401k Plan data: BOHL CO MEDICAL HEALTH BENEFITS PLAN plan

BOHL CO MEDICAL HEALTH BENEFITS PLAN 401k Plan overview

Plan Name	BOHL CO MEDICAL HEALTH BENEFITS PLAN
Plan identification number	501

BOHL CO MEDICAL HEALTH BENEFITS 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 Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

BOHL EQUIPMENT COMPANY has sponsored the creation of one or more 401k plans.

Company Name: BOHL EQUIPMENT COMPANY

Employer identification number (EIN): 344462234

NAIC Classification: 423800

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BOHL CO MEDICAL HEALTH BENEFITS 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 2018-01-01
501 2017-01-01
501 2016-01-01 STEVE BOHL STEVE BOHL 2017-10-15
501 2015-01-01 STEVE BOHL STEVE BOHL 2016-06-15
501 2014-01-01 STEVE BOHL STEVE BOHL 2016-06-15
501 2013-01-01 STEVE BOHL STEVE BOHL 2016-06-15
501 2012-01-01 LINDA BEACH LINDA BEACH 2016-07-26
501 2008-01-01 STEVE BOHL STEVE BOHL 2016-06-10
501 2007-01-01 STEVE BOHL STEVE BOHL 2016-06-10

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
501	2022-01-01
501	2021-01-01
501	2020-01-01
501	2019-01-01
501	2018-01-01
501	2017-01-01
501	2016-01-01	STEVE BOHL	STEVE BOHL	2017-10-15
501	2015-01-01	STEVE BOHL	STEVE BOHL	2016-06-15
501	2014-01-01	STEVE BOHL	STEVE BOHL	2016-06-15
501	2013-01-01	STEVE BOHL	STEVE BOHL	2016-06-15
501	2012-01-01	LINDA BEACH	LINDA BEACH	2016-07-26
501	2008-01-01	STEVE BOHL	STEVE BOHL	2016-06-10
501	2007-01-01	STEVE BOHL	STEVE BOHL	2016-06-10

Plan Statistics for BOHL CO MEDICAL HEALTH BENEFITS PLAN

401k plan membership statisitcs for BOHL CO MEDICAL HEALTH BENEFITS PLAN

Measure Date Value
2022: BOHL CO MEDICAL HEALTH BENEFITS PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 216
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 255
Total of all active and inactive participants 2022-01-01 255
2021: BOHL CO MEDICAL HEALTH BENEFITS PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 215
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 216
Total of all active and inactive participants 2021-01-01 216
2020: BOHL CO MEDICAL HEALTH BENEFITS PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 151
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 215
Total of all active and inactive participants 2020-01-01 215
2019: BOHL CO MEDICAL HEALTH BENEFITS PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 165
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 151
Total of all active and inactive participants 2019-01-01 151
2018: BOHL CO MEDICAL HEALTH BENEFITS PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 163
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 165
Total of all active and inactive participants 2018-01-01 165
2017: BOHL CO MEDICAL HEALTH BENEFITS PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 160
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 163
Total of all active and inactive participants 2017-01-01 163
2016: BOHL CO MEDICAL HEALTH BENEFITS PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 128
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 160
Total of all active and inactive participants 2016-01-01 160
2015: BOHL CO MEDICAL HEALTH BENEFITS PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 123
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 128
Total of all active and inactive participants 2015-01-01 128
2014: BOHL CO MEDICAL HEALTH BENEFITS PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 111
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 123
Total of all active and inactive participants 2014-01-01 123
2013: BOHL CO MEDICAL HEALTH BENEFITS PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 110
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 111
Total of all active and inactive participants 2013-01-01 111
2012: BOHL CO MEDICAL HEALTH BENEFITS PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 84
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 110
Total of all active and inactive participants 2012-01-01 110
2008: BOHL CO MEDICAL HEALTH BENEFITS PLAN 2008 401k membership
Total participants, beginning-of-year 2008-01-01 105
Total number of active participants reported on line 7a of the Form 5500 2008-01-01 104
Total of all active and inactive participants 2008-01-01 104
2007: BOHL CO MEDICAL HEALTH BENEFITS PLAN 2007 401k membership
Total participants, beginning-of-year 2007-01-01 90
Total number of active participants reported on line 7a of the Form 5500 2007-01-01 105
Total of all active and inactive participants 2007-01-01 105

