401k Plan data: GENTEX CORP. COMPLUS FLEXIBLE BENEFIT PLAN plan

GENTEX CORP. COMPLUS FLEXIBLE BENEFIT PLAN 401k Plan overview

Plan Name	GENTEX CORP. COMPLUS FLEXIBLE BENEFIT PLAN
Plan identification number	504

GENTEX CORP. COMPLUS FLEXIBLE BENEFIT 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 Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

GENTEX CORPORATION has sponsored the creation of one or more 401k plans.

Company Name: GENTEX CORPORATION

Employer identification number (EIN): 382030505

NAIC Classification: 336300

Additional information about GENTEX CORPORATION

Jurisdiction of Incorporation: Michigan Department of Licensing & Regulatory Affairs

Incorporation Date:

Company Identification Number: 085536

More information about GENTEX CORPORATION

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GENTEX CORP. COMPLUS FLEXIBLE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
504 2022-01-01
504 2021-01-01
504 2020-01-01
504 2019-01-01
504 2018-01-01
504 2017-01-01 KEVIN NASH, VP ACCOUNTING
504 2016-01-01 KEVIN NASH, VP ACCOUNTING
504 2015-01-01 KEVIN NASH, VP ACCOUNTING
504 2014-01-01 STEVEN R DOWNING, VP FINANCE
504 2013-01-01 STEVEN R DOWNING, VP FINANCE
504 2012-01-01 STEVEN R. DOWNING, VP FINANCE STEVEN R. DOWNING, VP FINANCE 2013-10-02
504 2011-01-01 STEVEN A. DYKMAN, VP FINANCE GENTEX STEVEN A. DYKMAN, VP FINANCE GENTEX 2012-08-17
504 2010-01-01 STEVEN A. DYKMAN, VP FINANCE GENTEX STEVEN A. DYKMAN, VP FINANCE GENTEX 2011-09-12
504 2009-01-01 STEVEN A. DYKMAN, VP FINANCE GENTEX STEVEN A. DYKMAN, VP FINANCE GENTEX 2010-08-18

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
504	2022-01-01
504	2021-01-01
504	2020-01-01
504	2019-01-01
504	2018-01-01
504	2017-01-01	KEVIN NASH, VP ACCOUNTING
504	2016-01-01	KEVIN NASH, VP ACCOUNTING
504	2015-01-01	KEVIN NASH, VP ACCOUNTING
504	2014-01-01	STEVEN R DOWNING, VP FINANCE
504	2013-01-01	STEVEN R DOWNING, VP FINANCE
504	2012-01-01	STEVEN R. DOWNING, VP FINANCE	STEVEN R. DOWNING, VP FINANCE	2013-10-02
504	2011-01-01	STEVEN A. DYKMAN, VP FINANCE GENTEX	STEVEN A. DYKMAN, VP FINANCE GENTEX	2012-08-17
504	2010-01-01	STEVEN A. DYKMAN, VP FINANCE GENTEX	STEVEN A. DYKMAN, VP FINANCE GENTEX	2011-09-12
504	2009-01-01	STEVEN A. DYKMAN, VP FINANCE GENTEX	STEVEN A. DYKMAN, VP FINANCE GENTEX	2010-08-18

