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INDUSTRIAL HARD CHROME, LTD. LIFE AND AD&D INSURANCE 401k Plan overview

Plan NameINDUSTRIAL HARD CHROME, LTD. LIFE AND AD&D INSURANCE
Plan identification number 502

INDUSTRIAL HARD CHROME, LTD. LIFE AND AD&D INSURANCE Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover

401k Sponsoring company profile

INDUSTRIAL HARD CHROME, LTD. has sponsored the creation of one or more 401k plans.

Company Name:INDUSTRIAL HARD CHROME, LTD.
Employer identification number (EIN):363392489
NAIC Classification:332810

Form 5500 Filing Information

Submission information for form 5500 for 401k plan INDUSTRIAL HARD CHROME, LTD. LIFE AND AD&D INSURANCE

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022022-03-01
5022021-03-01
5022020-03-01
5022019-03-01
5022018-03-01
5022017-03-01AUSTIN PETERSON
5022016-03-01AUSTIN PETERSON
5022015-03-01AUSTIN PETERSON
5022014-03-01AUSTIN PETERSON
5022013-03-01RICHARD A PETERSON
5022012-03-01RICHARD A PETERSON
5022011-03-01RICHARD A PETERSON
5022010-03-01RICHARD A PETERSON
5022009-03-01RICHARD A PETERSON

Plan Statistics for INDUSTRIAL HARD CHROME, LTD. LIFE AND AD&D INSURANCE

401k plan membership statisitcs for INDUSTRIAL HARD CHROME, LTD. LIFE AND AD&D INSURANCE

Measure Date Value
2022: INDUSTRIAL HARD CHROME, LTD. LIFE AND AD&D INSURANCE 2022 401k membership
Total participants, beginning-of-year2022-03-01112
Total number of active participants reported on line 7a of the Form 55002022-03-01110
Total of all active and inactive participants2022-03-01110
2021: INDUSTRIAL HARD CHROME, LTD. LIFE AND AD&D INSURANCE 2021 401k membership
Total participants, beginning-of-year2021-03-01110
Total number of active participants reported on line 7a of the Form 55002021-03-01112
Total of all active and inactive participants2021-03-01112
2020: INDUSTRIAL HARD CHROME, LTD. LIFE AND AD&D INSURANCE 2020 401k membership
Total participants, beginning-of-year2020-03-01120
Total number of active participants reported on line 7a of the Form 55002020-03-01110
Total of all active and inactive participants2020-03-01110
Total participants2020-03-01110
2019: INDUSTRIAL HARD CHROME, LTD. LIFE AND AD&D INSURANCE 2019 401k membership
Total participants, beginning-of-year2019-03-01132
Total number of active participants reported on line 7a of the Form 55002019-03-01120
Total of all active and inactive participants2019-03-01120
Total participants2019-03-01120
2018: INDUSTRIAL HARD CHROME, LTD. LIFE AND AD&D INSURANCE 2018 401k membership
Total participants, beginning-of-year2018-03-01134
Total number of active participants reported on line 7a of the Form 55002018-03-01132
Total of all active and inactive participants2018-03-01132
Total participants2018-03-01132
2017: INDUSTRIAL HARD CHROME, LTD. LIFE AND AD&D INSURANCE 2017 401k membership
Total participants, beginning-of-year2017-03-01121
Total number of active participants reported on line 7a of the Form 55002017-03-01134
Total of all active and inactive participants2017-03-01134
Total participants2017-03-01134
2016: INDUSTRIAL HARD CHROME, LTD. LIFE AND AD&D INSURANCE 2016 401k membership
Total participants, beginning-of-year2016-03-01106
Total number of active participants reported on line 7a of the Form 55002016-03-01121
Total of all active and inactive participants2016-03-01121
Total participants2016-03-01121
2015: INDUSTRIAL HARD CHROME, LTD. LIFE AND AD&D INSURANCE 2015 401k membership
Total participants, beginning-of-year2015-03-01104
Total number of active participants reported on line 7a of the Form 55002015-03-01106
Total of all active and inactive participants2015-03-01106
Total participants2015-03-010
2014: INDUSTRIAL HARD CHROME, LTD. LIFE AND AD&D INSURANCE 2014 401k membership
Total participants, beginning-of-year2014-03-0197
Total number of active participants reported on line 7a of the Form 55002014-03-01104
Total of all active and inactive participants2014-03-01104
Total participants2014-03-010
2013: INDUSTRIAL HARD CHROME, LTD. LIFE AND AD&D INSURANCE 2013 401k membership
Total participants, beginning-of-year2013-03-0196
Total number of active participants reported on line 7a of the Form 55002013-03-0197
Total of all active and inactive participants2013-03-0197
Total participants2013-03-010
2012: INDUSTRIAL HARD CHROME, LTD. LIFE AND AD&D INSURANCE 2012 401k membership
Total participants, beginning-of-year2012-03-0193
Total number of active participants reported on line 7a of the Form 55002012-03-0196
Total of all active and inactive participants2012-03-0196
Total participants2012-03-010
2011: INDUSTRIAL HARD CHROME, LTD. LIFE AND AD&D INSURANCE 2011 401k membership
Total participants, beginning-of-year2011-03-0181
Total number of active participants reported on line 7a of the Form 55002011-03-0193
Total of all active and inactive participants2011-03-0193
Total participants2011-03-0193
2010: INDUSTRIAL HARD CHROME, LTD. LIFE AND AD&D INSURANCE 2010 401k membership
Total participants, beginning-of-year2010-03-0175
Total number of active participants reported on line 7a of the Form 55002010-03-0181
Total of all active and inactive participants2010-03-0181
Total participants2010-03-0181
2009: INDUSTRIAL HARD CHROME, LTD. LIFE AND AD&D INSURANCE 2009 401k membership
Total participants, beginning-of-year2009-03-0194
Total number of active participants reported on line 7a of the Form 55002009-03-0175
Total of all active and inactive participants2009-03-0175
Total participants2009-03-0175