Measure	Date	Value
2022: BOHL CO MEDICAL HEALTH BENEFITS PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	216
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	255
Total of all active and inactive participants	2022-01-01	255
2021: BOHL CO MEDICAL HEALTH BENEFITS PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	215
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	216
Total of all active and inactive participants	2021-01-01	216
2020: BOHL CO MEDICAL HEALTH BENEFITS PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	151
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	215
Total of all active and inactive participants	2020-01-01	215
2019: BOHL CO MEDICAL HEALTH BENEFITS PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	165
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	151
Total of all active and inactive participants	2019-01-01	151
2018: BOHL CO MEDICAL HEALTH BENEFITS PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	163
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	165
Total of all active and inactive participants	2018-01-01	165
2017: BOHL CO MEDICAL HEALTH BENEFITS PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	160
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	163
Total of all active and inactive participants	2017-01-01	163
2016: BOHL CO MEDICAL HEALTH BENEFITS PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	128
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	160
Total of all active and inactive participants	2016-01-01	160
2015: BOHL CO MEDICAL HEALTH BENEFITS PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	123
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	128
Total of all active and inactive participants	2015-01-01	128
2014: BOHL CO MEDICAL HEALTH BENEFITS PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	111
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	123
Total of all active and inactive participants	2014-01-01	123
2013: BOHL CO MEDICAL HEALTH BENEFITS PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	110
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	111
Total of all active and inactive participants	2013-01-01	111
2012: BOHL CO MEDICAL HEALTH BENEFITS PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	84
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	110
Total of all active and inactive participants	2012-01-01	110
2008: BOHL CO MEDICAL HEALTH BENEFITS PLAN 2008 401k membership
Total participants, beginning-of-year	2008-01-01	105
Total number of active participants reported on line 7a of the Form 5500	2008-01-01	104
Total of all active and inactive participants	2008-01-01	104
2007: BOHL CO MEDICAL HEALTH BENEFITS PLAN 2007 401k membership
Total participants, beginning-of-year	2007-01-01	90
Total number of active participants reported on line 7a of the Form 5500	2007-01-01	105
Total of all active and inactive participants	2007-01-01	105

Form 5500 Responses for BOHL CO MEDICAL HEALTH BENEFITS PLAN

2022: BOHL CO MEDICAL HEALTH BENEFITS PLAN 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 benefit arrangement – Insurance	Yes
2021: BOHL CO MEDICAL HEALTH BENEFITS 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: BOHL CO MEDICAL HEALTH BENEFITS 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: BOHL CO MEDICAL HEALTH BENEFITS PLAN 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 benefit arrangement – Insurance	Yes
2018: BOHL CO MEDICAL HEALTH BENEFITS 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: BOHL CO MEDICAL HEALTH BENEFITS 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: BOHL CO MEDICAL HEALTH BENEFITS 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: BOHL CO MEDICAL HEALTH BENEFITS PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: BOHL CO MEDICAL HEALTH BENEFITS PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: BOHL CO MEDICAL HEALTH BENEFITS PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: BOHL CO MEDICAL HEALTH BENEFITS PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2008: BOHL CO MEDICAL HEALTH BENEFITS PLAN 2008 form 5500 responses
2008-01-01	Type of plan entity	Single employer plan
2008-01-01	Plan funding arrangement – Insurance	Yes
2008-01-01	Plan benefit arrangement – Insurance	Yes
2007: BOHL CO MEDICAL HEALTH BENEFITS PLAN 2007 form 5500 responses
2007-01-01	Type of plan entity	Single employer plan
2007-01-01	First time form 5500 has been submitted	Yes
2007-01-01	Plan funding arrangement – Insurance	Yes
2007-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00516133

Policy instance

Insurance contract or identification number	00516133
Number of Individuals Covered	151
Insurance policy start date	2021-10-01
Insurance policy end date	2022-09-30
Total amount of commissions paid to insurance broker	USD $21,059
Total amount of fees paid to insurance company	USD $8,595
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
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 $276,116
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $21,059
Amount paid for insurance broker fees	8595
Insurance broker organization code?	3

