401k Plan data: NIEMANN FOODS INC EMPLOYEE HEALTH CARE PLAN plan

NIEMANN FOODS INC EMPLOYEE HEALTH CARE PLAN 401k Plan overview

Plan Name	NIEMANN FOODS INC EMPLOYEE HEALTH CARE PLAN
Plan identification number	501

NIEMANN FOODS INC EMPLOYEE HEALTH CARE 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

401k Sponsoring company profile

NIEMANN FOODS, INC. has sponsored the creation of one or more 401k plans.

Company Name: NIEMANN FOODS, INC.

Employer identification number (EIN): 370475125

NAIC Classification: 445110
NAIC Description: Supermarkets and Other Grocery (except Convenience) Stores

Form 5500 Filing Information

Submission information for form 5500 for 401k plan NIEMANN FOODS INC EMPLOYEE HEALTH CARE 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 CHRISTOPHER J NIEMANN
501 2016-01-01 CHRISTOPHER J NIEMANN
501 2015-01-01 CHRISTOPHER J NIEMANN
501 2014-01-01 CHRISTOPHER J. NIEMANN
501 2013-01-01 CHRISTOPHER J. NIEMANN
501 2012-01-01 CHRISTOPHER J. NIEMANN
501 2011-01-01 CHRISTOPHER J NIEMANN
501 2009-01-01 CHRISTOPHER NIEMANN
501 2009-01-01 CHRISTOPHER NIEMANN 2010-10-08

Plan Statistics for NIEMANN FOODS INC EMPLOYEE HEALTH CARE PLAN

401k plan membership statisitcs for NIEMANN FOODS INC EMPLOYEE HEALTH CARE PLAN

Measure Date Value
2022: NIEMANN FOODS INC EMPLOYEE HEALTH CARE PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 999
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 1,216
Number of retired or separated participants receiving benefits 2022-01-01 5
Number of other retired or separated participants entitled to future benefits 2022-01-01 260
Total of all active and inactive participants 2022-01-01 1,481
2021: NIEMANN FOODS INC EMPLOYEE HEALTH CARE PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 1,236
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 971
Number of retired or separated participants receiving benefits 2021-01-01 12
Number of other retired or separated participants entitled to future benefits 2021-01-01 16
Total of all active and inactive participants 2021-01-01 999
2020: NIEMANN FOODS INC EMPLOYEE HEALTH CARE PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 1,284
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 1,205
Number of retired or separated participants receiving benefits 2020-01-01 11
Number of other retired or separated participants entitled to future benefits 2020-01-01 0
Total of all active and inactive participants 2020-01-01 1,216
2019: NIEMANN FOODS INC EMPLOYEE HEALTH CARE PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 1,123
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 1,281
Number of retired or separated participants receiving benefits 2019-01-01 3
Number of other retired or separated participants entitled to future benefits 2019-01-01 0
Total of all active and inactive participants 2019-01-01 1,284
2018: NIEMANN FOODS INC EMPLOYEE HEALTH CARE PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 1,121
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 1,121
Number of retired or separated participants receiving benefits 2018-01-01 2
Number of other retired or separated participants entitled to future benefits 2018-01-01 0
Total of all active and inactive participants 2018-01-01 1,123
2017: NIEMANN FOODS INC EMPLOYEE HEALTH CARE PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 1,161
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 1,121
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 0
Total of all active and inactive participants 2017-01-01 1,121
2016: NIEMANN FOODS INC EMPLOYEE HEALTH CARE PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 1,044
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 1,161
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 1,161
2015: NIEMANN FOODS INC EMPLOYEE HEALTH CARE PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 1,065
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 1,044
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 1,044
2014: NIEMANN FOODS INC EMPLOYEE HEALTH CARE PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 1,082
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 1,058
Number of retired or separated participants receiving benefits 2014-01-01 7
Total of all active and inactive participants 2014-01-01 1,065
Total participants 2014-01-01 0
2013: NIEMANN FOODS INC EMPLOYEE HEALTH CARE PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 1,039
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 1,082
Number of retired or separated participants receiving benefits 2013-01-01 12
Total of all active and inactive participants 2013-01-01 1,094
Total participants 2013-01-01 0
2012: NIEMANN FOODS INC EMPLOYEE HEALTH CARE PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 1,031
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 1,030
Number of retired or separated participants receiving benefits 2012-01-01 9
Total of all active and inactive participants 2012-01-01 1,039
Total participants 2012-01-01 0
2011: NIEMANN FOODS INC EMPLOYEE HEALTH CARE PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 1,009
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 1,021
Number of retired or separated participants receiving benefits 2011-01-01 10
Total of all active and inactive participants 2011-01-01 1,031
Total participants 2011-01-01 1,031
2009: NIEMANN FOODS INC EMPLOYEE HEALTH CARE PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 974
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 1,004
Number of retired or separated participants receiving benefits 2009-01-01 13
Number of other retired or separated participants entitled to future benefits 2009-01-01 0
Total of all active and inactive participants 2009-01-01 1,017