Form 5500 Responses for INDUSTRIAL HARD CHROME, LTD. LIFE AND AD&D INSURANCE

2022: INDUSTRIAL HARD CHROME, LTD. LIFE AND AD&D INSURANCE 2022 form 5500 responses
2022-03-01Type of plan entitySingle employer plan
2022-03-01Plan funding arrangement – InsuranceYes
2022-03-01Plan funding arrangement – General assets of the sponsorYes
2022-03-01Plan benefit arrangement – InsuranceYes
2022-03-01Plan benefit arrangement – General assets of the sponsorYes
2021: INDUSTRIAL HARD CHROME, LTD. LIFE AND AD&D INSURANCE 2021 form 5500 responses
2021-03-01Type of plan entitySingle employer plan
2021-03-01Plan funding arrangement – InsuranceYes
2021-03-01Plan funding arrangement – General assets of the sponsorYes
2021-03-01Plan benefit arrangement – InsuranceYes
2021-03-01Plan benefit arrangement – General assets of the sponsorYes
2020: INDUSTRIAL HARD CHROME, LTD. LIFE AND AD&D INSURANCE 2020 form 5500 responses
2020-03-01Type of plan entitySingle employer plan
2020-03-01Plan funding arrangement – InsuranceYes
2020-03-01Plan funding arrangement – General assets of the sponsorYes
2020-03-01Plan benefit arrangement – InsuranceYes
2020-03-01Plan benefit arrangement – General assets of the sponsorYes
2019: INDUSTRIAL HARD CHROME, LTD. LIFE AND AD&D INSURANCE 2019 form 5500 responses
2019-03-01Type of plan entitySingle employer plan
2019-03-01Plan funding arrangement – InsuranceYes
2019-03-01Plan funding arrangement – General assets of the sponsorYes
2019-03-01Plan benefit arrangement – InsuranceYes
2019-03-01Plan benefit arrangement – General assets of the sponsorYes
2018: INDUSTRIAL HARD CHROME, LTD. LIFE AND AD&D INSURANCE 2018 form 5500 responses
2018-03-01Type of plan entitySingle employer plan
2018-03-01Plan funding arrangement – InsuranceYes
2018-03-01Plan funding arrangement – General assets of the sponsorYes
2018-03-01Plan benefit arrangement – InsuranceYes
2018-03-01Plan benefit arrangement – General assets of the sponsorYes
2017: INDUSTRIAL HARD CHROME, LTD. LIFE AND AD&D INSURANCE 2017 form 5500 responses
2017-03-01Type of plan entitySingle employer plan
2017-03-01Plan funding arrangement – InsuranceYes
2017-03-01Plan funding arrangement – General assets of the sponsorYes
2017-03-01Plan benefit arrangement – InsuranceYes
2017-03-01Plan benefit arrangement – General assets of the sponsorYes
2016: INDUSTRIAL HARD CHROME, LTD. LIFE AND AD&D INSURANCE 2016 form 5500 responses
2016-03-01Type of plan entitySingle employer plan
2016-03-01Plan funding arrangement – InsuranceYes
2016-03-01Plan funding arrangement – General assets of the sponsorYes
2016-03-01Plan benefit arrangement – InsuranceYes
2016-03-01Plan benefit arrangement – General assets of the sponsorYes
2015: INDUSTRIAL HARD CHROME, LTD. LIFE AND AD&D INSURANCE 2015 form 5500 responses
2015-03-01Type of plan entitySingle employer plan
2015-03-01Plan funding arrangement – InsuranceYes
2015-03-01Plan funding arrangement – General assets of the sponsorYes
2015-03-01Plan benefit arrangement – InsuranceYes
2015-03-01Plan benefit arrangement – General assets of the sponsorYes
2014: INDUSTRIAL HARD CHROME, LTD. LIFE AND AD&D INSURANCE 2014 form 5500 responses
2014-03-01Type of plan entitySingle employer plan
2014-03-01Plan funding arrangement – InsuranceYes
2014-03-01Plan funding arrangement – General assets of the sponsorYes
2014-03-01Plan benefit arrangement – InsuranceYes
2014-03-01Plan benefit arrangement – General assets of the sponsorYes
2013: INDUSTRIAL HARD CHROME, LTD. LIFE AND AD&D INSURANCE 2013 form 5500 responses
2013-03-01Type of plan entitySingle employer plan
2013-03-01Plan funding arrangement – InsuranceYes
2013-03-01Plan funding arrangement – General assets of the sponsorYes
2013-03-01Plan benefit arrangement – InsuranceYes
2013-03-01Plan benefit arrangement – General assets of the sponsorYes
2012: INDUSTRIAL HARD CHROME, LTD. LIFE AND AD&D INSURANCE 2012 form 5500 responses
2012-03-01Type of plan entitySingle employer plan
2012-03-01Plan funding arrangement – InsuranceYes
2012-03-01Plan funding arrangement – General assets of the sponsorYes
2012-03-01Plan benefit arrangement – InsuranceYes
2012-03-01Plan benefit arrangement – General assets of the sponsorYes
2011: INDUSTRIAL HARD CHROME, LTD. LIFE AND AD&D INSURANCE 2011 form 5500 responses
2011-03-01Type of plan entitySingle employer plan
2011-03-01Plan funding arrangement – InsuranceYes
2011-03-01Plan funding arrangement – General assets of the sponsorYes
2011-03-01Plan benefit arrangement – InsuranceYes
2011-03-01Plan benefit arrangement – General assets of the sponsorYes
2010: INDUSTRIAL HARD CHROME, LTD. LIFE AND AD&D INSURANCE 2010 form 5500 responses
2010-03-01Type of plan entitySingle employer plan
2010-03-01Plan funding arrangement – InsuranceYes
2010-03-01Plan funding arrangement – General assets of the sponsorYes
2010-03-01Plan benefit arrangement – InsuranceYes
2010-03-01Plan benefit arrangement – General assets of the sponsorYes
