JERGENS, INC. has sponsored the creation of one or more 401k plans.
Additional information about JERGENS, INC.
Submission information for form 5500 for 401k plan JERGENS INC LIFE AD & D INSURANCE HOSPITAL SURGICAL
401k plan membership statisitcs for JERGENS INC LIFE AD & D INSURANCE HOSPITAL SURGICAL
Measure | Date | Value |
---|
2022: JERGENS INC LIFE AD & D INSURANCE HOSPITAL SURGICAL 2022 401k membership |
---|
Total participants, beginning-of-year | 2022-01-01 | 280 |
Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 259 |
Number of retired or separated participants receiving benefits | 2022-01-01 | 47 |
Number of other retired or separated participants entitled to future benefits | 2022-01-01 | 48 |
Total of all active and inactive participants | 2022-01-01 | 354 |
Number of employers contributing to the scheme | 2022-01-01 | 0 |
2021: JERGENS INC LIFE AD & D INSURANCE HOSPITAL SURGICAL 2021 401k membership |
---|
Total participants, beginning-of-year | 2021-01-01 | 265 |
Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 279 |
Number of retired or separated participants receiving benefits | 2021-01-01 | 38 |
Number of other retired or separated participants entitled to future benefits | 2021-01-01 | 7 |
Total of all active and inactive participants | 2021-01-01 | 324 |
Number of employers contributing to the scheme | 2021-01-01 | 0 |
2020: JERGENS INC LIFE AD & D INSURANCE HOSPITAL SURGICAL 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 | 230 |
Number of retired or separated participants receiving benefits | 2020-01-01 | 31 |
Number of other retired or separated participants entitled to future benefits | 2020-01-01 | 1 |
Total of all active and inactive participants | 2020-01-01 | 262 |
Number of employers contributing to the scheme | 2020-01-01 | 0 |
2019: JERGENS INC LIFE AD & D INSURANCE HOSPITAL SURGICAL 2019 401k membership |
---|
Total participants, beginning-of-year | 2019-01-01 | 263 |
Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 240 |
Number of retired or separated participants receiving benefits | 2019-01-01 | 30 |
Number of other retired or separated participants entitled to future benefits | 2019-01-01 | 3 |
Total of all active and inactive participants | 2019-01-01 | 273 |
Number of employers contributing to the scheme | 2019-01-01 | 0 |
2018: JERGENS INC LIFE AD & D INSURANCE HOSPITAL SURGICAL 2018 401k membership |
---|
Total participants, beginning-of-year | 2018-01-01 | 239 |
Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 230 |
Number of retired or separated participants receiving benefits | 2018-01-01 | 36 |
Number of other retired or separated participants entitled to future benefits | 2018-01-01 | 8 |
Total of all active and inactive participants | 2018-01-01 | 274 |
Number of employers contributing to the scheme | 2018-01-01 | 0 |
2017: JERGENS INC LIFE AD & D INSURANCE HOSPITAL SURGICAL 2017 401k membership |
---|
Total participants, beginning-of-year | 2017-01-01 | 203 |
Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 206 |
Number of retired or separated participants receiving benefits | 2017-01-01 | 1 |
Total of all active and inactive participants | 2017-01-01 | 207 |
Number of other retired or separated participants entitled to future benefits | 2017-01-01 | 1 |
Number of employers contributing to the scheme | 2017-01-01 | 0 |
2016: JERGENS INC LIFE AD & D INSURANCE HOSPITAL SURGICAL 2016 401k membership |
---|
Total participants, beginning-of-year | 2016-01-01 | 254 |
Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 209 |
Number of retired or separated participants receiving benefits | 2016-01-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2016-01-01 | 0 |
Total of all active and inactive participants | 2016-01-01 | 209 |
Number of employers contributing to the scheme | 2016-01-01 | 0 |
2015: JERGENS INC LIFE AD & D INSURANCE HOSPITAL SURGICAL 2015 401k membership |
---|
Total participants, beginning-of-year | 2015-01-01 | 242 |
Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 254 |
Number of retired or separated participants receiving benefits | 2015-01-01 | 1 |
Number of other retired or separated participants entitled to future benefits | 2015-01-01 | 0 |
Total of all active and inactive participants | 2015-01-01 | 255 |
Number of employers contributing to the scheme | 2015-01-01 | 0 |
2014: JERGENS INC LIFE AD & D INSURANCE HOSPITAL SURGICAL 2014 401k membership |
---|
Total participants, beginning-of-year | 2014-01-01 | 227 |
Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 242 |
Number of retired or separated participants receiving benefits | 2014-01-01 | 0 |
Total of all active and inactive participants | 2014-01-01 | 242 |
Number of other retired or separated participants entitled to future benefits | 2014-01-01 | 0 |
Number of employers contributing to the scheme | 2014-01-01 | 0 |
2013: JERGENS INC LIFE AD & D INSURANCE HOSPITAL SURGICAL 2013 401k membership |
---|
Total participants, beginning-of-year | 2013-01-01 | 221 |
Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 192 |
Number of retired or separated participants receiving benefits | 2013-01-01 | 35 |
Number of other retired or separated participants entitled to future benefits | 2013-01-01 | 0 |
Total of all active and inactive participants | 2013-01-01 | 227 |
2012: JERGENS INC LIFE AD & D INSURANCE HOSPITAL SURGICAL 2012 401k membership |
---|