Measure	Date	Value
2022: NIEMANN FOODS INC EMPLOYEE HEALTH CARE PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	999
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	1,216
Number of retired or separated participants receiving benefits	2022-01-01	5
Number of other retired or separated participants entitled to future benefits	2022-01-01	260
Total of all active and inactive participants	2022-01-01	1,481
2021: NIEMANN FOODS INC EMPLOYEE HEALTH CARE PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	1,236
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	971
Number of retired or separated participants receiving benefits	2021-01-01	12
Number of other retired or separated participants entitled to future benefits	2021-01-01	16
Total of all active and inactive participants	2021-01-01	999
2020: NIEMANN FOODS INC EMPLOYEE HEALTH CARE PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	1,284
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	1,205
Number of retired or separated participants receiving benefits	2020-01-01	11
Number of other retired or separated participants entitled to future benefits	2020-01-01	0
Total of all active and inactive participants	2020-01-01	1,216
2019: NIEMANN FOODS INC EMPLOYEE HEALTH CARE PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	1,123
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	1,281
Number of retired or separated participants receiving benefits	2019-01-01	3
Number of other retired or separated participants entitled to future benefits	2019-01-01	0
Total of all active and inactive participants	2019-01-01	1,284
2018: NIEMANN FOODS INC EMPLOYEE HEALTH CARE PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	1,121
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	1,121
Number of retired or separated participants receiving benefits	2018-01-01	2
Number of other retired or separated participants entitled to future benefits	2018-01-01	0
Total of all active and inactive participants	2018-01-01	1,123
2017: NIEMANN FOODS INC EMPLOYEE HEALTH CARE PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	1,161
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	1,121
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	0
Total of all active and inactive participants	2017-01-01	1,121
2016: NIEMANN FOODS INC EMPLOYEE HEALTH CARE PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	1,044
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	1,161
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	1,161
2015: NIEMANN FOODS INC EMPLOYEE HEALTH CARE PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	1,065
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	1,044
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	1,044
2014: NIEMANN FOODS INC EMPLOYEE HEALTH CARE PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	1,082
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	1,058
Number of retired or separated participants receiving benefits	2014-01-01	7
Total of all active and inactive participants	2014-01-01	1,065
Total participants	2014-01-01	0
2013: NIEMANN FOODS INC EMPLOYEE HEALTH CARE PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	1,039
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	1,082
Number of retired or separated participants receiving benefits	2013-01-01	12
Total of all active and inactive participants	2013-01-01	1,094
Total participants	2013-01-01	0
2012: NIEMANN FOODS INC EMPLOYEE HEALTH CARE PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	1,031
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	1,030
Number of retired or separated participants receiving benefits	2012-01-01	9
Total of all active and inactive participants	2012-01-01	1,039
Total participants	2012-01-01	0
2011: NIEMANN FOODS INC EMPLOYEE HEALTH CARE PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	1,009
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	1,021
Number of retired or separated participants receiving benefits	2011-01-01	10
Total of all active and inactive participants	2011-01-01	1,031
Total participants	2011-01-01	1,031
2009: NIEMANN FOODS INC EMPLOYEE HEALTH CARE PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	974
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	1,004
Number of retired or separated participants receiving benefits	2009-01-01	13
Number of other retired or separated participants entitled to future benefits	2009-01-01	0
Total of all active and inactive participants	2009-01-01	1,017