2009: INDUSTRIAL HARD CHROME, LTD. LIFE AND AD&D INSURANCE 2009 form 5500 responses
2009-03-01Type of plan entitySingle employer plan
2009-03-01Plan funding arrangement – InsuranceYes
2009-03-01Plan funding arrangement – General assets of the sponsorYes
2009-03-01Plan benefit arrangement – InsuranceYes
2009-03-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number10251892
Policy instance 5
Insurance contract or identification number10251892
Number of Individuals Covered110
Insurance policy start date2022-03-01
Insurance policy end date2023-02-28
Total amount of commissions paid to insurance brokerUSD $618
Total amount of fees paid to insurance companyUSD $116
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $4,650
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $618
Amount paid for insurance broker fees116
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number10252040
Policy instance 4
Insurance contract or identification number10252040
Number of Individuals Covered23
Insurance policy start date2022-03-01
Insurance policy end date2023-02-28
Total amount of commissions paid to insurance brokerUSD $701
Total amount of fees paid to insurance companyUSD $116
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedWEEKLY INCOME
Welfare Benefit Premiums Paid to CarrierUSD $7,013
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $701
Amount paid for insurance broker fees116
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number25051
Policy instance 3
Insurance contract or identification number25051
Number of Individuals Covered58
Insurance policy start date2022-03-01
Insurance policy end date2023-02-28
Total amount of commissions paid to insurance brokerUSD $6,427
Total amount of fees paid to insurance companyUSD $116
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $42,847
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,427
Amount paid for insurance broker fees116
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number10251893
Policy instance 2
Insurance contract or identification number10251893
Number of Individuals Covered37
Insurance policy start date2022-03-01
Insurance policy end date2023-02-28
Total amount of commissions paid to insurance brokerUSD $1,656
Total amount of fees paid to insurance companyUSD $116
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedWEEKLY INCOME
Welfare Benefit Premiums Paid to CarrierUSD $15,570
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,656
Amount paid for insurance broker fees116
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number10251891
Policy instance 1
Insurance contract or identification number10251891
Number of Individuals Covered38
Insurance policy start date2022-03-01
Insurance policy end date2023-02-28
Total amount of commissions paid to insurance brokerUSD $1,720
Total amount of fees paid to insurance companyUSD $116
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $11,649
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,720
Amount paid for insurance broker fees116
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number10251891
Policy instance 1
Insurance contract or identification number10251891
Number of Individuals Covered39
Insurance policy start date2021-03-01
Insurance policy end date2022-02-28
Total amount of commissions paid to insurance brokerUSD $2,151
Total amount of fees paid to insurance companyUSD $100
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $14,343
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,151
Amount paid for insurance broker fees100
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number10251893
Policy instance 2
Insurance contract or identification number10251893
Number of Individuals Covered40
Insurance policy start date2021-03-01
Insurance policy end date2022-02-28
Total amount of commissions paid to insurance brokerUSD $1,508
Total amount of fees paid to insurance companyUSD $106
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedWEEKLY INCOME
Welfare Benefit Premiums Paid to CarrierUSD $13,728
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,508
Amount paid for insurance broker fees106
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number25051
Policy instance 3
Insurance contract or identification number25051
Number of Individuals Covered60
Insurance policy start date2021-03-01
Insurance policy end date2022-02-28
Total amount of commissions paid to insurance brokerUSD $5,853
Total amount of fees paid to insurance companyUSD $299
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $39,015
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,853
Amount paid for insurance broker fees299
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number10252040
Policy instance 4
Insurance contract or identification number10252040
Number of Individuals Covered23
Insurance policy start date2021-03-01
Insurance policy end date2022-02-28
Total amount of commissions paid to insurance brokerUSD $577