Plan Statistics for GENTEX CORP. COMPLUS FLEXIBLE BENEFIT PLAN

401k plan membership statisitcs for GENTEX CORP. COMPLUS FLEXIBLE BENEFIT PLAN

Measure Date Value
2022: GENTEX CORP. COMPLUS FLEXIBLE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 5,445
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 5,567
Number of retired or separated participants receiving benefits 2022-01-01 61
Number of other retired or separated participants entitled to future benefits 2022-01-01 111
Total of all active and inactive participants 2022-01-01 5,739
2021: GENTEX CORP. COMPLUS FLEXIBLE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 5,157
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 5,445
Number of retired or separated participants receiving benefits 2021-01-01 61
Number of other retired or separated participants entitled to future benefits 2021-01-01 110
Total of all active and inactive participants 2021-01-01 5,616
2020: GENTEX CORP. COMPLUS FLEXIBLE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 5,594
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 5,157
Number of retired or separated participants receiving benefits 2020-01-01 48
Number of other retired or separated participants entitled to future benefits 2020-01-01 148
Total of all active and inactive participants 2020-01-01 5,353
2019: GENTEX CORP. COMPLUS FLEXIBLE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 5,244
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 5,594
Number of retired or separated participants receiving benefits 2019-01-01 34
Number of other retired or separated participants entitled to future benefits 2019-01-01 178
Total of all active and inactive participants 2019-01-01 5,806
2018: GENTEX CORP. COMPLUS FLEXIBLE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 5,176
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 5,244
Number of retired or separated participants receiving benefits 2018-01-01 45
Number of other retired or separated participants entitled to future benefits 2018-01-01 155
Total of all active and inactive participants 2018-01-01 5,444
2017: GENTEX CORP. COMPLUS FLEXIBLE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 5,109
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 5,176
Number of retired or separated participants receiving benefits 2017-01-01 33
Number of other retired or separated participants entitled to future benefits 2017-01-01 26
Total of all active and inactive participants 2017-01-01 5,235
2016: GENTEX CORP. COMPLUS FLEXIBLE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 5,970
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 5,109
Number of retired or separated participants receiving benefits 2016-01-01 12
Number of other retired or separated participants entitled to future benefits 2016-01-01 37
Total of all active and inactive participants 2016-01-01 5,158
2015: GENTEX CORP. COMPLUS FLEXIBLE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 5,186
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 5,970
Number of retired or separated participants receiving benefits 2015-01-01 204
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 6,174
2014: GENTEX CORP. COMPLUS FLEXIBLE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 3,428
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 5,186
Number of retired or separated participants receiving benefits 2014-01-01 202
Number of other retired or separated participants entitled to future benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 5,388
2013: GENTEX CORP. COMPLUS FLEXIBLE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 3,355
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 3,428
Number of retired or separated participants receiving benefits 2013-01-01 158
Total of all active and inactive participants 2013-01-01 3,586
2012: GENTEX CORP. COMPLUS FLEXIBLE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 3,086
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 3,355
Total of all active and inactive participants 2012-01-01 3,355
Total participants 2012-01-01 3,355
2011: GENTEX CORP. COMPLUS FLEXIBLE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 2,480
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 3,086
Total of all active and inactive participants 2011-01-01 3,086
Total participants 2011-01-01 3,086
2010: GENTEX CORP. COMPLUS FLEXIBLE BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 2,103
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 2,480
Total of all active and inactive participants 2010-01-01 2,480
Total participants 2010-01-01 2,480
2009: GENTEX CORP. COMPLUS FLEXIBLE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 2,568
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 2,103
Total of all active and inactive participants 2009-01-01 2,103
Total participants 2009-01-01 2,103

Measure	Date	Value
2022: GENTEX CORP. COMPLUS FLEXIBLE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	5,445
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	5,567
Number of retired or separated participants receiving benefits	2022-01-01	61
Number of other retired or separated participants entitled to future benefits	2022-01-01	111
Total of all active and inactive participants	2022-01-01	5,739
2021: GENTEX CORP. COMPLUS FLEXIBLE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	5,157
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	5,445
Number of retired or separated participants receiving benefits	2021-01-01	61
Number of other retired or separated participants entitled to future benefits	2021-01-01	110
Total of all active and inactive participants	2021-01-01	5,616
2020: GENTEX CORP. COMPLUS FLEXIBLE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	5,594
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	5,157
Number of retired or separated participants receiving benefits	2020-01-01	48
Number of other retired or separated participants entitled to future benefits	2020-01-01	148
Total of all active and inactive participants	2020-01-01	5,353
2019: GENTEX CORP. COMPLUS FLEXIBLE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	5,244
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	5,594
Number of retired or separated participants receiving benefits	2019-01-01	34
Number of other retired or separated participants entitled to future benefits	2019-01-01	178
Total of all active and inactive participants	2019-01-01	5,806
2018: GENTEX CORP. COMPLUS FLEXIBLE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	5,176
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	5,244
Number of retired or separated participants receiving benefits	2018-01-01	45
Number of other retired or separated participants entitled to future benefits	2018-01-01	155
Total of all active and inactive participants	2018-01-01	5,444
2017: GENTEX CORP. COMPLUS FLEXIBLE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	5,109
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	5,176
Number of retired or separated participants receiving benefits	2017-01-01	33
Number of other retired or separated participants entitled to future benefits	2017-01-01	26
Total of all active and inactive participants	2017-01-01	5,235
2016: GENTEX CORP. COMPLUS FLEXIBLE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	5,970
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	5,109
Number of retired or separated participants receiving benefits	2016-01-01	12
Number of other retired or separated participants entitled to future benefits	2016-01-01	37
Total of all active and inactive participants	2016-01-01	5,158
2015: GENTEX CORP. COMPLUS FLEXIBLE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	5,186
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	5,970
Number of retired or separated participants receiving benefits	2015-01-01	204
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	6,174
2014: GENTEX CORP. COMPLUS FLEXIBLE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	3,428
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	5,186
Number of retired or separated participants receiving benefits	2014-01-01	202
Number of other retired or separated participants entitled to future benefits	2014-01-01	0
Total of all active and inactive participants	2014-01-01	5,388
2013: GENTEX CORP. COMPLUS FLEXIBLE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	3,355
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	3,428
Number of retired or separated participants receiving benefits	2013-01-01	158
Total of all active and inactive participants	2013-01-01	3,586
2012: GENTEX CORP. COMPLUS FLEXIBLE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	3,086
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	3,355
Total of all active and inactive participants	2012-01-01	3,355
Total participants	2012-01-01	3,355
2011: GENTEX CORP. COMPLUS FLEXIBLE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	2,480
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	3,086
Total of all active and inactive participants	2011-01-01	3,086
Total participants	2011-01-01	3,086
2010: GENTEX CORP. COMPLUS FLEXIBLE BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	2,103
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	2,480
Total of all active and inactive participants	2010-01-01	2,480
Total participants	2010-01-01	2,480
2009: GENTEX CORP. COMPLUS FLEXIBLE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	2,568
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	2,103
Total of all active and inactive participants	2009-01-01	2,103
Total participants	2009-01-01	2,103