Total participants, beginning-of-year | 2012-04-01 | 206 |
Total number of active participants reported on line 7a of the Form 5500 | 2012-04-01 | 184 |
Number of retired or separated participants receiving benefits | 2012-04-01 | 37 |
Number of other retired or separated participants entitled to future benefits | 2012-04-01 | 0 |
Total of all active and inactive participants | 2012-04-01 | 221 |
2011: JERGENS INC LIFE AD & D INSURANCE HOSPITAL SURGICAL 2011 401k membership |
---|
Total participants, beginning-of-year | 2011-04-01 | 168 |
Total number of active participants reported on line 7a of the Form 5500 | 2011-04-01 | 134 |
Number of retired or separated participants receiving benefits | 2011-04-01 | 34 |
Total of all active and inactive participants | 2011-04-01 | 168 |
Total participants | 2011-04-01 | 168 |
2009: JERGENS INC LIFE AD & D INSURANCE HOSPITAL SURGICAL 2009 401k membership |
---|
Total participants, beginning-of-year | 2009-04-01 | 209 |
Total number of active participants reported on line 7a of the Form 5500 | 2009-04-01 | 175 |
Number of other retired or separated participants entitled to future benefits | 2009-04-01 | 25 |
Total of all active and inactive participants | 2009-04-01 | 200 |
Total participants | 2009-04-01 | 200 |
2008: JERGENS INC LIFE AD & D INSURANCE HOSPITAL SURGICAL 2008 401k membership |
---|
Total participants, beginning-of-year | 2008-04-01 | 212 |
Total number of active participants reported on line 7a of the Form 5500 | 2008-04-01 | 182 |
Number of retired or separated participants receiving benefits | 2008-04-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2008-04-01 | 27 |
Total of all active and inactive participants | 2008-04-01 | 209 |
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2008-04-01 | 0 |
Total participants | 2008-04-01 | 209 |
Number of participants with account balances | 2008-04-01 | 0 |
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2008-04-01 | 0 |
2022: JERGENS INC LIFE AD & D INSURANCE HOSPITAL SURGICAL 2022 form 5500 responses |
---|
2022-01-01 | Type of plan entity | Single employer plan |
2022-01-01 | Plan funding arrangement – Insurance | Yes |
2022-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2022-01-01 | Plan benefit arrangement – Insurance | Yes |
2022-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2021: JERGENS INC LIFE AD & D INSURANCE HOSPITAL SURGICAL 2021 form 5500 responses |
---|
2021-01-01 | Type of plan entity | Single employer plan |
2021-01-01 | Submission has been amended | Yes |
2021-01-01 | Plan funding arrangement – Insurance | Yes |
2021-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2021-01-01 | Plan benefit arrangement – Insurance | Yes |
2021-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2020: JERGENS INC LIFE AD & D INSURANCE HOSPITAL SURGICAL 2020 form 5500 responses |
---|
2020-01-01 | Type of plan entity | Single employer plan |
2020-01-01 | Plan funding arrangement – Insurance | Yes |
2020-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2020-01-01 | Plan benefit arrangement – Insurance | Yes |
2020-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2019: JERGENS INC LIFE AD & D INSURANCE HOSPITAL SURGICAL 2019 form 5500 responses |
---|
2019-01-01 | Type of plan entity | Single employer plan |
2019-01-01 | Plan funding arrangement – Insurance | Yes |
2019-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2019-01-01 | Plan benefit arrangement – Insurance | Yes |
2019-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2018: JERGENS INC LIFE AD & D INSURANCE HOSPITAL SURGICAL 2018 form 5500 responses |
---|
2018-01-01 | Type of plan entity | Single employer plan |
2018-01-01 | Plan funding arrangement – Insurance | Yes |
2018-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2018-01-01 | Plan benefit arrangement – Insurance | Yes |
2018-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2017: JERGENS INC LIFE AD & D INSURANCE HOSPITAL SURGICAL 2017 form 5500 responses |
---|
2017-01-01 | Type of plan entity | Single employer plan |
2017-01-01 | Submission has been amended | Yes |
2017-01-01 | Plan funding arrangement – Insurance | Yes |
2017-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2017-01-01 | Plan benefit arrangement – Insurance | Yes |
2017-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2016: JERGENS INC LIFE AD & D INSURANCE HOSPITAL SURGICAL 2016 form 5500 responses |
---|
2016-01-01 | Type of plan entity | Single employer plan |
2016-01-01 | Submission has been amended | Yes |
2016-01-01 | Plan funding arrangement – Insurance | Yes |
2016-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2016-01-01 | Plan benefit arrangement – Insurance | Yes |
2016-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2015: JERGENS INC LIFE AD & D INSURANCE HOSPITAL SURGICAL 2015 form 5500 responses |
---|
2015-01-01 | Type of plan entity | Single employer plan |
2015-01-01 | Submission has been amended | Yes |
2015-01-01 | Plan funding arrangement – Insurance | Yes |
2015-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2015-01-01 | Plan benefit arrangement – Insurance | Yes |
2015-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2014: JERGENS INC LIFE AD & D INSURANCE HOSPITAL SURGICAL 2014 form 5500 responses |
---|
2014-01-01 | Type of plan entity | Single employer plan |
2014-01-01 | Submission has been amended | Yes |
