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ALTENLOH, BRINCK & CO. US, INC. 401k Plan overview

Plan NameALTENLOH, BRINCK & CO. US, INC.
Plan identification number 501

ALTENLOH, BRINCK & CO. US, INC. Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Other welfare benefit cover

401k Sponsoring company profile

ALTENLOH, BRINCK & CO. US, INC. has sponsored the creation of one or more 401k plans.

Company Name:ALTENLOH, BRINCK & CO. US, INC.
Employer identification number (EIN):203946941
NAIC Classification:332610

Additional information about ALTENLOH, BRINCK & CO. US, INC.

Jurisdiction of Incorporation: Texas Secretary of State
Incorporation Date: 2010-10-11
Company Identification Number: 0801329662
Legal Registered Office Address: 2105 COUNTY ROAD 12C

BRYAN
United States of America (USA)
43506

More information about ALTENLOH, BRINCK & CO. US, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ALTENLOH, BRINCK & CO. US, INC.

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01JASON BEALE2023-09-22 JASON BEALE2023-09-22
5012021-01-01KIP WINZLER2022-06-23 KIP WINZLER2022-06-23
5012020-01-01KIP WINZELER2021-02-09 KIP WINZELER2021-02-09
5012019-01-01KIP WINZELER2020-07-15 KIP WINZELER2020-07-15
5012018-01-01
5012017-01-01
5012016-01-01
5012015-01-01
5012014-01-01
5012013-01-01
5012012-01-01LAURIE SCHLOSSER LAURIE SCHLOSSER2013-07-12
5012011-01-01LAURIE SCHLOSSER LAURIE SCHLOSSER2012-07-27

Plan Statistics for ALTENLOH, BRINCK & CO. US, INC.

401k plan membership statisitcs for ALTENLOH, BRINCK & CO. US, INC.

Measure Date Value
2022: ALTENLOH, BRINCK & CO. US, INC. 2022 401k membership
Total participants, beginning-of-year2022-01-01300
Total number of active participants reported on line 7a of the Form 55002022-01-01294
Total of all active and inactive participants2022-01-01294
2021: ALTENLOH, BRINCK & CO. US, INC. 2021 401k membership
Total participants, beginning-of-year2021-01-01251
Total number of active participants reported on line 7a of the Form 55002021-01-01300
Total of all active and inactive participants2021-01-01300
2020: ALTENLOH, BRINCK & CO. US, INC. 2020 401k membership
Total participants, beginning-of-year2020-01-01220
Total number of active participants reported on line 7a of the Form 55002020-01-01251
Total of all active and inactive participants2020-01-01251
2019: ALTENLOH, BRINCK & CO. US, INC. 2019 401k membership
Total participants, beginning-of-year2019-01-01235
Total number of active participants reported on line 7a of the Form 55002019-01-01220
Total of all active and inactive participants2019-01-01220
2018: ALTENLOH, BRINCK & CO. US, INC. 2018 401k membership
Total participants, beginning-of-year2018-01-01243
Total number of active participants reported on line 7a of the Form 55002018-01-01235
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-01235
2017: ALTENLOH, BRINCK & CO. US, INC. 2017 401k membership
Total participants, beginning-of-year2017-01-01234
Total number of active participants reported on line 7a of the Form 55002017-01-01243
Total of all active and inactive participants2017-01-01243
2016: ALTENLOH, BRINCK & CO. US, INC. 2016 401k membership
Total participants, beginning-of-year2016-01-01224
Total number of active participants reported on line 7a of the Form 55002016-01-01234
Total of all active and inactive participants2016-01-01234
2015: ALTENLOH, BRINCK & CO. US, INC. 2015 401k membership
Total participants, beginning-of-year2015-01-01193
Total number of active participants reported on line 7a of the Form 55002015-01-01224
Total of all active and inactive participants2015-01-01224
2014: ALTENLOH, BRINCK & CO. US, INC. 2014 401k membership
Total participants, beginning-of-year2014-01-01166
Total number of active participants reported on line 7a of the Form 55002014-01-01193
Number of retired or separated participants receiving benefits2014-01-010
Total of all active and inactive participants2014-01-01193
2013: ALTENLOH, BRINCK & CO. US, INC. 2013 401k membership
Total participants, beginning-of-year2013-01-01151
Total number of active participants reported on line 7a of the Form 55002013-01-01166
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-010
Total of all active and inactive participants2013-01-01166
2012: ALTENLOH, BRINCK & CO. US, INC. 2012 401k membership
Total participants, beginning-of-year2012-01-01152
Total number of active participants reported on line 7a of the Form 55002012-01-01151
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-010
Total of all active and inactive participants2012-01-01151
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Number of participants with account balances2012-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-010
2011: ALTENLOH, BRINCK & CO. US, INC. 2011 401k membership
Total participants, beginning-of-year2011-01-01121
Total number of active participants reported on line 7a of the Form 55002011-01-01152
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-010
Total of all active and inactive participants2011-01-01152
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Number of participants with account balances2011-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-010

Form 5500 Responses for ALTENLOH, BRINCK & CO. US, INC.

