| Policy instance | 2 |
| Insurance contract or identification number | CANCER | | Number of Individuals Covered | 14 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $368 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,184 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $255 | | Insurance broker organization code? | 3 | | Insurance broker name | AMERICAN FIDELITY ASSURANCE COMPANY |
|
| AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 ) |
| Policy contract number | ACCIDENT ONLY |
| Policy instance | 1 |
| Insurance contract or identification number | ACCIDENT ONLY | | Number of Individuals Covered | 21 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $543 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,392 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $351 | | Insurance broker organization code? | 3 | | Insurance broker name | AMERICAN FIDELITY ASSURANCE COMPANY |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 ) |
| Policy contract number | 30005134 |
| Policy instance | 6 |
| Insurance contract or identification number | 30005134 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-11-30 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 | | Insurance broker name | GADA SERVICES |
|
| AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 ) |
| Policy contract number | LTD |
| Policy instance | 3 |
| Insurance contract or identification number | LTD | | Number of Individuals Covered | 73 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $8,327 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $70,712 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,657 | | Insurance broker organization code? | 3 | | Insurance broker name | AMERICAN FIDELITY ASSURANCE COMPANY |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000400001000 |
| Policy instance | 12 |
| Insurance contract or identification number | 000400001000 | | Number of Individuals Covered | 89 | | Insurance policy start date | 2014-11-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $550 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,669 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $550 | | Insurance broker organization code? | 3 | | Insurance broker name | GADA SERVICES |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010197089 |
| Policy instance | 11 |
| Insurance contract or identification number | 000010197089 | | Number of Individuals Covered | 200 | | Insurance policy start date | 2014-11-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $331 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,209 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $331 | | Insurance broker organization code? | 3 | | Insurance broker name | GADA SERVICES |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000403005010 |
| Policy instance | 13 |
| Insurance contract or identification number | 000403005010 | | Number of Individuals Covered | 90 | | Insurance policy start date | 2014-11-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $40 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $267 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $40 | | Insurance broker organization code? | 3 | | Insurance broker name | GADA SERVICES |
|
| AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 ) |
| Policy contract number | MEDICAL INDIV |
| Policy instance | 7 |
| Insurance contract or identification number | MEDICAL INDIV | | Number of Individuals Covered | 4 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $156 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,133 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $91 | | Insurance broker organization code? | 3 | | Insurance broker name | AMERICAN FIDELITY ASSURANCE COMPANY |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 ) |
| Policy contract number | 30005134 |
| Policy instance | 6 |
| Insurance contract or identification number | 30005134 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-11-30 | | Total amount of commissions paid to insurance broker | USD $701 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $12,956 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $701 | | Insurance broker organization code? | 3 | | Insurance broker name | GADA SERVICES |
|
| AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 ) |
| Policy contract number | INDIVIDUAL HI |
| Policy instance | 5 |
| Insurance contract or identification number | INDIVIDUAL HI | | Number of Individuals Covered | 1 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $24 | | Welfare Benefit Premiums Paid to Carrier | USD $301 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $24 | | Insurance broker organization code? | 3 | | Insurance broker name | GADA SERVICES |
|
| AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 ) |
| Policy contract number | LTD |
| Policy instance | 3 |
| Insurance contract or identification number | LTD | | Number of Individuals Covered | 74 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $8,528 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $59,051 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,724 | | Insurance broker organization code? | 3 | | Insurance broker name | AMERICAN FIDELITY ASSURANCE COMPANY |
|
| AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 ) |
| Policy contract number | CANCER |
| Policy instance | 2 |
| Insurance contract or identification number | CANCER | | Number of Individuals Covered | 17 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $377 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,384 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $271 | | Insurance broker organization code? | 3 | | Insurance broker name | AMERICAN FIDELITY ASSURANCE COMPANY |
|
| AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 ) |
| Policy contract number | ACCIDENT ONLY |
| Policy instance | 1 |
| Insurance contract or identification number | ACCIDENT ONLY | | Number of Individuals Covered | 19 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $591 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,338 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $346 | | Insurance broker organization code? | 3 | | Insurance broker name | AMERICAN FIDELITY ASSURANCE COMPANY |