Form 5500 Responses for NIEMANN FOODS INC EMPLOYEE HEALTH CARE PLAN

2022: NIEMANN FOODS INC EMPLOYEE HEALTH CARE 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: NIEMANN FOODS INC EMPLOYEE HEALTH CARE 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: NIEMANN FOODS INC EMPLOYEE HEALTH CARE 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: NIEMANN FOODS INC EMPLOYEE HEALTH CARE 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: NIEMANN FOODS INC EMPLOYEE HEALTH CARE 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: NIEMANN FOODS INC EMPLOYEE HEALTH CARE 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: NIEMANN FOODS INC EMPLOYEE HEALTH CARE 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: NIEMANN FOODS INC EMPLOYEE HEALTH CARE 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: NIEMANN FOODS INC EMPLOYEE HEALTH CARE 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: NIEMANN FOODS INC EMPLOYEE HEALTH CARE 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: NIEMANN FOODS INC EMPLOYEE HEALTH CARE 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
2011: NIEMANN FOODS INC EMPLOYEE HEALTH CARE PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2009: NIEMANN FOODS INC EMPLOYEE HEALTH CARE PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	Yes
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

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

Policy contract number

0230498

Policy instance

Insurance contract or identification number	0230498
Number of Individuals Covered	1387
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $32,243
Total amount of fees paid to insurance company	USD $19,419
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $351,265
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $32,243
Amount paid for insurance broker fees	18207
Insurance broker organization code?	3

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

Policy contract number

0230783

Policy instance

Insurance contract or identification number	0230783
Number of Individuals Covered	261
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $5,155
Total amount of fees paid to insurance company	USD $1,484
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $27,753
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,155
Amount paid for insurance broker fees	1387
Additional information about fees paid to insurance broker	ADDL COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

0230782

Policy instance

Insurance contract or identification number	0230782
Number of Individuals Covered	307
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $14,601
Total amount of fees paid to insurance company	USD $4,178
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $77,859
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,601
Amount paid for insurance broker fees	3904
Insurance broker organization code?	3

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

Policy contract number

0230784

Policy instance

Insurance contract or identification number	0230784
Number of Individuals Covered	161
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $6,862
Total amount of fees paid to insurance company	USD $2,078
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $36,392
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,862
Amount paid for insurance broker fees	1952
Insurance broker organization code?	3

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

667035

Policy instance

Insurance contract or identification number	667035
Number of Individuals Covered	1216
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $55,770
Total amount of fees paid to insurance company	USD $16,933
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $713,455
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $55,770
Amount paid for insurance broker fees	16933
Additional information about fees paid to insurance broker	SPECIAL PROGRAMS
Insurance broker organization code?	3

DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )

Policy contract number

VF025956

Policy instance

Insurance contract or identification number	VF025956
Number of Individuals Covered	1348
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $66,543
Total amount of fees paid to insurance company	USD $30,000
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $580,825
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $66,543
Amount paid for insurance broker fees	30000
Additional information about fees paid to insurance broker	ADDL COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

0230498

Policy instance

Insurance contract or identification number	0230498
Number of Individuals Covered	1426
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $29,472
Total amount of fees paid to insurance company	USD $6,111
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $351,960
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $29,472
Amount paid for insurance broker fees	6111
Insurance broker organization code?	3

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

Policy contract number

0230784

Policy instance

Insurance contract or identification number	0230784
Number of Individuals Covered	189
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $6,722
Total amount of fees paid to insurance company	USD $778
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $40,306
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,722
Amount paid for insurance broker fees	778
Insurance broker organization code?	3

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

Policy contract number

0230782

Policy instance

Insurance contract or identification number	0230782
Number of Individuals Covered	344
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $13,209
Total amount of fees paid to insurance company	USD $1,441
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $79,537
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,209
Amount paid for insurance broker fees	1441
Insurance broker organization code?	3