Total amount of fees paid to insurance companyUSD $55
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedWEEKLY INCOME
Welfare Benefit Premiums Paid to CarrierUSD $5,766
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $577
Amount paid for insurance broker fees55
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number10251892
Policy instance 5
Insurance contract or identification number10251892
Number of Individuals Covered112
Insurance policy start date2021-03-01
Insurance policy end date2022-02-28
Total amount of commissions paid to insurance brokerUSD $528
Total amount of fees paid to insurance companyUSD $34
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,899
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $528
Amount paid for insurance broker fees34
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number10251892
Policy instance 6
Insurance contract or identification number10251892
Number of Individuals Covered110
Insurance policy start date2020-03-01
Insurance policy end date2021-02-28
Total amount of commissions paid to insurance brokerUSD $604
Total amount of fees paid to insurance companyUSD $210
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $4,537
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $604
Amount paid for insurance broker fees210
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number10252040
Policy instance 5
Insurance contract or identification number10252040
Number of Individuals Covered26
Insurance policy start date2020-03-01
Insurance policy end date2021-02-28
Total amount of commissions paid to insurance brokerUSD $729
Total amount of fees paid to insurance companyUSD $320
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedWEEKLY INCOME
Welfare Benefit Premiums Paid to CarrierUSD $7,291
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $729
Amount paid for insurance broker fees320
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number403007303
Policy instance 4
Insurance contract or identification number403007303
Number of Individuals Covered62
Insurance policy start date2020-03-01
Insurance policy end date2021-02-28
Total amount of commissions paid to insurance brokerUSD $456
Total amount of fees paid to insurance companyUSD $130
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,039
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $456
Amount paid for insurance broker fees130
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number25051
Policy instance 3
Insurance contract or identification number25051
Number of Individuals Covered62
Insurance policy start date2020-03-01
Insurance policy end date2021-02-28
Total amount of commissions paid to insurance brokerUSD $6,242
Total amount of fees paid to insurance companyUSD $1,571
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $41,612
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,242
Amount paid for insurance broker fees1571
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number10251893
Policy instance 2
Insurance contract or identification number10251893
Number of Individuals Covered35
Insurance policy start date2020-03-01
Insurance policy end date2021-02-28
Total amount of commissions paid to insurance brokerUSD $1,545
Total amount of fees paid to insurance companyUSD $609
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $14,187
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,545
Amount paid for insurance broker fees609
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number10251891
Policy instance 1
Insurance contract or identification number10251891
Number of Individuals Covered38
Insurance policy start date2020-03-01
Insurance policy end date2021-02-28
Total amount of commissions paid to insurance brokerUSD $2,053
Total amount of fees paid to insurance companyUSD $564
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $13,687
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,053
Amount paid for insurance broker fees564
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number10251892
Policy instance 4
Insurance contract or identification number10251892
Number of Individuals Covered120
Insurance policy start date2019-03-01
Insurance policy end date2020-02-29
Total amount of commissions paid to insurance brokerUSD $612
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $4,596
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $377
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number10251893
Policy instance 3
Insurance contract or identification number10251893
Number of Individuals Covered39
Insurance policy start date2019-03-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $1,347
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $11,707
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $984
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number10251891
Policy instance 2
Insurance contract or identification number10251891
Number of Individuals Covered39