|
| AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 ) |
| Policy contract number | STD |
| Policy instance | 4 |
| Insurance contract or identification number | STD | | Number of Individuals Covered | 3 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $111 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,393 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $111 | | Insurance broker organization code? | 3 | | Insurance broker name | GADA SERVICES |
|
| BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 ) |
| Policy contract number | GA6544 |
| Policy instance | 8 |
| Insurance contract or identification number | GA6544 | | Number of Individuals Covered | 137 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-10-31 | | Total amount of commissions paid to insurance broker | USD $46,976 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $658,903 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $46,976 | | Insurance broker organization code? | 3 | | Insurance broker name | GADA SERVICES |
|
| AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 ) |
| Policy contract number | ACCIDENT ONLY |
| Policy instance | 9 |
| Insurance contract or identification number | ACCIDENT ONLY | | Number of Individuals Covered | 19 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $417 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,700 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $417 | | Insurance broker organization code? | 3 | | Insurance broker name | GADA SERVICES |
|
| AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 ) |
| Policy contract number | CANCER |
| Policy instance | 8 |
| Insurance contract or identification number | CANCER | | Number of Individuals Covered | 15 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of fees paid to insurance company | USD $322 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,403 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 322 | | Insurance broker organization code? | 3 | | Insurance broker name | GADA SERVICES |
|
| AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 ) |
| Policy contract number | STD |
| Policy instance | 6 |
| Insurance contract or identification number | STD | | Number of Individuals Covered | 4 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $177 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,219 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $177 | | Insurance broker organization code? | 3 | | Insurance broker name | GADA SERVICES |
|
| AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 ) |
| Policy contract number | INDIVIDUAL HI |
| Policy instance | 5 |
| Insurance contract or identification number | INDIVIDUAL HI | | Number of Individuals Covered | 1 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $28 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $356 | | 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 | | Insurance broker organization code? | 3 | | Insurance broker name | GADA SERVICES |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 ) |
| Policy contract number | 30005134 |
| Policy instance | 4 |
| Insurance contract or identification number | 30005134 | | Number of Individuals Covered | 84 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $901 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $15,099 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $901 | | Insurance broker organization code? | 3 | | Insurance broker name | GADA SERVICES |
|
| AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 ) |
| Policy contract number | MEDICAL INDIV |
| Policy instance | 3 |
| Insurance contract or identification number | MEDICAL INDIV | | Number of Individuals Covered | 3 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $23 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $281 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $23 | | Insurance broker name | AMERICAN FIDELITY ASSURANCE COMPANY |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TM05760009 |
| Policy instance | 2 |
| Insurance contract or identification number | TM05760009 | | Number of Individuals Covered | 383 | | Insurance policy start date | 2011-11-01 | | Insurance policy end date | 2012-10-31 | | Total amount of commissions paid to insurance broker | USD $8,774 | | Total amount of fees paid to insurance company | USD $1,225 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $78,559 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,774 | | Amount paid for insurance broker fees | 1225 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | GADA SERVICES |
|
| AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 ) |
| Policy contract number | LTD |
| Policy instance | 7 |
| Insurance contract or identification number | LTD | | Number of Individuals Covered | 55 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $6,024 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $57,901 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,392 | | Insurance broker organization code? | 3 | | Insurance broker name | GADA SERVICES |
|
| BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 ) |
| Policy contract number | 1053220000 |
| Policy instance | 1 |
| Insurance contract or identification number | 1053220000 | | Number of Individuals Covered | 86 | | Insurance policy start date | 2011-11-01 | | Insurance policy end date | 2012-10-31 | | Total amount of commissions paid to insurance broker | USD $30,240 | | Welfare Benefit Premiums Paid to Carrier | USD $479,421 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $30,240 | | Insurance broker organization code? | 3 | | Insurance broker name | GADA SERVICES |
|
| AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 ) |
| Policy contract number | ACCIDENT ONLY |
| Policy instance | 6 |
| Insurance contract or identification number | ACCIDENT ONLY | | Number of Individuals Covered | 22 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $87 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,979 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 ) |