Form 5500 Responses for GENTEX CORP. COMPLUS FLEXIBLE BENEFIT PLAN

2022: GENTEX CORP. COMPLUS FLEXIBLE BENEFIT 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: GENTEX CORP. COMPLUS FLEXIBLE BENEFIT 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: GENTEX CORP. COMPLUS FLEXIBLE BENEFIT 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: GENTEX CORP. COMPLUS FLEXIBLE BENEFIT 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: GENTEX CORP. COMPLUS FLEXIBLE BENEFIT 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: GENTEX CORP. COMPLUS FLEXIBLE BENEFIT 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: GENTEX CORP. COMPLUS FLEXIBLE BENEFIT 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: GENTEX CORP. COMPLUS FLEXIBLE BENEFIT 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: GENTEX CORP. COMPLUS FLEXIBLE BENEFIT 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: GENTEX CORP. COMPLUS FLEXIBLE BENEFIT 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: GENTEX CORP. COMPLUS FLEXIBLE BENEFIT 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: GENTEX CORP. COMPLUS FLEXIBLE BENEFIT PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	Yes
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2010: GENTEX CORP. COMPLUS FLEXIBLE BENEFIT PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2009: GENTEX CORP. COMPLUS FLEXIBLE BENEFIT PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GVTL0AQMV

Policy instance

Insurance contract or identification number	GVTL0AQMV
Number of Individuals Covered	2420
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of fees paid to insurance company	USD $13,750
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $901,115
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	13750
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

05642B

Policy instance

Insurance contract or identification number	05642B
Number of Individuals Covered	2
Insurance policy start date	2021-11-01
Insurance policy end date	2022-10-31
Total amount of commissions paid to insurance broker	USD $1,233
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Other welfare benefits provided	EVACUATION
Welfare Benefit Premiums Paid to Carrier	USD $12,325
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,233
Additional information about fees paid to insurance broker	COMMISSIONS
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0AQMV

Policy instance

Insurance contract or identification number	GLUG0AQMV
Number of Individuals Covered	4908
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of fees paid to insurance company	USD $5,836
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $104,770
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	5836
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUD0AQMV

Policy instance

Insurance contract or identification number	GUD0AQMV
Number of Individuals Covered	4908
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of fees paid to insurance company	USD $11,656
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $285,190
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	11656
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUC0AQMV

Policy instance

Insurance contract or identification number	GUC0AQMV
Number of Individuals Covered	1800
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of fees paid to insurance company	USD $13,750
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $593,738
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	13750
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30042946

Policy instance

Insurance contract or identification number	30042946
Number of Individuals Covered	3249
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of fees paid to insurance company	USD $92,407
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $637,288
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	92407
Additional information about fees paid to insurance broker	ADMINSTRATION
Insurance broker organization code?	5

PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 12208 )

Policy contract number

783589

Policy instance

Insurance contract or identification number	783589
Number of Individuals Covered	4220
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Welfare Benefit Premiums Paid to Carrier	USD $932,838
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )

