SYSTEMS TECHNOLOGY GROUP, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan SYSTEMS TECHNOLOGY GROUP HEALTH PLAN
| Measure | Date | Value |
|---|
| 2021: SYSTEMS TECHNOLOGY GROUP HEALTH PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-09-01 | 381 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-09-01 | 300 |
| Total of all active and inactive participants | 2021-09-01 | 300 |
| Total participants, beginning-of-year | 2021-01-01 | 362 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 381 |
| Total of all active and inactive participants | 2021-01-01 | 381 |
| 2020: SYSTEMS TECHNOLOGY GROUP HEALTH PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 380 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 362 |
| Number of retired or separated participants receiving benefits | 2020-01-01 | 0 |
| 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 | 362 |
| 2019: SYSTEMS TECHNOLOGY GROUP HEALTH PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 338 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 380 |
| Number of retired or separated participants receiving benefits | 2019-01-01 | 0 |
| 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 | 380 |
| 2018: SYSTEMS TECHNOLOGY GROUP HEALTH PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 330 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 338 |
| Number of retired or separated participants receiving benefits | 2018-01-01 | 1 |
| Number of other retired or separated participants entitled to future benefits | 2018-01-01 | 45 |
| Total of all active and inactive participants | 2018-01-01 | 384 |
| 2017: SYSTEMS TECHNOLOGY GROUP HEALTH PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 273 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 300 |
| Total of all active and inactive participants | 2017-01-01 | 300 |
| 2016: SYSTEMS TECHNOLOGY GROUP HEALTH PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 185 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 261 |
| Total of all active and inactive participants | 2016-01-01 | 261 |
| BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) |
| Policy contract number | 156841 |
| Policy instance | 5 |
| Insurance contract or identification number | 156841 | | Number of Individuals Covered | 614 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-08-31 | | Total amount of commissions paid to insurance broker | USD $105,544 | | Total amount of fees paid to insurance company | USD $3,728 | | Health 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 | 3728 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 | | Commission paid to Insurance Broker | USD $105,544 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GVTL0AM6H |
| Policy instance | 4 |
| Insurance contract or identification number | GVTL0AM6H | | Number of Individuals Covered | 128 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-09-01 | | Total amount of commissions paid to insurance broker | USD $3,374 | | Total amount of fees paid to insurance company | USD $1,429 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $33,741 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,374 | | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 1429 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG0AM6H |
| Policy instance | 3 |
| Insurance contract or identification number | GLUG0AM6H | | Number of Individuals Covered | 300 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-09-01 | | Total amount of commissions paid to insurance broker | USD $2,045 | | Total amount of fees paid to insurance company | USD $992 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $20,453 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,045 | | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 992 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUG 0AM6H |
| Policy instance | 2 |
| Insurance contract or identification number | GUG 0AM6H | | Number of Individuals Covered | 299 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-09-01 | | Total amount of commissions paid to insurance broker | USD $3,499 | | Total amount of fees paid to insurance company | USD $1,702 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $34,991 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,499 | | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 1702 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLTD0AM6H |
| Policy instance | 1 |
| Insurance contract or identification number | GLTD0AM6H | | Number of Individuals Covered | 300 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-09-01 | | Total amount of commissions paid to insurance broker | USD $2,159 | | Total amount of fees paid to insurance company | USD $1,051 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $21,587 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,159 | | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 1051 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLTD0AM6H |
| Policy instance | 1 |
| Insurance contract or identification number | GLTD0AM6H | | Number of Individuals Covered | 381 | | Insurance policy start date | 2020-09-01 | | Insurance policy end date | 2021-09-01 | | Total amount of commissions paid to insurance broker | USD $2,294 | | Total amount of fees paid to insurance company | USD $1,926 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $22,942 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,294 | | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 1356 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUG 0AM6H |
| Policy instance | 2 |