| Policy contract number | CANCER |
| Policy instance | 5 |
| Insurance contract or identification number | CANCER | | Number of Individuals Covered | 19 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $267 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,093 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 ) |
| Policy contract number | LTD |
| Policy instance | 4 |
| Insurance contract or identification number | LTD | | Number of Individuals Covered | 62 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $4,105 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $58,961 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF GEORGIA INC. (National Association of Insurance Commissioners NAIC id number: 96237 ) |
| Policy contract number | 5529 |
| Policy instance | 7 |
| Insurance contract or identification number | 5529 | | Insurance policy start date | 2010-11-01 | | Insurance policy end date | 2011-10-31 | | Total amount of commissions paid to insurance broker | USD $20,799 | | Total amount of fees paid to insurance company | USD $593 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $386,305 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 ) |
| Policy contract number | INDIVIDUAL HI |
| Policy instance | 2 |
| Insurance contract or identification number | INDIVIDUAL HI | | Number of Individuals Covered | 1 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $26 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $319 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 ) |
| Policy contract number | 30005134 |
| Policy instance | 1 |
| Insurance contract or identification number | 30005134 | | Number of Individuals Covered | 102 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $969 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $14,696 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 ) |
| Policy contract number | STD |
| Policy instance | 3 |
| Insurance contract or identification number | STD | | Number of Individuals Covered | 5 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $250 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,131 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 ) |
| Policy contract number | ACCIDENT ONLY |
| Policy instance | 7 |
| Insurance contract or identification number | ACCIDENT ONLY | | Number of Individuals Covered | 7 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $129 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,612 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $129 | | Insurance broker organization code? | 3 | | Insurance broker name | GADA SERVICES |
|
| AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 ) |
| Policy contract number | CANCER |
| Policy instance | 6 |
| Insurance contract or identification number | CANCER | | Number of Individuals Covered | 10 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $348 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,352 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $348 | | Insurance broker organization code? | 3 | | Insurance broker name | GADA SERVICES |
|
| AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 ) |
| Policy contract number | LTD |
| Policy instance | 5 |
| Insurance contract or identification number | LTD | | Number of Individuals Covered | 48 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $4,570 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $57,135 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,570 | | Insurance broker organization code? | 3 | | Insurance broker name | GADA SERVICES |
|
| AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 ) |
| Policy contract number | STD |
| Policy instance | 4 |
| Insurance contract or identification number | STD | | Number of Individuals Covered | 7 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $466 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,831 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $466 | | Insurance broker organization code? | 3 | | Insurance broker name | GADA SERVICES |
|
| AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 ) |
| Policy contract number | INDIVIDUAL HI |
| Policy instance | 3 |
| Insurance contract or identification number | INDIVIDUAL HI | | Number of Individuals Covered | 1 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $26 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $319 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $26 | | Insurance broker organization code? | 3 | | Insurance broker name | GADA SERVICES |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 ) |
| Policy contract number | 30005134 |
| Policy instance | 2 |
| Insurance contract or identification number | 30005134 | | Number of Individuals Covered | 70 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $815 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $12,157 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $815 | | Insurance broker organization code? | 3 | | Insurance broker name | GADA SERVICES |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TM05760009 |
| Policy instance | 1 |
| Insurance contract or identification number | TM05760009 | | Number of Individuals Covered | 201 | | Insurance policy start date | 2009-11-01 | | Insurance policy end date | 2010-10-31 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF GEORGIA INC. (National Association of Insurance Commissioners NAIC id number: 96237 ) |
| Policy contract number | 5529 |
| Policy instance | 8 |
| Insurance contract or identification number | 5529 | | Number of Individuals Covered | 128 | | Insurance policy start date | 2009-11-01 | | Insurance policy end date | 2010-10-31 | | Total amount of commissions paid to insurance broker | USD $21,379 | | Total amount of fees paid to insurance company | USD $8,112 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $421,065 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $21,379 | | Amount paid for insurance broker fees | 8112 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE SERVICES AND OTHER FEES | | Insurance broker organization code? | 3 | | Insurance broker name | GADA SERVICES |
|