Insurance policy start date2019-03-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $1,614
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $10,758
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,092
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00455882
Policy instance 1
Insurance contract or identification number00455882
Number of Individuals Covered90
Insurance policy start date2019-03-01
Insurance policy end date2020-02-28
Total amount of commissions paid to insurance brokerUSD $5,660
Total amount of fees paid to insurance companyUSD $1,570
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $76,308
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,420
Amount paid for insurance broker fees1570
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00455882
Policy instance 1
Insurance contract or identification number00455882
Number of Individuals Covered99
Insurance policy start date2018-03-01
Insurance policy end date2019-02-28
Total amount of commissions paid to insurance brokerUSD $5,851
Total amount of fees paid to insurance companyUSD $1,126
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $79,191
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,851
Amount paid for insurance broker fees1126
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AKWX
Policy instance 2
Insurance contract or identification numberG000AKWX
Number of Individuals Covered132
Insurance policy start date2018-03-01
Insurance policy end date2019-02-28
Total amount of commissions paid to insurance brokerUSD $10,220
Total amount of fees paid to insurance companyUSD $3,715
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $80,580
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,220
Amount paid for insurance broker fees3715
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AKWX
Policy instance 2
Insurance contract or identification numberG000AKWX
Number of Individuals Covered134
Insurance policy start date2017-03-01
Insurance policy end date2018-02-28
Total amount of commissions paid to insurance brokerUSD $9,612
Total amount of fees paid to insurance companyUSD $3,455
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $74,434
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,612
Amount paid for insurance broker fees3455
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
Insurance broker nameCLEAR INSIGHT BENEFITS CONSULTING
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00455882
Policy instance 1
Insurance contract or identification number00455882
Number of Individuals Covered105
Insurance policy start date2017-03-01
Insurance policy end date2018-02-28
Total amount of commissions paid to insurance brokerUSD $5,519
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $74,515
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,519
Insurance broker organization code?3
Insurance broker nameCLEAR INSIGHT BENEFITS CONSULTING
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AKWX
Policy instance 2
Insurance contract or identification numberG000AKWX
Number of Individuals Covered106
Insurance policy start date2015-03-01
Insurance policy end date2016-02-28
Total amount of commissions paid to insurance brokerUSD $8,459
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $63,952
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,459
Insurance broker organization code?3
Insurance broker nameCLEAR INSIGHT BENEFITS CONSULTING
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00455882
Policy instance 1
Insurance contract or identification number00455882
Number of Individuals Covered75
Insurance policy start date2015-03-01
Insurance policy end date2016-02-28
Total amount of commissions paid to insurance brokerUSD $3,963
Total amount of fees paid to insurance companyUSD $1,290
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $53,442
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,963
Insurance broker organization code?3
Amount paid for insurance broker fees1290
Additional information about fees paid to insurance brokerBROKER FEES
Insurance broker nameVERITAS RISK SERVICES, LLC
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00455882
Policy instance 1
Insurance contract or identification number00455882
Number of Individuals Covered62
Insurance policy start date2014-03-01
Insurance policy end date2015-02-28
Total amount of commissions paid to insurance brokerUSD $3,467
Total amount of fees paid to insurance companyUSD $1,413
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $46,767
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,157
Amount paid for insurance broker fees1413
Additional information about fees paid to insurance brokerBROKER FEES
Insurance broker organization code?3
Insurance broker nameTHE HUNKEN AGENCY, INC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AKWX
Policy instance 2
Insurance contract or identification numberG000AKWX
Number of Individuals Covered104
Insurance policy start date2014-03-01
Insurance policy end date2015-02-28