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

Policy contract number

L03679

Policy instance

Insurance contract or identification number	L03679
Number of Individuals Covered	255
Insurance policy start date	2021-10-01
Insurance policy end date	2022-09-30
Total amount of commissions paid to insurance broker	USD $40,191
Total amount of fees paid to insurance company	USD $5,520
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,386,964
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $40,191
Amount paid for insurance broker fees	5520
Insurance broker organization code?	3

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

Policy contract number

0097864-01

Policy instance

Insurance contract or identification number	0097864-01
Number of Individuals Covered	216
Insurance policy start date	2020-10-01
Insurance policy end date	2021-09-30
Total amount of commissions paid to insurance broker	USD $46,583
Total amount of fees paid to insurance company	USD $19,410
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,804
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $46,583
Amount paid for insurance broker fees	19410
Insurance broker organization code?	3

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00516133

Policy instance

Insurance contract or identification number	00516133
Number of Individuals Covered	162
Insurance policy start date	2020-10-01
Insurance policy end date	2021-09-30
Total amount of commissions paid to insurance broker	USD $22,140
Total amount of fees paid to insurance company	USD $7,603
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
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 $289,559
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $22,140
Amount paid for insurance broker fees	7603
Insurance broker organization code?	3

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

Policy contract number

039300000001

Policy instance

Insurance contract or identification number	039300000001
Number of Individuals Covered	215
Insurance policy start date	2019-10-01
Insurance policy end date	2020-09-30
Total amount of commissions paid to insurance broker	USD $45,882
Total amount of fees paid to insurance company	USD $19,121
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,951
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $45,882
Amount paid for insurance broker fees	19121
Insurance broker organization code?	3

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00516133

Policy instance

Insurance contract or identification number	00516133
Number of Individuals Covered	160
Insurance policy start date	2019-10-01
Insurance policy end date	2020-09-30
Total amount of commissions paid to insurance broker	USD $18,151
Total amount of fees paid to insurance company	USD $11,319
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
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 $252,113
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,151
Amount paid for insurance broker fees	11319
Insurance broker organization code?	3

MEDICAL MUTUAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 95828 )

Policy contract number

Policy instance

Number of Individuals Covered	135
Insurance policy start date	2018-10-01
Insurance policy end date	2019-09-30
Total amount of commissions paid to insurance broker	USD $47,395
Total amount of fees paid to insurance company	USD $20,712
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,993
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $47,395
Amount paid for insurance broker fees	20712
Insurance broker organization code?	3

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00516133

Policy instance

Insurance contract or identification number	00516133
Number of Individuals Covered	165
Insurance policy start date	2018-10-01
Insurance policy end date	2019-09-30
Total amount of commissions paid to insurance broker	USD $21,681
Total amount of fees paid to insurance company	USD $10,061
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
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 $285,074
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $21,681
Amount paid for insurance broker fees	10061
Insurance broker organization code?	3

CONSUMERS LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62375 )

Policy contract number

00516133

Policy instance

Insurance contract or identification number	00516133
Number of Individuals Covered	157
Insurance policy start date	2017-10-01
Insurance policy end date	2018-09-30
Total amount of commissions paid to insurance broker	USD $18,097
Total amount of fees paid to insurance company	USD $9,704
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
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 $248,235
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,097
Amount paid for insurance broker fees	9704
Insurance broker organization code?	3

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

Policy contract number

Policy instance

Number of Individuals Covered	130
Insurance policy start date	2017-10-01
Insurance policy end date	2018-09-30
Total amount of commissions paid to insurance broker	USD $44,532
Total amount of fees paid to insurance company	USD $19,685
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,444
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $44,532
Amount paid for insurance broker fees	19685
Insurance broker organization code?	3

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

Policy contract number

Policy instance

Number of Individuals Covered	131
Insurance policy start date	2016-10-01
Insurance policy end date	2017-09-30
Total amount of commissions paid to insurance broker	USD $47,526
Total amount of fees paid to insurance company	USD $10,243
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,028
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CONSUMERS LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62375 )