2014-01-01 | Plan funding arrangement – Insurance | Yes |
2014-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2014-01-01 | Plan benefit arrangement – Insurance | Yes |
2014-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2013: JERGENS INC LIFE AD & D INSURANCE HOSPITAL SURGICAL 2013 form 5500 responses |
---|
2013-01-01 | Type of plan entity | Single employer plan |
2013-01-01 | Submission has been amended | No |
2013-01-01 | This submission is the final filing | No |
2013-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2013-01-01 | Plan is a collectively bargained plan | No |
2013-01-01 | Plan funding arrangement – Insurance | Yes |
2013-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2013-01-01 | Plan benefit arrangement – Insurance | Yes |
2013-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2012: JERGENS INC LIFE AD & D INSURANCE HOSPITAL SURGICAL 2012 form 5500 responses |
---|
2012-04-01 | Type of plan entity | Single employer plan |
2012-04-01 | Submission has been amended | No |
2012-04-01 | This submission is the final filing | No |
2012-04-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
2012-04-01 | Plan is a collectively bargained plan | No |
2012-04-01 | Plan funding arrangement – Insurance | Yes |
2012-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2012-04-01 | Plan benefit arrangement – Insurance | Yes |
2012-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2011: JERGENS INC LIFE AD & D INSURANCE HOSPITAL SURGICAL 2011 form 5500 responses |
---|
2011-04-01 | Type of plan entity | Single employer plan |
2011-04-01 | Submission has been amended | No |
2011-04-01 | This submission is the final filing | No |
2011-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2011-04-01 | Plan is a collectively bargained plan | No |
2011-04-01 | Plan funding arrangement – Insurance | Yes |
2011-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2011-04-01 | Plan benefit arrangement – Insurance | Yes |
2011-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2009: JERGENS INC LIFE AD & D INSURANCE HOSPITAL SURGICAL 2009 form 5500 responses |
---|
2009-04-01 | Type of plan entity | Single employer plan |
2009-04-01 | Submission has been amended | No |
2009-04-01 | This submission is the final filing | No |
2009-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2009-04-01 | Plan is a collectively bargained plan | No |
2009-04-01 | Plan funding arrangement – Insurance | Yes |
2009-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2009-04-01 | Plan benefit arrangement – Insurance | Yes |
2009-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2008: JERGENS INC LIFE AD & D INSURANCE HOSPITAL SURGICAL 2008 form 5500 responses |
---|
2008-04-01 | Type of plan entity | Single employer plan |
2008-04-01 | Submission has been amended | No |
2008-04-01 | This submission is the final filing | No |
2008-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2008-04-01 | Plan is a collectively bargained plan | No |
2008-04-01 | Plan funding arrangement – Insurance | Yes |
2008-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2008-04-01 | Plan benefit arrangement – Insurance | Yes |
2008-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GLUG0BSFL |
Policy instance | 4 |
Insurance contract or identification number | GLUG0BSFL | Number of Individuals Covered | 315 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $7,486 | Total amount of fees paid to insurance company | USD $5,013 | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $110,818 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,486 | Amount paid for insurance broker fees | 5013 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
|
UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | LS0373 |
Policy instance | 3 |
Insurance contract or identification number | LS0373 | Number of Individuals Covered | 280 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | EMPLOYEE ASSISTANCE PROGRAM | Welfare Benefit Premiums Paid to Carrier | USD $4,366 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
MEDICAL MUTUAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 29076 ) |
Policy contract number | 800157 |
Policy instance | 2 |
Insurance contract or identification number | 800157 | Number of Individuals Covered | 201 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $35,580 | Total amount of fees paid to insurance company | USD $17,262 | Health Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $35,580 | Amount paid for insurance broker fees | 17262 | Additional information about fees paid to insurance broker | FEES | Insurance broker organization code? | 3 |
|
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 544747 |
Policy instance | 1 |
Insurance contract or identification number | 544747 | Number of Individuals Covered | 259 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENT, CRITICAL ILLNESS | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 544747 |
Policy instance | 1 |
Insurance contract or identification number | 544747 | Number of Individuals Covered | 220 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $1,562 | Total amount of fees paid to insurance company | USD $4,780 | Vision Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENT, CRITICAL ILLNESS | Welfare Benefit Premiums Paid to Carrier | USD $47,342 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,562 | Amount paid for insurance broker fees | 4780 | Additional information about fees paid to insurance broker | FEES | Insurance broker organization code? | 3 |