Policy contract number

1081

Policy instance

Insurance contract or identification number	1081
Number of Individuals Covered	9009
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of fees paid to insurance company	USD $2,976
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $150,651
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	2976
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

92371

Policy instance

Insurance contract or identification number	92371
Number of Individuals Covered	928
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $-214
Welfare Benefit Premiums Paid to Carrier	USD $135,037
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $-214
Additional information about fees paid to insurance broker	COMMISSIONS
Insurance broker organization code?	3

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

V6557

Policy instance

Insurance contract or identification number	V6557
Number of Individuals Covered	596
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $21,351
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $97,107
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $21,351
Additional information about fees paid to insurance broker	COMMISSIONS
Insurance broker organization code?	3

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

V6557

Policy instance

Insurance contract or identification number	V6557
Number of Individuals Covered	857
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $21,359
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $106,837
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $21,359
Additional information about fees paid to insurance broker	COMMISSIONS
Insurance broker organization code?	3

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

05642A

Policy instance

Insurance contract or identification number	05642A
Number of Individuals Covered	1
Insurance policy start date	2021-05-25
Insurance policy end date	2022-05-24
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $7,644
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30042946

Policy instance

Insurance contract or identification number	30042946
Number of Individuals Covered	3155
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $619,333
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUC0AQMV

Policy instance

Insurance contract or identification number	GUC0AQMV
Number of Individuals Covered	1701
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of fees paid to insurance company	USD $19,633
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $566,201
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	19633
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GVTL0AQMV

Policy instance

Insurance contract or identification number	GVTL0AQMV
Number of Individuals Covered	2413
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of fees paid to insurance company	USD $21,250
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $871,825
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	21250
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUD0AQMV

Policy instance

Insurance contract or identification number	GUD0AQMV
Number of Individuals Covered	4725
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of fees paid to insurance company	USD $16,035
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $282,673
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	16035
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0AQMV

Policy instance

Insurance contract or identification number	GLUG0AQMV
Number of Individuals Covered	4725
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of fees paid to insurance company	USD $7,819
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $127,573
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	7819
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

V6557

Policy instance

Insurance contract or identification number	V6557
Number of Individuals Covered	757
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $28,526
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $137,789
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $28,524
Additional information about fees paid to insurance broker	COMMISSIONS
Insurance broker organization code?	3

PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 12208 )

Policy contract number

783589

Policy instance

Insurance contract or identification number	783589
Number of Individuals Covered	4053
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Welfare Benefit Premiums Paid to Carrier	USD $942,032
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )

Policy contract number

1081

Policy instance

Insurance contract or identification number	1081
Number of Individuals Covered	3968
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of fees paid to insurance company	USD $5,234
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $147,847
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	5234
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

92371

Policy instance

Insurance contract or identification number	92371
Number of Individuals Covered	917
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $-23
Welfare Benefit Premiums Paid to Carrier	USD $173,287
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $-23
Additional information about fees paid to insurance broker	COMMISSIONS
Insurance broker organization code?	3

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

V6557

Policy instance

Insurance contract or identification number	V6557
Number of Individuals Covered	532
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $27,132
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $124,469
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $27,126
Additional information about fees paid to insurance broker	COMMISSIONS
Insurance broker organization code?	3

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

05642A

Policy instance

Insurance contract or identification number	05642A
Number of Individuals Covered	1
Insurance policy start date	2020-05-25
Insurance policy end date	2021-05-24
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $15,288
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

V6557

Policy instance

Insurance contract or identification number	V6557
Number of Individuals Covered	1
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $26
Other welfare benefits provided	CANCER
Welfare Benefit Premiums Paid to Carrier	USD $262
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $26
Additional information about fees paid to insurance broker	COMMISSIONS
Insurance broker organization code?	3

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

V6557

Policy instance

Insurance contract or identification number	V6557
Number of Individuals Covered	1
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $7
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $88
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
Additional information about fees paid to insurance broker	COMMISSIONS
Insurance broker organization code?	3

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

05642B

Policy instance

Insurance contract or identification number	05642B
Number of Individuals Covered	2
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $112
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Other welfare benefits provided	EVACUATION
Welfare Benefit Premiums Paid to Carrier	USD $2,241
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $112
Additional information about fees paid to insurance broker	COMMISSIONS
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUC0AQMV

Policy instance

Insurance contract or identification number	GUC0AQMV
Number of Individuals Covered	1702
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of fees paid to insurance company	USD $21,250
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $560,067
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	21250
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30042946