Policy contract number

00516133

Policy instance

Insurance contract or identification number	00516133
Number of Individuals Covered	150
Insurance policy start date	2016-10-01
Insurance policy end date	2017-09-30
Total amount of commissions paid to insurance broker	USD $17,361
Total amount of fees paid to insurance company	USD $9,886
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
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 $232,866
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47029 )

Policy contract number

30032921

Policy instance

Insurance contract or identification number	30032921
Number of Individuals Covered	91
Insurance policy start date	2014-05-01
Insurance policy end date	2015-04-30
Total amount of commissions paid to insurance broker	USD $871
Total amount of fees paid to insurance company	USD $0
Vision 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 $871
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	BROKER COMMISSIONS
Insurance broker organization code?	3
Insurance broker name	FIRST INSURANCE GROUP OF MIDWEST

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47029 )

Policy contract number

12220727

Policy instance

Insurance contract or identification number	12220727
Number of Individuals Covered	41
Insurance policy start date	2014-08-01
Insurance policy end date	2015-07-31
Total amount of commissions paid to insurance broker	USD $922
Total amount of fees paid to insurance company	USD $0
Vision 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 $922
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	BROKER COMMISSIONS
Insurance broker organization code?	3
Insurance broker name	FIRST INSURANCE GROUP OF MIDWEST

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

KM05731876

Policy instance

Insurance contract or identification number	KM05731876
Number of Individuals Covered	446
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $7,368
Total amount of fees paid to insurance company	USD $356
Dental Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $123,155
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,320
Amount paid for insurance broker fees	356
Additional information about fees paid to insurance broker	BROKER COMMISSIONS AND FEES
Insurance broker organization code?	3
Insurance broker name	FIRST INSURANCE GROUP OF MIDWEST

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

KM05569277

Policy instance

Insurance contract or identification number	KM05569277
Number of Individuals Covered	101
Insurance policy start date	2014-09-01
Insurance policy end date	2015-08-31
Total amount of commissions paid to insurance broker	USD $1,689
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $28,289
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,689
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	BROKER COMMISSIONS
Insurance broker organization code?	3
Insurance broker name	FIRST INSURANCE GROUP OF MIDWEST

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

Policy contract number

Policy instance

Number of Individuals Covered	120
Insurance policy start date	2014-10-01
Insurance policy end date	2015-09-30
Total amount of commissions paid to insurance broker	USD $37,683
Total amount of fees paid to insurance company	USD $11,517
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,383
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $37,683
Amount paid for insurance broker fees	11517
Additional information about fees paid to insurance broker	BROKER FEES AND COMMISSIONS
Insurance broker organization code?	3
Insurance broker name	FIRST INSURANCE GROUP OF MIDWEST

CONSUMERS LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62375 )

Policy contract number

Policy instance

Number of Individuals Covered	134
Insurance policy start date	2015-01-01
Insurance policy end date	2015-09-30
Total amount of commissions paid to insurance broker	USD $1,255
Total amount of fees paid to insurance company	USD $523
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $10,619
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,255
Amount paid for insurance broker fees	523
Additional information about fees paid to insurance broker	BROKER COMMISSIONS AND FEES
Insurance broker organization code?	3
Insurance broker name	FIRST INSURANCE GROUP OF MIDWEST

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

Policy contract number

Policy instance

Number of Individuals Covered	123
Insurance policy start date	2013-10-01
Insurance policy end date	2014-09-30
Total amount of commissions paid to insurance broker	USD $32,955
Total amount of fees paid to insurance company	USD $37,575
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 $1,013
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $32,955
Amount paid for insurance broker fees	37575
Additional information about fees paid to insurance broker	BROKER COMMISSIONS AND FEES
Insurance broker organization code?	3
Insurance broker name	FIRST INSURANCE OF THE MIDWEST

CONSUMERS LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62375 )

Policy contract number

Policy instance

Number of Individuals Covered	131
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $1,712
Total amount of fees paid to insurance company	USD $714
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 $14,464
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,712
Amount paid for insurance broker fees	714
Additional information about fees paid to insurance broker	BROKER COMMISSIONS AND FEES
Insurance broker organization code?	3
Insurance broker name	FIRST INSURANCE GROUP OF MIDWEST