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

Policy contract number

0230783

Policy instance

Insurance contract or identification number	0230783
Number of Individuals Covered	279
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $4,845
Total amount of fees paid to insurance company	USD $587
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $28,995
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,845
Amount paid for insurance broker fees	587
Additional information about fees paid to insurance broker	ADDL COMPENSATION
Insurance broker organization code?	3

DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )

Policy contract number

VF025956

Policy instance

Insurance contract or identification number	VF025956
Number of Individuals Covered	1346
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $51,573
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $450,214
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $51,573

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

667035

Policy instance

Insurance contract or identification number	667035
Number of Individuals Covered	1312
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $58,405
Total amount of fees paid to insurance company	USD $18,408
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $700,904
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $58,405
Amount paid for insurance broker fees	18408
Additional information about fees paid to insurance broker	SPECIAL PROGRAMS
Insurance broker organization code?	3

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

Policy contract number

586960

Policy instance

Insurance contract or identification number	586960
Number of Individuals Covered	258
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $6,689
Total amount of fees paid to insurance company	USD $1,004
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $114,134
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,689
Amount paid for insurance broker fees	1004
Additional information about fees paid to insurance broker	ADDL COMPENSATION
Insurance broker organization code?	3

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

667035

Policy instance

Insurance contract or identification number	667035
Number of Individuals Covered	1424
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $61,240
Total amount of fees paid to insurance company	USD $13,715
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $667,184
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $61,240
Amount paid for insurance broker fees	13715
Additional information about fees paid to insurance broker	SPECIAL PROGRAMS
Insurance broker organization code?	3

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

Policy contract number

0219638

Policy instance

Insurance contract or identification number	0219638
Number of Individuals Covered	1195
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $3,256
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $68,350
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,256
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 )

Policy contract number

30011125

Policy instance

Insurance contract or identification number	30011125
Number of Individuals Covered	789
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $2,336
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 $2,336
Insurance broker organization code?	3

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

667035

Policy instance

Insurance contract or identification number	667035
Number of Individuals Covered	1503
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $65,700
Total amount of fees paid to insurance company	USD $14,586
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $566,052
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $65,700
Amount paid for insurance broker fees	14586
Additional information about fees paid to insurance broker	SPECIAL PROGRAMS
Insurance broker organization code?	3

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

Policy contract number

0219638

Policy instance

Insurance contract or identification number	0219638
Number of Individuals Covered	1281
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $6,154
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $73,903
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,154
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 )

Policy contract number

30011125

Policy instance

Insurance contract or identification number	30011125
Number of Individuals Covered	831
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $2,083
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 $2,083
Insurance broker organization code?	3

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

Policy contract number

586960

Policy instance

Insurance contract or identification number	586960
Number of Individuals Covered	293
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $3,584
Total amount of fees paid to insurance company	USD $745
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $119,100
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,584
Amount paid for insurance broker fees	745
Additional information about fees paid to insurance broker	ADDL COMPENSATION
Insurance broker organization code?	3

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

200868

Policy instance

Insurance contract or identification number	200868
Number of Individuals Covered	1400
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $8,504
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $56,695
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,504
Insurance broker organization code?	3

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

667035

Policy instance

Insurance contract or identification number	667035
Number of Individuals Covered	1688
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $65,840
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $421,303
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $65,840
Additional information about fees paid to insurance broker	SPECIAL PROGRAMS 11160
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 )

Policy contract number

30011125

Policy instance

Insurance contract or identification number	30011125
Number of Individuals Covered	909
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $2,550
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 $2,550
Insurance broker organization code?	3

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

Policy contract number

586960

Policy instance

Insurance contract or identification number	586960
Number of Individuals Covered	328
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $6,577
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $116,775
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,577
Insurance broker organization code?	3

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

Policy contract number

586960

Policy instance

Insurance contract or identification number	586960
Number of Individuals Covered	337
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $3,691
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $105,647
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,691
Insurance broker organization code?	3
Insurance broker name	WARD FINANCIAL SERVICES INC