Total amount of commissions paid to insurance brokerUSD $7,366
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $54,725
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,124
Insurance broker organization code?3
Insurance broker nameCLEAR INSIGHT BENEFITS CONSULTING
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00455882
Policy instance 1
Insurance contract or identification number00455882
Number of Individuals Covered55
Insurance policy start date2013-03-01
Insurance policy end date2014-02-28
Total amount of commissions paid to insurance brokerUSD $3,199
Total amount of fees paid to insurance companyUSD $1,321
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $43,450
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,169
Amount paid for insurance broker fees1321
Additional information about fees paid to insurance brokerBROKER FEES
Insurance broker organization code?3
Insurance broker nameTHE HUNKEN AGENCY, INC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AKWX
Policy instance 2
Insurance contract or identification numberG000AKWX
Number of Individuals Covered97
Insurance policy start date2013-03-01
Insurance policy end date2014-02-28
Total amount of commissions paid to insurance brokerUSD $7,319
Total amount of fees paid to insurance companyUSD $1,112
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $54,269
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,319
Amount paid for insurance broker fees1112
Additional information about fees paid to insurance brokerBROKER FEES
Insurance broker organization code?3
Insurance broker nameVERITAS RISK SERVICES, LLC
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00455882
Policy instance 2
Insurance contract or identification number00455882
Number of Individuals Covered59
Insurance policy start date2012-03-01
Insurance policy end date2013-02-28
Total amount of commissions paid to insurance brokerUSD $3,290
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $44,680
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $30
Insurance broker organization code?3
Insurance broker nameVERITAS RISK SERVICES, LLC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AKWX
Policy instance 1
Insurance contract or identification numberG000AKWX
Number of Individuals Covered96
Insurance policy start date2012-03-01
Insurance policy end date2013-02-28
Total amount of commissions paid to insurance brokerUSD $7,254
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $53,964
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,254
Insurance broker organization code?3
Insurance broker nameVERITAS RISK SERVICES, LLC
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00455882
Policy instance 1
Insurance contract or identification number00455882
Number of Individuals Covered93
Insurance policy start date2011-03-01
Insurance policy end date2012-02-29
Total amount of commissions paid to insurance brokerUSD $5,493
Total amount of fees paid to insurance companyUSD $1,675
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $57,140
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number06362
Policy instance 2
Insurance contract or identification number06362
Number of Individuals Covered40
Insurance policy start date2011-03-01
Insurance policy end date2012-02-29
Total amount of commissions paid to insurance brokerUSD $2,930
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $24,298
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00455882
Policy instance 1
Insurance contract or identification number00455882
Number of Individuals Covered61
Insurance policy start date2010-03-01
Insurance policy end date2011-02-28
Total amount of commissions paid to insurance brokerUSD $4,105
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $44,778
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,105
Insurance broker organization code?3
Insurance broker nameVERITAS RISK SERVICES, LLC
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL 136668
Policy instance 3
Insurance contract or identification numberGL 136668
Number of Individuals Covered81
Insurance policy start date2010-03-01
Insurance policy end date2011-02-28
Total amount of commissions paid to insurance brokerUSD $846
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $5,640
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $846
Insurance broker organization code?3
Insurance broker nameVERITAS RISK SERVICES, LLC
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number06362
Policy instance 2
Insurance contract or identification number06362
Number of Individuals Covered39
Insurance policy start date2010-03-01
Insurance policy end date2011-02-28
Total amount of commissions paid to insurance brokerUSD $2,809
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $23,085
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,809
Insurance broker organization code?3
Insurance broker nameVERITAS RISK SERVICES, LLC

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