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

KM05569277

Policy instance

Insurance contract or identification number	KM05569277
Number of Individuals Covered	114
Insurance policy start date	2013-09-01
Insurance policy end date	2014-08-31
Total amount of commissions paid to insurance broker	USD $1,715
Total amount of fees paid to insurance company	USD $0
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 $24,494
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,715
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	BROKER COMMISSIONS AND FEES
Insurance broker organization code?	3
Insurance broker name	FIRST INSURANCE GROUP OF MIDWEST

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

KM05731876

Policy instance

Insurance contract or identification number	KM05731876
Number of Individuals Covered	412
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Total amount of commissions paid to insurance broker	USD $7,148
Total amount of fees paid to insurance company	USD $243
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
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $110,869
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,198
Amount paid for insurance broker fees	243
Additional information about fees paid to insurance broker	BROKER COMMISSIONS AND FEES
Insurance broker organization code?	3
Insurance broker name	FIRST INSURANCE GROUP OF MIDWEST

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47029 )

Policy contract number

12220727

Policy instance

Insurance contract or identification number	12220727
Number of Individuals Covered	38
Insurance policy start date	2013-08-01
Insurance policy end date	2014-07-31
Total amount of commissions paid to insurance broker	USD $823
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision 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 $823
Additional information about fees paid to insurance broker	BROKER COMMISSIONS AND FEES
Insurance broker organization code?	3
Insurance broker name	FIRST INSURANCE GROUP OF MIDWEST

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47029 )

Policy contract number

30032921

Policy instance

Insurance contract or identification number	30032921
Number of Individuals Covered	94
Insurance policy start date	2013-05-01
Insurance policy end date	2014-04-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CONSUMERS LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62375 )

Policy contract number

Policy instance

Number of Individuals Covered	130
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $1,596
Total amount of fees paid to insurance company	USD $665
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 $13,488
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,596
Amount paid for insurance broker fees	665
Additional information about fees paid to insurance broker	BROKER COMMISSIONS AND FEES
Insurance broker organization code?	3
Insurance broker name	FIRST INSURANCE GROUP OF MIDWEST

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

KM05731876

Policy instance

Insurance contract or identification number	KM05731876
Number of Individuals Covered	229
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $6,567
Total amount of fees paid to insurance company	USD $0
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
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $98,471
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,849
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	BROKER COMMISSIONS
Insurance broker organization code?	3
Insurance broker name	FIRST INSURANCE GROUP OF MIDWEST

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47029 )

Policy contract number

30032921

Policy instance

Insurance contract or identification number	30032921
Number of Individuals Covered	81
Insurance policy start date	2012-05-01
Insurance policy end date	2013-04-30
Total amount of commissions paid to insurance broker	USD $766
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision 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 $766
Additional information about fees paid to insurance broker	BROKER COMMISSIONS
Insurance broker organization code?	3
Insurance broker name	FIRST INSURANCE GROUP OF MIDWEST

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47029 )

Policy contract number

12220727

Policy instance

Insurance contract or identification number	12220727
Number of Individuals Covered	34
Insurance policy start date	2012-08-01
Insurance policy end date	2013-07-31
Total amount of commissions paid to insurance broker	USD $823
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision 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 $823
Additional information about fees paid to insurance broker	BROKER COMMISSIONS
Insurance broker organization code?	3
Insurance broker name	FIRST INSURANCE GROUP OF MIDWEST

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

KM05569277

Policy instance

Insurance contract or identification number	KM05569277
Number of Individuals Covered	112
Insurance policy start date	2012-09-01
Insurance policy end date	2013-08-31
Total amount of commissions paid to insurance broker	USD $1,881
Total amount of fees paid to insurance company	USD $0
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 $27,825
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,881
Additional information about fees paid to insurance broker	BROKER COMMISSIONS
Insurance broker organization code?	3
Insurance broker name	FIRST INSURANCE GROUP OF MIDWEST

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

Policy contract number

Policy instance

Number of Individuals Covered	112
Insurance policy start date	2012-10-01
Insurance policy end date	2013-09-30
Total amount of commissions paid to insurance broker	USD $27,963
Total amount of fees paid to insurance company	USD $33,498
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 $804
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $27,963
Amount paid for insurance broker fees	33498
Additional information about fees paid to insurance broker	BROKER COMMISSIONS AND FEES
Insurance broker organization code?	3
Insurance broker name	FIRST INSURANCE OF THE MIDWEST