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 )

Policy contract number

30011125

Policy instance

Insurance contract or identification number	30011125
Number of Individuals Covered	891
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $2,603
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 $2,603
Insurance broker organization code?	3
Insurance broker name	HEARTLAND HEALTHCARE COALITION

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

200868

Policy instance

Insurance contract or identification number	200868
Number of Individuals Covered	1415
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $9,019
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $60,127
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,019
Insurance broker organization code?	3
Insurance broker name	R W GARRETT AGENCY INC

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

667035

Policy instance

Insurance contract or identification number	667035
Number of Individuals Covered	1734
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $68,680
Total amount of fees paid to insurance company	USD $11,920
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $439,454
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $68,680
Amount paid for insurance broker fees	11920
Additional information about fees paid to insurance broker	SPECIAL PROGRAMS
Insurance broker organization code?	3
Insurance broker name	COTTINGHAM & BUTLER INS SERVS INC

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

P67037

Policy instance

Insurance contract or identification number	P67037
Number of Individuals Covered	1772
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $63,190
Total amount of fees paid to insurance company	USD $9,585
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $383,219
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $63,190
Amount paid for insurance broker fees	9585
Additional information about fees paid to insurance broker	SPECIAL PROGRAMS
Insurance broker organization code?	3
Insurance broker name	COTTINGHAM & BUTLER INS SERVS INC

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

200868

Policy instance

Insurance contract or identification number	200868
Number of Individuals Covered	1410
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $9,004
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $59,155
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,873
Insurance broker organization code?	3
Insurance broker name	UNITED BENEFITS ADVISORS INC

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 )

Policy contract number

30011125

Policy instance

Insurance contract or identification number	30011125
Number of Individuals Covered	851
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $916
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 $916
Insurance broker organization code?	3
Insurance broker name	HEARTLAND HEALTHCARE COALITION

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

Policy contract number

586960

Policy instance

Insurance contract or identification number	586960
Number of Individuals Covered	271
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $3,693
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $95,862
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,693
Insurance broker organization code?	3
Insurance broker name	WARD FINANCIAL SERVICES INC

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

Policy contract number

586960

Policy instance

Insurance contract or identification number	586960
Number of Individuals Covered	264
Insurance policy start date	2014-01-01
Insurance policy end date	2015-01-01
Total amount of commissions paid to insurance broker	USD $5,006
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $106,540
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,006
Insurance broker organization code?	3
Insurance broker name	WARD FINANCIAL SERVICES, INC.

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

200868

Policy instance

Insurance contract or identification number	200868
Number of Individuals Covered	1412
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $8,639
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $57,591
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,639
Insurance broker organization code?	3
Insurance broker name	R W GARRETT AGENCY INC.

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

67035

Policy instance

Insurance contract or identification number	67035
Number of Individuals Covered	1800
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $64,440
Total amount of fees paid to insurance company	USD $9,846
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $364,474
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $64,440
Amount paid for insurance broker fees	9846
Additional information about fees paid to insurance broker	SPECIAL PROGRAMS
Insurance broker organization code?	3
Insurance broker name	COTTINGHAM & BUTLER INS SERV

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 )

Policy contract number

30011125

Policy instance

Insurance contract or identification number	30011125
Number of Individuals Covered	840
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $889
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 $889
Insurance broker organization code?	3
Insurance broker name	HEARTLAND HEALTHCARE COALITION

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

67035

Policy instance

Insurance contract or identification number	67035
Number of Individuals Covered	1855
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $64,015
Total amount of fees paid to insurance company	USD $14,550
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $288,817
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $64,015
Amount paid for insurance broker fees	14550
Additional information about fees paid to insurance broker	SPECIAL PROGRAMS
Insurance broker organization code?	3
Insurance broker name	COTTINGHAM & BUTLER INS SERV

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 )

Policy contract number

30011125

Policy instance

Insurance contract or identification number	30011125
Number of Individuals Covered	835
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $879
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 $879
Insurance broker organization code?	3
Insurance broker name	HEARTLAND HEALTHCARE COALITION

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

Policy contract number

586960

Policy instance

Insurance contract or identification number	586960
Number of Individuals Covered	285
Insurance policy start date	2013-01-01
Insurance policy end date	2014-01-01
Total amount of commissions paid to insurance broker	USD $6,485
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $97,641
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,485
Insurance broker organization code?	3
Insurance broker name	WARD FINANCIAL SERVICES, INC.