Policy instance

Insurance contract or identification number	30042946
Number of Individuals Covered	3331
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $627,426
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 12208 )

Policy contract number

783589

Policy instance

Insurance contract or identification number	783589
Number of Individuals Covered	4286
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Welfare Benefit Premiums Paid to Carrier	USD $987,598
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )

Policy contract number

1081

Policy instance

Insurance contract or identification number	1081
Number of Individuals Covered	4127
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of fees paid to insurance company	USD $5,765
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $154,598
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	5765
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

92371

Policy instance

Insurance contract or identification number	92371
Number of Individuals Covered	895
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $18,407
Welfare Benefit Premiums Paid to Carrier	USD $166,844
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,407
Insurance broker organization code?	3

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

V6557

Policy instance

Insurance contract or identification number	V6557
Number of Individuals Covered	358
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $31,481
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $157,971
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $31,481
Insurance broker organization code?	3

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

V6557

Policy instance

Insurance contract or identification number	V6557
Number of Individuals Covered	485
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $43,208
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $253,103
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $43,208
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GVTL0AQMV

Policy instance

Insurance contract or identification number	GVTL0AQMV
Number of Individuals Covered	2539
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of fees paid to insurance company	USD $21,250
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $967,253
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	21250
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUD0AQMV

Policy instance

Insurance contract or identification number	GUD0AQMV
Number of Individuals Covered	4773
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of fees paid to insurance company	USD $16,883
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $299,874
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	16883
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0AQMV

Policy instance

Insurance contract or identification number	GLUG0AQMV
Number of Individuals Covered	4773
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of fees paid to insurance company	USD $8,690
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $134,019
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	8690
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

05642A

Policy instance

Insurance contract or identification number	05642A
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUD0AQMV

Policy instance

Insurance contract or identification number	GUD0AQMV
Number of Individuals Covered	6448
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of fees paid to insurance company	USD $11,660
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $307,366
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	11660
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

V6557

Policy instance

Insurance contract or identification number	V6557
Number of Individuals Covered	785
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $23,560
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $167,847
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $23,560
Insurance broker organization code?	3

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

V6557

Policy instance

Insurance contract or identification number	V6557
Number of Individuals Covered	994
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $65,183
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $260,641
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $65,183
Insurance broker organization code?	3

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

92371

Policy instance

Insurance contract or identification number	92371
Number of Individuals Covered	1147
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $25,767
Welfare Benefit Premiums Paid to Carrier	USD $167,843
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $25,767
Insurance broker organization code?	3

DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )

Policy contract number

1081

Policy instance

Insurance contract or identification number	1081
Number of Individuals Covered	4514
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of fees paid to insurance company	USD $6,933
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	6933
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 12208 )

Policy contract number

783589

Policy instance

Insurance contract or identification number	783589
Number of Individuals Covered	4688
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Welfare Benefit Premiums Paid to Carrier	USD $1,735,268
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0AQMV

Policy instance

Insurance contract or identification number	GLUG0AQMV
Number of Individuals Covered	5594
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of fees paid to insurance company	USD $6,156
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $136,870
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	6156
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30042946

Policy instance

Insurance contract or identification number	30042946
Number of Individuals Covered	3554
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $623,975
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUC0AQMV

Policy instance

Insurance contract or identification number	GUC0AQMV
Number of Individuals Covered	1793
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of fees paid to insurance company	USD $13,337
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $528,585
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	13337
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GVTL0AQMV

Policy instance

Insurance contract or identification number	GVTL0AQMV
Number of Individuals Covered	2954
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of fees paid to insurance company	USD $13,750
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $894,598
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	13750
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

CIGNA INTERNATIONAL (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

05642A

Policy instance

Insurance contract or identification number	05642A
Number of Individuals Covered	148
Insurance policy start date	2018-05-25
Insurance policy end date	2019-05-24
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $13,311
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CIGNA INTERNATIONAL (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

05642A

Policy instance

Insurance contract or identification number	05642A
Number of Individuals Covered	1
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $13,311
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

92371

Policy instance

Insurance contract or identification number	92371
Number of Individuals Covered	948
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $24,069
Welfare Benefit Premiums Paid to Carrier	USD $168,719
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $24,069
Insurance broker organization code?	3

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

V6557

Policy instance

Insurance contract or identification number	V6557
Number of Individuals Covered	1169
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $17,003
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $161,714
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $17,003
Insurance broker organization code?	3