| Insurance contract or identification number | GUG 0AM6H | | Number of Individuals Covered | 380 | | Insurance policy start date | 2020-09-01 | | Insurance policy end date | 2021-09-01 | | Total amount of commissions paid to insurance broker | USD $3,721 | | Total amount of fees paid to insurance company | USD $3,127 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $37,215 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,721 | | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 2201 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG0AM6H |
| Policy instance | 3 |
| Insurance contract or identification number | GLUG0AM6H | | Number of Individuals Covered | 381 | | Insurance policy start date | 2020-09-01 | | Insurance policy end date | 2021-09-01 | | Total amount of commissions paid to insurance broker | USD $2,169 | | Total amount of fees paid to insurance company | USD $1,823 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $21,691 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,169 | | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 1283 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GVTL0AM6H |
| Policy instance | 4 |
| Insurance contract or identification number | GVTL0AM6H | | Number of Individuals Covered | 154 | | Insurance policy start date | 2020-09-01 | | Insurance policy end date | 2021-09-01 | | Total amount of commissions paid to insurance broker | USD $2,926 | | Total amount of fees paid to insurance company | USD $2,259 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $29,255 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,926 | | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 1610 |
|
| BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) |
| Policy contract number | 156841 |
| Policy instance | 5 |
| Insurance contract or identification number | 156841 | | Number of Individuals Covered | 751 | | Insurance policy start date | 2020-09-01 | | Insurance policy end date | 2021-08-31 | | Total amount of commissions paid to insurance broker | USD $105,872 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $103,594 | | Insurance broker organization code? | 3 |
|
| BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) |
| Policy contract number | 156841 |
| Policy instance | 5 |
| Insurance contract or identification number | 156841 | | Number of Individuals Covered | 721 | | Insurance policy start date | 2019-09-01 | | Insurance policy end date | 2020-08-31 | | Total amount of commissions paid to insurance broker | USD $93,724 | | Total amount of fees paid to insurance company | USD $4,281 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $93,724 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 4281 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GVTL0AM6H |
| Policy instance | 4 |
| Insurance contract or identification number | GVTL0AM6H | | Number of Individuals Covered | 126 | | Insurance policy start date | 2019-09-01 | | Insurance policy end date | 2020-09-01 | | Total amount of commissions paid to insurance broker | USD $2,635 | | Total amount of fees paid to insurance company | USD $1,505 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $26,346 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,635 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 1505 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG0AM6H |
| Policy instance | 3 |
| Insurance contract or identification number | GLUG0AM6H | | Number of Individuals Covered | 362 | | Insurance policy start date | 2019-09-01 | | Insurance policy end date | 2020-09-01 | | Total amount of commissions paid to insurance broker | USD $2,237 | | Total amount of fees paid to insurance company | USD $1,309 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $22,369 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,237 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 1309 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUG 0AM6H |
| Policy instance | 2 |
| Insurance contract or identification number | GUG 0AM6H | | Number of Individuals Covered | 362 | | Insurance policy start date | 2019-09-01 | | Insurance policy end date | 2020-09-01 | | Total amount of commissions paid to insurance broker | USD $3,836 | | Total amount of fees paid to insurance company | USD $2,241 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $38,362 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,836 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 2241 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLTD0AM6H |
| Policy instance | 1 |
| Insurance contract or identification number | GLTD0AM6H | | Number of Individuals Covered | 362 | | Insurance policy start date | 2019-09-01 | | Insurance policy end date | 2020-09-01 | | Total amount of commissions paid to insurance broker | USD $2,365 | | Total amount of fees paid to insurance company | USD $1,380 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $23,645 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,365 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 1380 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLTD0AM6H |
| Policy instance | 1 |
| Insurance contract or identification number | GLTD0AM6H | | Number of Individuals Covered | 380 | | Insurance policy start date | 2018-09-01 | | Insurance policy end date | 2019-09-01 | | Total amount of commissions paid to insurance broker | USD $2,137 | | Total amount of fees paid to insurance company | USD $0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $21,366 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,137 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUG 0AM6H |
| Policy instance | 2 |