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

200868

Policy instance

Insurance contract or identification number	200868
Number of Individuals Covered	1401
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $8,171
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $54,556
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,171
Insurance broker organization code?	3
Insurance broker name	R W GARRETT AGENCY INC.

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

67035

Policy instance

Insurance contract or identification number	67035
Number of Individuals Covered	1878
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $62,290
Total amount of fees paid to insurance company	USD $9,163
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $267,743
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $62,290
Amount paid for insurance broker fees	9163
Insurance broker organization code?	3
Insurance broker name	COTTINGHAM & BUTLER INS SERV

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

200868

Policy instance

Insurance contract or identification number	200868
Number of Individuals Covered	1313
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $7,698
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $51,323
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,698
Insurance broker organization code?	3
Insurance broker name	R W GARRETT AGENCY INC.

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 )

Policy contract number

30011125

Policy instance

Insurance contract or identification number	30011125
Number of Individuals Covered	769
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $2,521
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 $2,521
Insurance broker organization code?	3
Insurance broker name	HEARTLAND HEALTHCARE COALITION

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

Policy contract number

586960

Policy instance

Insurance contract or identification number	586960
Number of Individuals Covered	295
Insurance policy start date	2012-01-01
Insurance policy end date	2013-01-01
Total amount of commissions paid to insurance broker	USD $3,621
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $114,306
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,621
Insurance broker organization code?	3
Insurance broker name	WARD FINANCIAL SERVICES, INC.

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

67035

Policy instance

Insurance contract or identification number	67035
Number of Individuals Covered	1795
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $61,040
Total amount of fees paid to insurance company	USD $5,952
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $354,934
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

200868

Policy instance

Insurance contract or identification number	200868
Number of Individuals Covered	1269
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $6,732
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $44,881
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: 12516 )

Policy contract number

30011125

Policy instance

Insurance contract or identification number	30011125
Number of Individuals Covered	740
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $2,445
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

586960

Policy instance

Insurance contract or identification number	586960
Number of Individuals Covered	300
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $5,143
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $98,372
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

200868

Policy instance

Insurance contract or identification number	200868
Number of Individuals Covered	1192
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $6,474
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $43,161
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,474
Insurance broker organization code?	3
Insurance broker name	R W GARRETT AGENCY INC.

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 )

Policy contract number

30011125

Policy instance

Insurance contract or identification number	30011125
Number of Individuals Covered	714
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $2,398
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 $2,398
Insurance broker organization code?	3
Insurance broker name	HEARTLAND HEALTHCARE COALITION

TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 )

Policy contract number

1X-189

Policy instance

Insurance contract or identification number	1X-189
Number of Individuals Covered	916
Insurance policy start date	2009-12-01
Insurance policy end date	2010-11-30
Total amount of commissions paid to insurance broker	USD $34,748
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $177,016
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,297
Insurance broker organization code?	3
Insurance broker name	WARD FINANCIAL SEVICES

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

Policy contract number

586960

Policy instance

Insurance contract or identification number	586960
Number of Individuals Covered	271
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $5,033
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $92,732
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,510
Insurance broker organization code?	3
Insurance broker name	WARD FINANCIAL SERVICES, INC.

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

67035

Policy instance

Insurance contract or identification number	67035
Number of Individuals Covered	1743
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $55,760
Total amount of fees paid to insurance company	USD $22,652
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $234,284
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $55,760
Amount paid for insurance broker fees	22652
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3
Insurance broker name	R W GARRETT AGENCY INC

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:	NIEMANN FOODS, INC.
Employer identification number (EIN):	370475125
NAIC Classification:	445110
NAIC Description:	Supermarkets and Other Grocery (except Convenience) Stores