|
MEDICAL MUTUAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 29076 ) |
Policy contract number | 800157 |
Policy instance | 2 |
Insurance contract or identification number | 800157 | Number of Individuals Covered | 186 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $32,835 | Total amount of fees paid to insurance company | USD $21,161 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $3,050 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $32,835 | Amount paid for insurance broker fees | 21161 | Additional information about fees paid to insurance broker | FEES | Insurance broker organization code? | 3 |
|
UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | LS0373 |
Policy instance | 3 |
Insurance contract or identification number | LS0373 | Number of Individuals Covered | 250 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | EMPLOYEE ASSISTANCE PROGRAM | Welfare Benefit Premiums Paid to Carrier | USD $3,036 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GLUG0BSFL |
Policy instance | 4 |
Insurance contract or identification number | GLUG0BSFL | Number of Individuals Covered | 282 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $2,771 | Total amount of fees paid to insurance company | USD $2,684 | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $69,272 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,771 | Amount paid for insurance broker fees | 2684 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
|
MEDICAL MUTUAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 29076 ) |
Policy contract number | 800157 |
Policy instance | 2 |
Insurance contract or identification number | 800157 | Number of Individuals Covered | 191 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $33,763 | Total amount of fees paid to insurance company | USD $23,736 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $3,234 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $33,763 | Amount paid for insurance broker fees | 23736 | Additional information about fees paid to insurance broker | FEES | Insurance broker organization code? | 3 |
|
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 544747 |
Policy instance | 1 |
Insurance contract or identification number | 544747 | Number of Individuals Covered | 261 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $11,985 | Total amount of fees paid to insurance company | USD $5,249 | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT, ACCIDENT, CRITICAL ILLNESS | Welfare Benefit Premiums Paid to Carrier | USD $173,585 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $11,985 | Amount paid for insurance broker fees | 5249 | Additional information about fees paid to insurance broker | FEES | Insurance broker organization code? | 3 |
|
MEDICAL MUTUAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 29076 ) |
Policy contract number | 800157 |
Policy instance | 2 |
Insurance contract or identification number | 800157 | Number of Individuals Covered | 182 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $32,258 | Total amount of fees paid to insurance company | USD $26,969 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $3,440 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $26,875 | Amount paid for insurance broker fees | 20771 | Additional information about fees paid to insurance broker | FEES | Insurance broker organization code? | 3 |
|
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 544747 |
Policy instance | 1 |
Insurance contract or identification number | 544747 | Number of Individuals Covered | 273 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $10,540 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT, ACCIDENT, CRITICAL ILLNESS | Welfare Benefit Premiums Paid to Carrier | USD $138,881 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $10,540 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
|
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 98944291001 |
Policy instance | 3 |
Insurance contract or identification number | 98944291001 | Number of Individuals Covered | 332 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $17,613 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 544747 |
Policy instance | 1 |
Insurance contract or identification number | 544747 | Number of Individuals Covered | 264 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT, ACCIDENT, CRITICAL ILLNESS | Welfare Benefit Premiums Paid to Carrier | USD $245,581 | 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 number | 800157 |
Policy instance | 2 |
Insurance contract or identification number | 800157 | Number of Individuals Covered | 174 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $30,755 | Total amount of fees paid to insurance company | USD $19,472 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $3,462 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $30,755 | Amount paid for insurance broker fees | 19472 | Additional information about fees paid to insurance broker | FEES | Insurance broker organization code? | 3 |
|
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 98944291001 |
Policy instance | 3 |
Insurance contract or identification number | 98944291001 | Number of Individuals Covered | 307 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $16,698 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 10182764 |