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

V6557

Policy instance

Insurance contract or identification number	V6557
Number of Individuals Covered	1446
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $55,009
Welfare Benefit Premiums Paid to Carrier	USD $259,898
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $55,009
Insurance broker organization code?	3

DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )

Policy contract number

1081

Policy instance

Insurance contract or identification number	1081
Number of Individuals Covered	4080
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CIGNA INTERNATIONAL (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

05642A

Policy instance

Insurance contract or identification number	05642A
Number of Individuals Covered	151
Insurance policy start date	2017-05-25
Insurance policy end date	2018-05-24
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $13,311
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: 39616 )

Policy contract number

30042946

Policy instance

Insurance contract or identification number	30042946
Number of Individuals Covered	3330
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $6,838
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $575,646
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,838
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0AQMV

Policy instance

Insurance contract or identification number	GLUG0AQMV
Number of Individuals Covered	5244
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of fees paid to insurance company	USD $5,606
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $136,796
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	5606
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 12208 )

Policy contract number

783589

Policy instance

Insurance contract or identification number	783589
Number of Individuals Covered	4401
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Welfare Benefit Premiums Paid to Carrier	USD $1,576,885
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUC0AQMV

Policy instance

Insurance contract or identification number	GUC0AQMV
Number of Individuals Covered	1620
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of fees paid to insurance company	USD $8,750
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $479,912
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	8750
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GVTL0AQMV

Policy instance

Insurance contract or identification number	GVTL0AQMV
Number of Individuals Covered	2961
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of fees paid to insurance company	USD $8,750
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $976,714
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	8750
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUD0AQMV

Policy instance

Insurance contract or identification number	GUD0AQMV
Number of Individuals Covered	5243
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of fees paid to insurance company	USD $8,750
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $291,027
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	8750
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUD0AQMV

Policy instance

Insurance contract or identification number	GUD0AQMV
Number of Individuals Covered	5176
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of fees paid to insurance company	USD $8,972
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $273,805
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	8972
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	ADVANTAGE BENEFITS GROUP

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GVTL0AQMV

Policy instance

Insurance contract or identification number	GVTL0AQMV
Number of Individuals Covered	3296
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of fees paid to insurance company	USD $20,000
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $717,795
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	20000
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	ADVANTAGE BENEFITS GROUP

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUC0AQMV

Policy instance

Insurance contract or identification number	GUC0AQMV
Number of Individuals Covered	1483
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of fees paid to insurance company	USD $15,212
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $422,638
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	15212
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	ADVANTAGE BENEFITS GROUP

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30042946

Policy instance

Insurance contract or identification number	30042946
Number of Individuals Covered	3163
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $6,614
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $511,639
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,614
Insurance broker organization code?	3
Insurance broker name	ADVANTAGE BENEFITS GROUP INC.

PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 12208 )

Policy contract number

783589

Policy instance

Insurance contract or identification number	783589
Number of Individuals Covered	4422
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Welfare Benefit Premiums Paid to Carrier	USD $1,516,246
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CIGNA INTERNATIONAL (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

05642A

Policy instance

Insurance contract or identification number	05642A
Number of Individuals Covered	142
Insurance policy start date	2016-05-25
Insurance policy end date	2017-05-24
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $14,634
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )

Policy contract number

1081

Policy instance

Insurance contract or identification number	1081
Number of Individuals Covered	4080
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

V6557

Policy instance

Insurance contract or identification number	V6557
Number of Individuals Covered	1046
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $70,009
Welfare Benefit Premiums Paid to Carrier	USD $279,849
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $70,009
Insurance broker organization code?	3
Insurance broker name	ADVANTAGE BENEFITS GROUP

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

V6557

Policy instance

Insurance contract or identification number	V6557
Number of Individuals Covered	970
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $27,003
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $184,928
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $27,003
Insurance broker organization code?	3
Insurance broker name	ADVANTAGE BENEFITS GROUP

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0AQMV

Policy instance

Insurance contract or identification number	GLUG0AQMV
Number of Individuals Covered	5176
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of fees paid to insurance company	USD $5,030
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $129,396
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	5030
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	ADVANTAGE BENEFITS GROUP

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:	GENTEX CORPORATION
Employer identification number (EIN):	382030505
NAIC Classification:	336300

Jurisdiction of Incorporation:	Michigan Department of Licensing & Regulatory Affairs
Incorporation Date:
Company Identification Number:	085536