401k Plan data: WCOG-INSTITUTE FOR ORTHOPAEDIC SURGERY GROUP INSURANCE PLAN plan

WCOG-INSTITUTE FOR ORTHOPAEDIC SURGERY GROUP INSURANCE PLAN 401k Plan overview

Plan Name	WCOG-INSTITUTE FOR ORTHOPAEDIC SURGERY GROUP INSURANCE PLAN
Plan identification number	501

WCOG-INSTITUTE FOR ORTHOPAEDIC SURGERY GROUP INSURANCE PLAN Benefits

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

401k Sponsoring company profile

WEST CENTRAL OHIO GROUP LTD has sponsored the creation of one or more 401k plans.

Company Name: WEST CENTRAL OHIO GROUP LTD

Employer identification number (EIN): 341848147

NAIC Classification: 621493
NAIC Description: Freestanding Ambulatory Surgical and Emergency Centers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan WCOG-INSTITUTE FOR ORTHOPAEDIC SURGERY GROUP INSURANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-01-01
501 2021-01-01
501 2020-01-01
501 2019-01-01
501 2019-01-01
501 2018-01-01
501 2017-01-01 PAT FARMER
501 2016-01-01 PAT FARMER
501 2015-01-01 PAT FARMER

Plan Statistics for WCOG-INSTITUTE FOR ORTHOPAEDIC SURGERY GROUP INSURANCE PLAN

401k plan membership statisitcs for WCOG-INSTITUTE FOR ORTHOPAEDIC SURGERY GROUP INSURANCE PLAN

Measure Date Value
2022: WCOG-INSTITUTE FOR ORTHOPAEDIC SURGERY GROUP INSURANCE PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 149
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 114
Number of retired or separated participants receiving benefits 2022-01-01 1
Number of other retired or separated participants entitled to future benefits 2022-01-01 1
Total of all active and inactive participants 2022-01-01 116
Total participants 2022-01-01 116
2021: WCOG-INSTITUTE FOR ORTHOPAEDIC SURGERY GROUP INSURANCE PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 149
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 121
Total of all active and inactive participants 2021-01-01 121
Total participants 2021-01-01 121
2020: WCOG-INSTITUTE FOR ORTHOPAEDIC SURGERY GROUP INSURANCE PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 140
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 105
Total of all active and inactive participants 2020-01-01 105
Total participants 2020-01-01 105
2019: WCOG-INSTITUTE FOR ORTHOPAEDIC SURGERY GROUP INSURANCE PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 133
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 87
Total of all active and inactive participants 2019-01-01 87
Total participants 2019-01-01 87
2018: WCOG-INSTITUTE FOR ORTHOPAEDIC SURGERY GROUP INSURANCE PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 119
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 96
Number of retired or separated participants receiving benefits 2018-01-01 1
Total of all active and inactive participants 2018-01-01 97
Total participants 2018-01-01 97
2017: WCOG-INSTITUTE FOR ORTHOPAEDIC SURGERY GROUP INSURANCE PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 124
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 88
Number of retired or separated participants receiving benefits 2017-01-01 2
Total of all active and inactive participants 2017-01-01 90
Total participants 2017-01-01 90
2016: WCOG-INSTITUTE FOR ORTHOPAEDIC SURGERY GROUP INSURANCE PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 122
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 82
Number of retired or separated participants receiving benefits 2016-01-01 1
Total of all active and inactive participants 2016-01-01 83
Total participants 2016-01-01 83
2015: WCOG-INSTITUTE FOR ORTHOPAEDIC SURGERY GROUP INSURANCE PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 114
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 82
Number of retired or separated participants receiving benefits 2015-01-01 1
Total of all active and inactive participants 2015-01-01 83
Total participants 2015-01-01 0