Policy instance | 5 |
Insurance contract or identification number | 10182764 | Number of Individuals Covered | 200 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $1,366 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $26,555 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 405003750 |
Policy instance | 7 |
Insurance contract or identification number | 405003750 | Number of Individuals Covered | 51 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $523 | Total amount of fees paid to insurance company | USD $523 | Other welfare benefits provided | CRITICAL ILLNESS | Welfare Benefit Premiums Paid to Carrier | USD $10,423 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 404002974 |
Policy instance | 6 |
Insurance contract or identification number | 404002974 | Number of Individuals Covered | 52 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $558 | Total amount of fees paid to insurance company | USD $647 | Other welfare benefits provided | ACCIDENT | Welfare Benefit Premiums Paid to Carrier | USD $12,165 | 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 number | 0058436-01 |
Policy instance | 4 |
Insurance contract or identification number | 0058436-01 | Number of Individuals Covered | 158 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $27,910 | Total amount of fees paid to insurance company | USD $21,821 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $3,540 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $27,910 | Amount paid for insurance broker fees | 21821 | Additional information about fees paid to insurance broker | BONUSES, OVERRIDES, ENTERTAINMENT, MEALS OR GIFTS. | Insurance broker organization code? | 3 | Insurance broker name | GALLAGHER BENEFIT SERVICES, INC. |
|
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 1D027168 |
Policy instance | 2 |
Insurance contract or identification number | 1D027168 | Number of Individuals Covered | 162 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $2,703 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $102,022 | 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 number | 58436-01 |
Policy instance | 1 |
Insurance contract or identification number | 58436-01 | Number of Individuals Covered | 158 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $27,910 | Total amount of fees paid to insurance company | USD $21,821 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $3,540 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 98944291001 |
Policy instance | 3 |
Insurance contract or identification number | 98944291001 | Number of Individuals Covered | 277 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $14,736 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 10182763 |
Policy instance | 4 |
Insurance contract or identification number | 10182763 | Number of Individuals Covered | 237 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $1,742 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $33,817 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 98944291001 |
Policy instance | 5 |
Insurance contract or identification number | 98944291001 | Number of Individuals Covered | 277 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $14,736 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 000010182764 |
Policy instance | 3 |
Insurance contract or identification number | 000010182764 | Number of Individuals Covered | 200 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $1,366 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $26,555 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 1366 | Additional information about fees paid to insurance broker | BROKER BONUS | Insurance broker organization code? | 3 | Insurance broker name | GALLAGHER BENEFIT SERVICES, INC. |
|
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 000010182763 |
Policy instance | 2 |
Insurance contract or identification number | 000010182763 | Number of Individuals Covered | 237 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $1,742 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $33,817 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 1742 | Additional information about fees paid to insurance broker | BROKER BONUS | Insurance broker organization code? | 5 | Insurance broker name | GALLAGHER BENEFIT SERVICES, INC. |
|
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 00001D027168 |
Policy instance | 1 |
Insurance contract or identification number | 00001D027168 | Number of Individuals Covered | 162 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $2,703 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $102,022 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 2703 | Additional information about fees paid to insurance broker | BROKER BONUS | Insurance broker organization code? | 3 | Insurance broker name | GALLAGHER BENEFIT SERVICES, INC. |
|
MEDICAL MUTUAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 29076 ) |
Policy contract number | 0045202-01 |
Policy instance | 4 |
Insurance contract or identification number | 0045202-01 | Number of Individuals Covered | 169 | Insurance policy start date | 2015-01-01 | Insurance policy end date | 2015-12-31 | Total amount of commissions paid to insurance broker | USD $29,984 | Total amount of fees paid to insurance company | USD $20,207 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $5,503 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $29,984 | Amount paid for insurance broker fees | 20207 | Insurance broker organization code? | 3 | Insurance broker name | GALLAGHER BENEFIT SERVICES, INC. |