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47029 )

Policy contract number

12255701

Policy instance

Insurance contract or identification number	12255701
Number of Individuals Covered	378
Insurance policy start date	2011-05-01
Insurance policy end date	2012-04-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

Policy instance

Number of Individuals Covered	110
Insurance policy start date	2011-10-01
Insurance policy end date	2012-09-30
Total amount of commissions paid to insurance broker	USD $29,926
Total amount of fees paid to insurance company	USD $5,345
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 $745,816
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $29,926
Amount paid for insurance broker fees	5345
Additional information about fees paid to insurance broker	BROKER COMMISSIONS AND FEES
Insurance broker organization code?	3
Insurance broker name	FIRST INSURANCE GROUP OF MIDWEST

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

Policy contract number

00171482

Policy instance

Insurance contract or identification number	00171482
Number of Individuals Covered	103
Insurance policy start date	2011-10-01
Insurance policy end date	2012-09-30
Total amount of commissions paid to insurance broker	USD $1,210
Total amount of fees paid to insurance company	USD $0
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
Welfare Benefit Premiums Paid to Carrier	USD $13,278
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,210
Additional information about fees paid to insurance broker	BROKER COMMISSIONS
Insurance broker organization code?	3
Insurance broker name	FIRST INSURANCE GROUP OF MIDWEST

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47029 )

Policy contract number

12220727

Policy instance

Insurance contract or identification number	12220727
Number of Individuals Covered	32
Insurance policy start date	2011-08-01
Insurance policy end date	2012-07-31
Total amount of commissions paid to insurance broker	USD $815
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision 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 $815
Additional information about fees paid to insurance broker	BROKER COMMISSIONS
Insurance broker organization code?	3
Insurance broker name	FIRST INSURANCE GROUP OF MIDWEST

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

KM05731876

Policy instance

Insurance contract or identification number	KM05731876
Number of Individuals Covered	219
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Total amount of commissions paid to insurance broker	USD $6,430
Total amount of fees paid to insurance company	USD $0
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
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $88,776
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,789
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	BROKER COMMISSIONS
Insurance broker organization code?	3
Insurance broker name	FIRST INSURANCE GROUP OF MIDWEST

CONSUMERS LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62375 )

Policy contract number

Policy instance

Number of Individuals Covered	113
Insurance policy start date	2012-10-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $379
Total amount of fees paid to insurance company	USD $158
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 $3,201
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $379
Amount paid for insurance broker fees	158
Additional information about fees paid to insurance broker	BROKER COMMISSIONS AND FEES
Insurance broker organization code?	3
Insurance broker name	FIRST INSURANCE GROUP OF MIDWEST

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

KM05569277

Policy instance

Insurance contract or identification number	KM05569277
Number of Individuals Covered	113
Insurance policy start date	2011-09-01
Insurance policy end date	2012-08-31
Total amount of commissions paid to insurance broker	USD $1,763
Total amount of fees paid to insurance company	USD $0
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
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $28,794
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,763
Additional information about fees paid to insurance broker	BROKER COMMISSIONS
Insurance broker organization code?	3
Insurance broker name	FIRST INSURANCE GROUP OF MIDWEST

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00369781

Policy instance

Insurance contract or identification number	00369781
Number of Individuals Covered	99
Insurance policy start date	2007-06-01
Insurance policy end date	2008-05-31
Total amount of commissions paid to insurance broker	USD $3,062
Total amount of fees paid to insurance company	USD $834
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $33,579
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,002
Amount paid for insurance broker fees	834
Additional information about fees paid to insurance broker	BROKER COMMISSIONS AND FEES
Insurance broker organization code?	3
Insurance broker name	LUCIDO-MORRIS & ASSO LLC

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47029 )

Policy contract number

12255701

Policy instance

Insurance contract or identification number	12255701
Number of Individuals Covered	416
Insurance policy start date	2007-05-01
Insurance policy end date	2008-04-30
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47029 )