Measure	Date	Value
2022: WCOG-INSTITUTE FOR ORTHOPAEDIC SURGERY GROUP INSURANCE PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	149
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	114
Number of retired or separated participants receiving benefits	2022-01-01	1
Number of other retired or separated participants entitled to future benefits	2022-01-01	1
Total of all active and inactive participants	2022-01-01	116
Total participants	2022-01-01	116
2021: WCOG-INSTITUTE FOR ORTHOPAEDIC SURGERY GROUP INSURANCE PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	149
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	121
Total of all active and inactive participants	2021-01-01	121
Total participants	2021-01-01	121
2020: WCOG-INSTITUTE FOR ORTHOPAEDIC SURGERY GROUP INSURANCE PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	140
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	105
Total of all active and inactive participants	2020-01-01	105
Total participants	2020-01-01	105
2019: WCOG-INSTITUTE FOR ORTHOPAEDIC SURGERY GROUP INSURANCE PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	133
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	87
Total of all active and inactive participants	2019-01-01	87
Total participants	2019-01-01	87
2018: WCOG-INSTITUTE FOR ORTHOPAEDIC SURGERY GROUP INSURANCE PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	119
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	96
Number of retired or separated participants receiving benefits	2018-01-01	1
Total of all active and inactive participants	2018-01-01	97
Total participants	2018-01-01	97
2017: WCOG-INSTITUTE FOR ORTHOPAEDIC SURGERY GROUP INSURANCE PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	124
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	88
Number of retired or separated participants receiving benefits	2017-01-01	2
Total of all active and inactive participants	2017-01-01	90
Total participants	2017-01-01	90
2016: WCOG-INSTITUTE FOR ORTHOPAEDIC SURGERY GROUP INSURANCE PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	122
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	82
Number of retired or separated participants receiving benefits	2016-01-01	1
Total of all active and inactive participants	2016-01-01	83
Total participants	2016-01-01	83
2015: WCOG-INSTITUTE FOR ORTHOPAEDIC SURGERY GROUP INSURANCE PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	114
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	82
Number of retired or separated participants receiving benefits	2015-01-01	1
Total of all active and inactive participants	2015-01-01	83
Total participants	2015-01-01	0

Form 5500 Responses for WCOG-INSTITUTE FOR ORTHOPAEDIC SURGERY GROUP INSURANCE PLAN

2022: WCOG-INSTITUTE FOR ORTHOPAEDIC SURGERY GROUP INSURANCE PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Submission has been amended	Yes
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2021: WCOG-INSTITUTE FOR ORTHOPAEDIC SURGERY GROUP INSURANCE PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2020: WCOG-INSTITUTE FOR ORTHOPAEDIC SURGERY GROUP INSURANCE PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2019: WCOG-INSTITUTE FOR ORTHOPAEDIC SURGERY GROUP INSURANCE PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	Yes
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2018: WCOG-INSTITUTE FOR ORTHOPAEDIC SURGERY GROUP INSURANCE PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2017: WCOG-INSTITUTE FOR ORTHOPAEDIC SURGERY GROUP INSURANCE PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2016: WCOG-INSTITUTE FOR ORTHOPAEDIC SURGERY GROUP INSURANCE PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: WCOG-INSTITUTE FOR ORTHOPAEDIC SURGERY GROUP INSURANCE PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	First time form 5500 has been submitted	Yes
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

466673

Policy instance

Insurance contract or identification number	466673
Number of Individuals Covered	64
Insurance policy start date	2022-01-01
Insurance policy end date	2023-01-01
Total amount of commissions paid to insurance broker	USD $3,116
Other welfare benefits provided	LIFESTYLE ADD/LIFESTYLE LIFE
Welfare Benefit Premiums Paid to Carrier	USD $20,773
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,116
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

133705

Policy instance

Insurance contract or identification number	133705
Number of Individuals Covered	1
Insurance policy start date	2022-01-01
Insurance policy end date	2023-01-01
Total amount of commissions paid to insurance broker	USD $299
Other welfare benefits provided	GROUP LONG TERM CARE
Welfare Benefit Premiums Paid to Carrier	USD $1,651
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $299
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

GY787

Policy instance

Insurance contract or identification number	GY787
Number of Individuals Covered	16
Insurance policy start date	2022-04-01
Insurance policy end date	2023-03-31
Total amount of commissions paid to insurance broker	USD $1,286
Other welfare benefits provided	CRITICAL ILLNESS & ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $11,854
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $306
Insurance broker organization code?	3

MEDICAL MUTUAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 29076 )

Policy contract number

0084283-01

Policy instance

Insurance contract or identification number	0084283-01
Number of Individuals Covered	111
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $41,895
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,055
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $41,895
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