|
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 000010182764 |
Policy instance | 3 |
Insurance contract or identification number | 000010182764 | Number of Individuals Covered | 220 | Insurance policy start date | 2015-01-01 | Insurance policy end date | 2015-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $167 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $23,638 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 167 | Additional information about fees paid to insurance broker | BROKER BONUS | Insurance broker organization code? | 3 | Insurance broker name | GALLAGHER BENEFIT SERVICES, INC. |
|
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 000010182763 |
Policy instance | 2 |
Insurance contract or identification number | 000010182763 | Number of Individuals Covered | 256 | Insurance policy start date | 2015-01-01 | Insurance policy end date | 2015-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $225 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD & D | Welfare Benefit Premiums Paid to Carrier | USD $31,490 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 225 | Additional information about fees paid to insurance broker | BROKER BONUS | Insurance broker organization code? | 3 | Insurance broker name | GALLAGHER BENEFIT SERVICES, INC. |
|
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 00001D027168 |
Policy instance | 1 |
Insurance contract or identification number | 00001D027168 | Number of Individuals Covered | 179 | Insurance policy start date | 2015-01-01 | Insurance policy end date | 2015-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $439 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $124,170 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 439 | Additional information about fees paid to insurance broker | BROKER BONUS | Insurance broker organization code? | 3 | Insurance broker name | GALLAGHER BENEFIT SERVICES, INC. |
|
MEDICAL MUTUAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 29076 ) |
Policy contract number | 0038849-01 |
Policy instance | 4 |
Insurance contract or identification number | 0038849-01 | Number of Individuals Covered | 161 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-12-31 | Total amount of commissions paid to insurance broker | USD $28,518 | Total amount of fees paid to insurance company | USD $18,245 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $5,110 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $28,518 | Amount paid for insurance broker fees | 18245 | Insurance broker organization code? | 3 | Insurance broker name | GALLAGHER BENEFIT SERVICES, INC. |
|
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 000010182763 |
Policy instance | 2 |
Insurance contract or identification number | 000010182763 | Number of Individuals Covered | 242 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $1,327 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD & D | Welfare Benefit Premiums Paid to Carrier | USD $30,051 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 1327 | Additional information about fees paid to insurance broker | BROKER BONUS | Insurance broker organization code? | 3 | Insurance broker name | GALLAGHER BENEFIT SERVICES, INC. |
|
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 00001D027168 |
Policy instance | 1 |
Insurance contract or identification number | 00001D027168 | Number of Individuals Covered | 171 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $1,258 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $117,065 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 1258 | Additional information about fees paid to insurance broker | BROKER BONUS | Insurance broker organization code? | 3 | Insurance broker name | GALLAGHER BENEFIT SERVICES, INC. |
|
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 000010182764 |
Policy instance | 3 |
Insurance contract or identification number | 000010182764 | Number of Individuals Covered | 208 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $983 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $22,323 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 983 | Additional information about fees paid to insurance broker | BROKER BONUS | Insurance broker organization code? | 3 | Insurance broker name | GALLAGHER BENEFIT SERVICES, INC. |
|
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 98944291001 |
Policy instance | 3 |
Insurance contract or identification number | 98944291001 | Number of Individuals Covered | 253 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $13,308 | 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 number | 38849-01 |
Policy instance | 1 |
Insurance contract or identification number | 38849-01 | Number of Individuals Covered | 161 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-12-31 | Total amount of commissions paid to insurance broker | USD $28,518 | Total amount of fees paid to insurance company | USD $18,245 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $5,110 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $28,518 | Amount paid for insurance broker fees | 18245 | Insurance broker organization code? | 3 |