Policy contract number

12220727

Policy instance

Insurance contract or identification number	12220727
Number of Individuals Covered	0
Insurance policy start date	2007-08-01
Insurance policy end date	2008-07-31
Total amount of commissions paid to insurance broker	USD $867
Total amount of fees paid to insurance company	USD $0
Vision 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 $867
Additional information about fees paid to insurance broker	BROKER COMMISSIONS
Insurance broker organization code?	3
Insurance broker name	R/L KING AGENCY

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

KM05569277

Policy instance

Insurance contract or identification number	KM05569277
Number of Individuals Covered	214
Insurance policy start date	2007-09-01
Insurance policy end date	2008-08-31
Total amount of commissions paid to insurance broker	USD $2,980
Total amount of fees paid to insurance company	USD $1,149
Dental Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $38,148
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,980
Amount paid for insurance broker fees	1149
Additional information about fees paid to insurance broker	COMMISSIONS AND FEES PAID TO BROKER
Insurance broker organization code?	3
Insurance broker name	R.L. KING AGENCY, INC.

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

Policy contract number

Policy instance

Number of Individuals Covered	102
Insurance policy start date	2007-06-01
Insurance policy end date	2008-05-31
Total amount of commissions paid to insurance broker	USD $35,146
Total amount of fees paid to insurance company	USD $0
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 $35,146
Additional information about fees paid to insurance broker	BROKER COMMISSIONS
Insurance broker organization code?	3
Insurance broker name	RON KING INSURANCE AGENCY

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

Policy contract number

Policy instance

Number of Individuals Covered	105
Insurance policy start date	2006-10-01
Insurance policy end date	2007-05-31
Total amount of commissions paid to insurance broker	USD $20,239
Total amount of fees paid to insurance company	USD $0
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 $20,239
Additional information about fees paid to insurance broker	BROKER COMMISSIONS
Insurance broker organization code?	3
Insurance broker name	RON KING INSURANCE AGENCY

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47029 )

Policy contract number

12255701

Policy instance

Insurance contract or identification number	12255701
Number of Individuals Covered	403
Insurance policy start date	2006-05-01
Insurance policy end date	2007-04-30
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47029 )

Policy contract number

12220727

Policy instance

Insurance contract or identification number	12220727
Number of Individuals Covered	41
Insurance policy start date	2006-08-01
Insurance policy end date	2007-07-31
Total amount of commissions paid to insurance broker	USD $883
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $13,736
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $883
Additional information about fees paid to insurance broker	BROKER COMMISSIONS
Insurance broker organization code?	3
Insurance broker name	R/L KING AGENCY

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00369781

Policy instance

Insurance contract or identification number	00369781
Number of Individuals Covered	109
Insurance policy start date	2006-06-01
Insurance policy end date	2007-05-31
Total amount of commissions paid to insurance broker	USD $2,699
Total amount of fees paid to insurance company	USD $707
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $28,673
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,646
Amount paid for insurance broker fees	707
Additional information about fees paid to insurance broker	BROKER COMMISSIONS AND FEES
Insurance broker organization code?	3
Insurance broker name	LUCIDO-MORRIS & ASSO LLC

Potentially related plans

BOHL COMPANIES 401(K) RETIREMENT PLAN [EIN = 341562071]

Was this data useful?

If you found the data here useful, PLEASE HELP US. We are a start-up and believe in making information freely available. By linking to us, posting on twitter, facebook and linkedin about us and generally spreading the word, you'll help us to grow. Our vision is to provide high quality data about the activities of all the companies in the world and where possible make it free to use and view. Finding and integrating data from thousands of data sources is time consuming and needs lots of effort. By simply spreading the word about us, you will help us. Please use the share buttons. It will only take a few seconds of your time. Thanks for helping

Information Disclaimer

The information provided on this website is not advice, endorsement or recommendation
The information published is supplied by third parties so we make no warranty on the accuracy, completeness etc. This information is provided "as-is". The information is subject to change as we obtain updates and corrections from the primary information sources.
You are free to use the information for your own personal research on the understanding to do so is at your own risk.

See full terms and conditions

Company Name:	BOHL EQUIPMENT COMPANY
Employer identification number (EIN):	344462234
NAIC Classification:	423800