466672

Policy instance

Insurance contract or identification number	466672
Number of Individuals Covered	138
Insurance policy start date	2022-01-01
Insurance policy end date	2023-01-01
Total amount of commissions paid to insurance broker	USD $8,153
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $114,167
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,153
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

466672

Policy instance

Insurance contract or identification number	466672
Number of Individuals Covered	121
Insurance policy start date	2021-01-01
Insurance policy end date	2022-01-01
Total amount of commissions paid to insurance broker	USD $7,665
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $99,669
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,665
Insurance broker organization code?	3

CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )

Policy contract number

0000009510

Policy instance

Insurance contract or identification number	0000009510
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Other welfare benefits provided	CANCER, SPECIAL EVENTS, HOSPITAL CO
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

GY787

Policy instance

Insurance contract or identification number	GY787
Number of Individuals Covered	17
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $1,179
Total amount of fees paid to insurance company	USD $25
Other welfare benefits provided	CRITICAL ILLNESS & ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $12,853
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $237
Amount paid for insurance broker fees	20
Additional information about fees paid to insurance broker	AWARDS, PRIZES, BONUSES OR OTHER NON-MONETARY COMPENSATION
Insurance broker organization code?	3

MEDICAL MUTUAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 29076 )

Policy contract number

0084283-01

Policy instance

Insurance contract or identification number	0084283-01
Number of Individuals Covered	110
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $41,702
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,825
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $41,702
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

133705 0800

Policy instance

Insurance contract or identification number	133705 0800
Number of Individuals Covered	1
Insurance policy start date	2021-01-01
Insurance policy end date	2022-01-01
Total amount of commissions paid to insurance broker	USD $347
Other welfare benefits provided	GROUP LONG TERM CARE
Welfare Benefit Premiums Paid to Carrier	USD $1,736
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $347
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

133705 0001

Policy instance

Insurance contract or identification number	133705 0001
Number of Individuals Covered	15
Insurance policy start date	2021-01-01
Insurance policy end date	2022-01-01
Total amount of commissions paid to insurance broker	USD $575
Other welfare benefits provided	GROUP LONG TERM CARE
Welfare Benefit Premiums Paid to Carrier	USD $2,877
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $575
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

466673

Policy instance

Insurance contract or identification number	466673
Number of Individuals Covered	62
Insurance policy start date	2021-01-01
Insurance policy end date	2022-01-01
Total amount of commissions paid to insurance broker	USD $3,074
Other welfare benefits provided	LIFESTYLE ADD, LIFESTYLE LIFE
Welfare Benefit Premiums Paid to Carrier	USD $20,492
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,074

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

466672

Policy instance

Insurance contract or identification number	466672
Number of Individuals Covered	106
Insurance policy start date	2020-01-01
Insurance policy end date	2021-01-01
Total amount of commissions paid to insurance broker	USD $8,348
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $90,882
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,348
Insurance broker organization code?	3

MEDICAL MUTUAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 29076 )

Policy contract number

0084283-01

Policy instance

Insurance contract or identification number	0084283-01
Number of Individuals Covered	101
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $38,120
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,349
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $38,120
Insurance broker organization code?	3

CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )

Policy contract number

0000009510

Policy instance

Insurance contract or identification number	0000009510
Number of Individuals Covered	72
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $2,601
Other welfare benefits provided	CANCER, SPECIAL EVENTS, HOSPITAL CO
Welfare Benefit Premiums Paid to Carrier	USD $23,305
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $735
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

133705 0001

Policy instance

Insurance contract or identification number	133705 0001
Number of Individuals Covered	17
Insurance policy start date	2020-01-01
Insurance policy end date	2021-01-01
Total amount of commissions paid to insurance broker	USD $888
Other welfare benefits provided	GROUP LONG TERM CARE
Welfare Benefit Premiums Paid to Carrier	USD $4,087
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $888
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

466673

Policy instance

Insurance contract or identification number	466673
Number of Individuals Covered	71
Insurance policy start date	2020-01-01
Insurance policy end date	2021-01-01
Total amount of commissions paid to insurance broker	USD $3,730
Other welfare benefits provided	LIFESTYLE ADD, LIFESTYLE LIFE
Welfare Benefit Premiums Paid to Carrier	USD $22,793
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,730
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