|
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 10182763 |
Policy instance | 4 |
Insurance contract or identification number | 10182763 | Number of Individuals Covered | 242 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $1,327 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $30,051 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $0 | Amount paid for insurance broker fees | 1327 | Additional information about fees paid to insurance broker | BROKER BONUS | Insurance broker organization code? | 3 |
|
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 10182764 |
Policy instance | 5 |
Insurance contract or identification number | 10182764 | Number of Individuals Covered | 208 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $983 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $22,323 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $0 | Amount paid for insurance broker fees | 983 | Additional information about fees paid to insurance broker | BROKER BONUS | Insurance broker organization code? | 3 |
|
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | YS750 |
Policy instance | 6 |
Insurance contract or identification number | YS750 | Number of Individuals Covered | 17 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-12-31 | Total amount of commissions paid to insurance broker | USD $269 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | ACCIDENT, CRITICAL ILLNESS | Welfare Benefit Premiums Paid to Carrier | USD $1,487 | 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 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
|
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | YU921 |
Policy instance | 7 |
Insurance contract or identification number | YU921 | Number of Individuals Covered | 10 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-12-31 | Total amount of commissions paid to insurance broker | USD $117 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | ACCIDENT, CRITICAL ILLNESS | Welfare Benefit Premiums Paid to Carrier | USD $959 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $38 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
|
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 1D027168 |
Policy instance | 2 |
Insurance contract or identification number | 1D027168 | Number of Individuals Covered | 171 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $1,258 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $117,065 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $0 | Amount paid for insurance broker fees | 1258 | Additional information about fees paid to insurance broker | BROKER BONUS | Insurance broker organization code? | 3 |
|
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 890042 |
Policy instance | 1 |
Insurance contract or identification number | 890042 | Number of Individuals Covered | 192 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | 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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $69,341 | 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 number | NOT AVAILABLE |
Policy instance | 2 |
Insurance contract or identification number | NOT AVAILABLE | Number of Individuals Covered | 152 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $17,909 | Total amount of fees paid to insurance company | USD $11,459 | 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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $4,851 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $17,909 | Amount paid for insurance broker fees | 11459 | Additional information about fees paid to insurance broker | INCLUDE OTHER FORMS OF COMPENSATION PAID TO AGENT; DO NOT DIRECTLY AFFECT PREMIUM | Insurance broker organization code? | 3 | Insurance broker name | GALLAGHER BENEFIT SERVICES |
|
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 890042 |
Policy instance | 1 |
Insurance contract or identification number | 890042 | Number of Individuals Covered | 371 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $74,000 | 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 number | NOT AVAILABLE |
Policy instance | 2 |
Insurance contract or identification number | NOT AVAILABLE | Number of Individuals Covered | 158 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $5,015 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 890042 |
Policy instance | 1 |
Insurance contract or identification number | 890042 | Number of Individuals Covered | 383 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Life Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | 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 number | |
Policy instance | 2 |
Number of Individuals Covered | 144 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $4,940 | 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 number | |
Policy instance | 2 |
Number of Individuals Covered | 138 | Insurance policy start date | 2010-07-01 | Insurance policy end date | 2011-06-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $5,215 |
|
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 890042 |
Policy instance | 1 |
Insurance contract or identification number | 890042 | Number of Individuals Covered | 322 | Insurance policy start date | 2010-01-01 | Insurance policy end date | 2010-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT |
|