2022: ALTENLOH, BRINCK & CO. US, INC. 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – InsuranceYes
2021: ALTENLOH, BRINCK & CO. US, INC. 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – InsuranceYes
2020: ALTENLOH, BRINCK & CO. US, INC. 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – InsuranceYes
2019: ALTENLOH, BRINCK & CO. US, INC. 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – InsuranceYes
2018: ALTENLOH, BRINCK & CO. US, INC. 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – InsuranceYes
2017: ALTENLOH, BRINCK & CO. US, INC. 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – InsuranceYes
2016: ALTENLOH, BRINCK & CO. US, INC. 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – InsuranceYes
2015: ALTENLOH, BRINCK & CO. US, INC. 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: ALTENLOH, BRINCK & CO. US, INC. 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: ALTENLOH, BRINCK & CO. US, INC. 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: ALTENLOH, BRINCK & CO. US, INC. 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: ALTENLOH, BRINCK & CO. US, INC. 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01First time form 5500 has been submittedYes
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number169637
Policy instance 5
Insurance contract or identification number169637
Number of Individuals Covered218
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $8,968
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Commission paid to Insurance BrokerUSD $8,968
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number169637
Policy instance 4
Insurance contract or identification number169637
Number of Individuals Covered250
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $2,217
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Commission paid to Insurance BrokerUSD $1,294
Insurance broker organization code?3
COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 )
Policy contract numberL04397
Policy instance 3
Insurance contract or identification numberL04397
Number of Individuals Covered294
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $492,710
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number169637
Policy instance 2
Insurance contract or identification number169637
Number of Individuals Covered294
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $12,812
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Commission paid to Insurance BrokerUSD $12,812
Additional information about fees paid to insurance brokerCOMMISSIONS
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number169637
Policy instance 1
Insurance contract or identification number169637
Number of Individuals Covered173
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $12,495
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Commission paid to Insurance BrokerUSD $12,495
Insurance broker organization code?3
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract numberCLI71862
Policy instance 1
Insurance contract or identification numberCLI71862
Number of Individuals Covered245
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $269,799
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00326130
Policy instance 2
Insurance contract or identification number00326130
Number of Individuals Covered300
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $29,395
Total amount of fees paid to insurance companyUSD $6,975
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedOPTIONAL LIFE
Welfare Benefit Premiums Paid to CarrierUSD $226,163
Commission paid to Insurance BrokerUSD $29,395
Amount paid for insurance broker fees6975
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?4
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00326130
Policy instance 2
Insurance contract or identification number00326130
Number of Individuals Covered251
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $24,616
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedOPTIONAL LIFE
Welfare Benefit Premiums Paid to CarrierUSD $189,442
Commission paid to Insurance BrokerUSD $24,616
Insurance broker organization code?4
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract numberCLI71862
Policy instance 1
Insurance contract or identification numberCLI71862
Number of Individuals Covered193
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $229,175
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00326130
Policy instance 2
Insurance contract or identification number00326130
Number of Individuals Covered220
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $23,840
Total amount of fees paid to insurance companyUSD $7,122
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedOPTIONAL LIFE
Welfare Benefit Premiums Paid to CarrierUSD $183,253
Commission paid to Insurance BrokerUSD $23,840
Insurance broker organization code?4
Amount paid for insurance broker fees7122
Additional information about fees paid to insurance brokerFEES PAID
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract numberCLI71862
Policy instance 1
Insurance contract or identification numberCLI71862
Number of Individuals Covered185
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $287,288
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00326130
Policy instance 2
Insurance contract or identification number00326130
Number of Individuals Covered235
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $22,338
Total amount of fees paid to insurance companyUSD $5,500
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedOPTIONAL LIFE
Welfare Benefit Premiums Paid to CarrierUSD $171,311
Commission paid to Insurance BrokerUSD $22,338
Insurance broker organization code?4
Amount paid for insurance broker fees5500
Additional information about fees paid to insurance brokerFEES PAID
HEALTHSMART BENEFIT SOLUTIONS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number0044797-01
Policy instance 1
Insurance contract or identification number0044797-01
Number of Individuals Covered235
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $49,434