133705 0800

Policy instance

Insurance contract or identification number	133705 0800
Number of Individuals Covered	1
Insurance policy start date	2020-01-01
Insurance policy end date	2021-01-01
Total amount of commissions paid to insurance broker	USD $157
Other welfare benefits provided	GROUP LONG TERM CARE
Welfare Benefit Premiums Paid to Carrier	USD $629
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $157

COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 )

Policy contract number

225577

Policy instance

Insurance contract or identification number	225577
Insurance policy start date	2020-01-01
Insurance policy end date	2020-01-03
Total amount of commissions paid to insurance broker	USD $12
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $119
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

GY787

Policy instance

Insurance contract or identification number	GY787
Number of Individuals Covered	18
Insurance policy start date	2020-04-01
Insurance policy end date	2021-03-31
Total amount of commissions paid to insurance broker	USD $1,402
Total amount of fees paid to insurance company	USD $210
Other welfare benefits provided	CRITICAL ILLNESS & ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $14,310
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $323
Amount paid for insurance broker fees	150
Additional information about fees paid to insurance broker	AWARDS, PRIZES, BONUSES OR OTHER NON-MONETARY COMPENSATION
Insurance broker organization code?	3

CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )

Policy contract number

9510

Policy instance

Insurance contract or identification number	9510
Number of Individuals Covered	71
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $3,243
Other welfare benefits provided	ACCIDENT & CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $23,915
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $911
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

GY787

Policy instance

Insurance contract or identification number	GY787
Number of Individuals Covered	24
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $2,798
Total amount of fees paid to insurance company	USD $145
Other welfare benefits provided	HOSPITALIZATION, CANCER & SPECIAL E
Welfare Benefit Premiums Paid to Carrier	USD $16,536
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $872
Amount paid for insurance broker fees	103
Additional information about fees paid to insurance broker	AWARDS, PRIZES, BONUSES OR OTHER NON-MONETARY COMPENSATION
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

466673

Policy instance

Insurance contract or identification number	466673
Number of Individuals Covered	77
Insurance policy start date	2019-01-01
Insurance policy end date	2020-01-01
Total amount of commissions paid to insurance broker	USD $3,767
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $25,035
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,767
Insurance broker organization code?	3

MEDICAL MUTUAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 29076 )

Policy contract number

0084283-01

Policy instance

Insurance contract or identification number	0084283-01
Number of Individuals Covered	96
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $36,225
Total amount of fees paid to insurance company	USD $15,916
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,295
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $36,225
Amount paid for insurance broker fees	15916
Additional information about fees paid to insurance broker	BONUSES, OVERRIDES, ENTERTAINMENT, MEALS OR GIFTS
Insurance broker organization code?	3

NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )

Policy contract number

33058

Policy instance

Insurance contract or identification number	33058
Number of Individuals Covered	79
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $697
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $11,620
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $697
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

466672

Policy instance

Insurance contract or identification number	466672
Number of Individuals Covered	105
Insurance policy start date	2019-01-01
Insurance policy end date	2020-01-01
Total amount of commissions paid to insurance broker	USD $7,213
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $92,710
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,213
Insurance broker organization code?	3

COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 )

Policy contract number

225577

Policy instance

Insurance contract or identification number	225577
Number of Individuals Covered	84
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $4,589
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $57,366
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,868
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

133705

Policy instance

Insurance contract or identification number	133705
Number of Individuals Covered	17
Insurance policy start date	2019-01-01
Insurance policy end date	2020-01-01
Total amount of commissions paid to insurance broker	USD $914
Other welfare benefits provided	GROUP LONG TERM CARE
Welfare Benefit Premiums Paid to Carrier	USD $4,597
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $914
Insurance broker organization code?	3

ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )

Policy contract number

00171999

Policy instance

Insurance contract or identification number	00171999
Number of Individuals Covered	132
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $547
Total amount of fees paid to insurance company	USD $39
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,920
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $450
Insurance broker organization code?	3
Amount paid for insurance broker fees	39
Additional information about fees paid to insurance broker	BONUS, OVERRIDE AND NON MONETARY COMPENSATION

COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 )

Policy contract number

225577

Policy instance

Insurance contract or identification number	225577
Number of Individuals Covered	84
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $4,749
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $59,366
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,968
Insurance broker organization code?	3

COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 )

Policy contract number

00171999

Policy instance

Insurance contract or identification number	00171999
Number of Individuals Covered	97
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $27,936
Total amount of fees paid to insurance company	USD $1,800
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,089,750
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $21,240
Insurance broker organization code?	3
Amount paid for insurance broker fees	1800
Additional information about fees paid to insurance broker	BONUS, OVERRIDE AND NON MONETARY COMPENSATION

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

466672

Policy instance

Insurance contract or identification number	466672
Number of Individuals Covered	93
Insurance policy start date	2018-01-01
Insurance policy end date	2019-01-01
Total amount of commissions paid to insurance broker	USD $6,748
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $75,970
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,748
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

466673

Policy instance

Insurance contract or identification number	466673
Number of Individuals Covered	84
Insurance policy start date	2018-01-01
Insurance policy end date	2019-01-01
Total amount of commissions paid to insurance broker	USD $3,333
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $22,550
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,333
Insurance broker organization code?	3

NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )

Policy contract number

33058

Policy instance

Insurance contract or identification number	33058
Number of Individuals Covered	83
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $772
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $12,859
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $772
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

133705

Policy instance

Insurance contract or identification number	133705
Number of Individuals Covered	17
Insurance policy start date	2018-01-01
Insurance policy end date	2019-01-01
Total amount of commissions paid to insurance broker	USD $910
Other welfare benefits provided	GROUP LONG TERM CARE
Welfare Benefit Premiums Paid to Carrier	USD $4,835
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $910
Insurance broker organization code?	3

CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )

Policy contract number

9510

Policy instance

Insurance contract or identification number	9510
Number of Individuals Covered	70
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $4,691
Other welfare benefits provided	HOSPITALIZATION, CANCER, ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $25,454
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,567
Insurance broker organization code?	3

COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 )

Policy contract number

225577

Policy instance

Insurance contract or identification number	225577
Number of Individuals Covered	82
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $4,515
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $56,435
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,822
Insurance broker organization code?	3
Insurance broker name	CORNERSTONE BROKER INS SERVICES AG

ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )

Policy contract number

00171999

Policy instance

Insurance contract or identification number	00171999
Number of Individuals Covered	128
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $593
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,190
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $456
Insurance broker organization code?	3
Insurance broker name	CORNERSTONE BROKER INSURANCE SVCS

COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 )

Policy contract number

00171999

Policy instance

Insurance contract or identification number	00171999
Number of Individuals Covered	91
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $30,902
Total amount of fees paid to insurance company	USD $912
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,021,291
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $22,073
Insurance broker organization code?	3
Amount paid for insurance broker fees	912
Additional information about fees paid to insurance broker	INCENTIVES, EDUCATION, COMMUNICATION AND TRAINING
Insurance broker name	CORNERSTONE BROKER INSURANCE SVCS

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

466673

Policy instance

Insurance contract or identification number	466673
Number of Individuals Covered	82
Insurance policy start date	2017-01-01
Insurance policy end date	2018-01-01
Total amount of commissions paid to insurance broker	USD $3,144
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $21,071
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,144
Insurance broker name	HUSTON FINANCIAL SERVICES INC

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

466672

Policy instance

Insurance contract or identification number	466672
Number of Individuals Covered	92
Insurance policy start date	2017-01-01
Insurance policy end date	2018-01-01
Total amount of commissions paid to insurance broker	USD $6,303
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $67,058
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,303
Insurance broker organization code?	3
Insurance broker name	HUSTON FINANCIAL SERVICES INC

COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 )

Policy contract number

00171999

Policy instance

Insurance contract or identification number	00171999
Number of Individuals Covered	216
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $29,705
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $733,880
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $21,218
Insurance broker organization code?	3
Insurance broker name	CORNERSTONE BROKER INSURANCE SVCS

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

466672

Policy instance

Insurance contract or identification number	466672
Number of Individuals Covered	123
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $4,944
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $47,223
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,944
Insurance broker organization code?	3
Insurance broker name	HUSTON FINANCIAL SERVICES

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Company Name:	WEST CENTRAL OHIO GROUP LTD
Employer identification number (EIN):	341848147
NAIC Classification:	621493
NAIC Description:	Freestanding Ambulatory Surgical and Emergency Centers