| Insurance contract or identification number | GUG 0AM6H | | Number of Individuals Covered | 380 | | Insurance policy start date | 2018-09-01 | | Insurance policy end date | 2019-09-01 | | Total amount of commissions paid to insurance broker | USD $3,483 | | Total amount of fees paid to insurance company | USD $0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $34,827 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,483 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG0AM6H |
| Policy instance | 3 |
| Insurance contract or identification number | GLUG0AM6H | | Number of Individuals Covered | 380 | | Insurance policy start date | 2018-09-01 | | Insurance policy end date | 2019-09-01 | | Total amount of commissions paid to insurance broker | USD $2,036 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $20,359 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,036 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GVTL0AM6H |
| Policy instance | 4 |
| Insurance contract or identification number | GVTL0AM6H | | Number of Individuals Covered | 124 | | Insurance policy start date | 2018-09-01 | | Insurance policy end date | 2019-09-01 | | Total amount of commissions paid to insurance broker | USD $2,332 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $23,316 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,332 | | Insurance broker organization code? | 3 |
|
| BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) |
| Policy contract number | 156841 |
| Policy instance | 5 |
| Insurance contract or identification number | 156841 | | Number of Individuals Covered | 714 | | Insurance policy start date | 2018-09-01 | | Insurance policy end date | 2019-08-31 | | Total amount of commissions paid to insurance broker | USD $123,506 | | Total amount of fees paid to insurance company | USD $3,615 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $123,506 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 3615 |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 0808632 |
| Policy instance | 6 |
| Insurance contract or identification number | 0808632 | | Number of Individuals Covered | 414 | | Insurance policy start date | 2016-09-01 | | Insurance policy end date | 2017-08-31 | | Total amount of commissions paid to insurance broker | USD $5,323 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $103,595 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,323 | | Insurance broker organization code? | 3 | | Insurance broker name | GRACE AND PORTA BENEFITS INC |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 908992 |
| Policy instance | 5 |
| Insurance contract or identification number | 908992 | | Number of Individuals Covered | 463 | | Insurance policy start date | 2016-09-01 | | Insurance policy end date | 2017-08-31 | | Total amount of commissions paid to insurance broker | USD $61,026 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $61,026 | | Additional information about fees paid to insurance broker | AGENT OF RECORD | | Insurance broker organization code? | 3 | | Insurance broker name | GRACE AND PORTA BENEFITS INC |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GVTL0AM6H |
| Policy instance | 4 |
| Insurance contract or identification number | GVTL0AM6H | | Number of Individuals Covered | 58 | | Insurance policy start date | 2016-09-01 | | Insurance policy end date | 2017-09-01 | | Total amount of commissions paid to insurance broker | USD $1,656 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $16,559 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,656 | | Additional information about fees paid to insurance broker | AGENT OF RECORD | | Insurance broker organization code? | 3 | | Insurance broker name | GRACE AND PORTA BENEFITS INC |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG0AM6H |
| Policy instance | 3 |
| Insurance contract or identification number | GLUG0AM6H | | Number of Individuals Covered | 262 | | Insurance policy start date | 2016-09-01 | | Insurance policy end date | 2017-09-01 | | Total amount of commissions paid to insurance broker | USD $1,477 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $14,773 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,477 | | Additional information about fees paid to insurance broker | AGENT OF RECORD | | Insurance broker organization code? | 3 | | Insurance broker name | GRACE AND PORTA BENEFITS INC |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUG 0AM6H |
| Policy instance | 2 |
| Insurance contract or identification number | GUG 0AM6H | | Number of Individuals Covered | 262 | | Insurance policy start date | 2016-09-01 | | Insurance policy end date | 2017-09-01 | | Total amount of commissions paid to insurance broker | USD $2,522 | | Total amount of fees paid to insurance company | USD $0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $25,220 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,522 | | Additional information about fees paid to insurance broker | AGENT OF RECORD | | Insurance broker organization code? | 3 | | Insurance broker name | GRACE AND PORTA BENEFITS INC |
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| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLTD0AM6H |
| Policy instance | 1 |
| Insurance contract or identification number | GLTD0AM6H | | Number of Individuals Covered | 262 | | Insurance policy start date | 2016-09-01 | | Insurance policy end date | 2017-09-01 | | Total amount of commissions paid to insurance broker | USD $1,517 | | Total amount of fees paid to insurance company | USD $0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $15,168 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,517 | | Additional information about fees paid to insurance broker | AGENT OF RECORD | | Insurance broker organization code? | 3 | | Insurance broker name | GRACE AND PORTA BENEFITS INC |
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