Total amount of fees paid to insurance companyUSD $700
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $385,272
Commission paid to Insurance BrokerUSD $49,434
Insurance broker organization code?3
Amount paid for insurance broker fees700
Additional information about fees paid to insurance brokerPLAN DOC FEES
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00326130
Policy instance 2
Insurance contract or identification number00326130
Number of Individuals Covered224
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $14,897
Total amount of fees paid to insurance companyUSD $4,010
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedOPTIONAL LIFE
Welfare Benefit Premiums Paid to CarrierUSD $110,195
Commission paid to Insurance BrokerUSD $14,897
Insurance broker organization code?3
Amount paid for insurance broker fees4010
Additional information about fees paid to insurance brokerFEES PAID
Insurance broker nameKAMINSKY & ASSOCIATES, INC.
MEDICAL MUTUAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 29076 )
Policy contract number0044797-01
Policy instance 1
Insurance contract or identification number0044797-01
Number of Individuals Covered171
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $42,921
Total amount of fees paid to insurance companyUSD $22
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $10,222
Commission paid to Insurance BrokerUSD $42,921
Insurance broker organization code?3
Amount paid for insurance broker fees22
Additional information about fees paid to insurance brokerFEES PAID
Insurance broker nameKAMINSKY & ASSOCIATES, INC.
COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 )
Policy contract number001741935
Policy instance 1
Insurance contract or identification number001741935
Number of Individuals Covered166
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $27,808
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $897,969
Commission paid to Insurance BrokerUSD $27,808
Insurance broker organization code?3
Insurance broker nameKAMINSKY & ASSOCIATES, INC.
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00326130
Policy instance 2
Insurance contract or identification number00326130
Number of Individuals Covered193
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $13,071
Total amount of fees paid to insurance companyUSD $812
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedOPTIONAL LIFE
Welfare Benefit Premiums Paid to CarrierUSD $94,748
Commission paid to Insurance BrokerUSD $13,071
Insurance broker organization code?3
Amount paid for insurance broker fees812
Additional information about fees paid to insurance brokerFEES PAID
Insurance broker nameKAMINSKY & ASSOCIATES, INC.
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00326130
Policy instance 2
Insurance contract or identification number00326130
Number of Individuals Covered166
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $8,665
Total amount of fees paid to insurance companyUSD $2,132
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedOPTIONAL LIFE
Welfare Benefit Premiums Paid to CarrierUSD $60,448
Commission paid to Insurance BrokerUSD $4,337
Insurance broker organization code?3
Amount paid for insurance broker fees2132
Additional information about fees paid to insurance brokerFEES PAID
Insurance broker nameSAVAGE AND ASSOCIATES, INC.
COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 )
Policy contract number001741935
Policy instance 1
Insurance contract or identification number001741935
Number of Individuals Covered134
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $26,432
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $745,993
Commission paid to Insurance BrokerUSD $11,056
Insurance broker organization code?3
Insurance broker nameSAVAGE & ASSOCIATES, INC.
MEDICAL MUTUAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 29076 )
Policy contract number331349-003
Policy instance 2
Insurance contract or identification number331349-003
Number of Individuals Covered130
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $21,204
Total amount of fees paid to insurance companyUSD $4
Are there contracts with allocated funds for individual policies?No
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $7,785
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $21,204
Insurance broker organization code?3
Amount paid for insurance broker fees4
Additional information about fees paid to insurance brokerFEES PAID
Insurance broker nameSAVAGE AND ASSOCIATES
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00326130
Policy instance 1
Insurance contract or identification number00326130
Number of Individuals Covered151
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $7,969
Total amount of fees paid to insurance companyUSD $184
Are there contracts with allocated funds for individual policies?No
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedOPTIONAL LIFE
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 CarrierUSD $55,031
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,969
Insurance broker organization code?3
Amount paid for insurance broker fees184
Additional information about fees paid to insurance brokerFEES PAID
Insurance broker nameSAVAGE AND ASSOCIATES, INC.
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00326130
Policy instance 1
Insurance contract or identification number00326130
Number of Individuals Covered152
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $6,485
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $40,140
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MEDICAL MUTUAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 29076 )
Policy contract number0015317-01
Policy instance 2
Insurance contract or identification number0015317-01
Number of Individuals Covered128
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $20,620
Total amount of fees paid to insurance companyUSD $7,329
Are there contracts with allocated funds for individual policies?No
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $7,690
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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