HARDINGS MARKETS-WEST, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan HARDING'S MARKETS-WEST, INC. PRE-TAX PREMIUM PLAN
401k plan membership statisitcs for HARDING'S MARKETS-WEST, INC. PRE-TAX PREMIUM PLAN
| Measure | Date | Value |
|---|
| 2022: HARDING'S MARKETS-WEST, INC. PRE-TAX PREMIUM PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 149 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 136 |
| Number of retired or separated participants receiving benefits | 2022-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2022-01-01 | 0 |
| Total of all active and inactive participants | 2022-01-01 | 136 |
| 2021: HARDING'S MARKETS-WEST, INC. PRE-TAX PREMIUM PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 171 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 149 |
| Number of retired or separated participants receiving benefits | 2021-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-01-01 | 0 |
| Total of all active and inactive participants | 2021-01-01 | 149 |
| 2020: HARDING'S MARKETS-WEST, INC. PRE-TAX PREMIUM PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 170 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 171 |
| 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 | 171 |
| 2019: HARDING'S MARKETS-WEST, INC. PRE-TAX PREMIUM PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 166 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 170 |
| 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 | 170 |
| 2018: HARDING'S MARKETS-WEST, INC. PRE-TAX PREMIUM PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 0 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 166 |
| Number of retired or separated participants receiving benefits | 2018-01-01 | 0 |
| 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 | 166 |
| 2017: HARDING'S MARKETS-WEST, INC. PRE-TAX PREMIUM PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 157 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 0 |
| 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 | 0 |
| 2016: HARDING'S MARKETS-WEST, INC. PRE-TAX PREMIUM PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 176 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 0 |
| 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 | 0 |
| 2015: HARDING'S MARKETS-WEST, INC. PRE-TAX PREMIUM PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 176 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 0 |
| 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 | 0 |
| 2014: HARDING'S MARKETS-WEST, INC. PRE-TAX PREMIUM PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 174 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 188 |
| Number of retired or separated participants receiving benefits | 2014-01-01 | 0 |
| 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 | 188 |
| 2013: HARDING'S MARKETS-WEST, INC. PRE-TAX PREMIUM PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 163 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 174 |
| Total of all active and inactive participants | 2013-01-01 | 174 |
| 2012: HARDING'S MARKETS-WEST, INC. PRE-TAX PREMIUM PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 124 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 163 |
| Total of all active and inactive participants | 2012-01-01 | 163 |
| 2011: HARDING'S MARKETS-WEST, INC. PRE-TAX PREMIUM PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-01-01 | 121 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 124 |
| Total of all active and inactive participants | 2011-01-01 | 124 |
| 2010: HARDING'S MARKETS-WEST, INC. PRE-TAX PREMIUM PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-01-01 | 107 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-01-01 | 121 |
| Total of all active and inactive participants | 2010-01-01 | 121 |
| 2009: HARDING'S MARKETS-WEST, INC. PRE-TAX PREMIUM PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-01-01 | 108 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 107 |
| Total of all active and inactive participants | 2009-01-01 | 107 |
| 2022: HARDING'S MARKETS-WEST, INC. PRE-TAX PREMIUM 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 funding arrangement – General assets of the sponsor | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: HARDING'S MARKETS-WEST, INC. PRE-TAX PREMIUM 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 funding arrangement – General assets of the sponsor | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: HARDING'S MARKETS-WEST, INC. PRE-TAX PREMIUM 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 funding arrangement – General assets of the sponsor | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: HARDING'S MARKETS-WEST, INC. PRE-TAX PREMIUM 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 funding arrangement – General assets of the sponsor | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: HARDING'S MARKETS-WEST, INC. PRE-TAX PREMIUM 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 funding arrangement – General assets of the sponsor | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: HARDING'S MARKETS-WEST, INC. PRE-TAX PREMIUM 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 funding arrangement – General assets of the sponsor | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: HARDING'S MARKETS-WEST, INC. PRE-TAX PREMIUM 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 funding arrangement – General assets of the sponsor | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: HARDING'S MARKETS-WEST, INC. PRE-TAX PREMIUM 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 funding arrangement – General assets of the sponsor | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: HARDING'S MARKETS-WEST, INC. PRE-TAX PREMIUM 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 funding arrangement – General assets of the sponsor | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: HARDING'S MARKETS-WEST, INC. PRE-TAX PREMIUM 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 funding arrangement – General assets of the sponsor | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2012: HARDING'S MARKETS-WEST, INC. PRE-TAX PREMIUM 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 funding arrangement – General assets of the sponsor | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2011: HARDING'S MARKETS-WEST, INC. PRE-TAX PREMIUM 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 funding arrangement – General assets of the sponsor | Yes |
| 2011-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2010: HARDING'S MARKETS-WEST, INC. PRE-TAX PREMIUM PLAN 2010 form 5500 responses |
|---|
| 2010-01-01 | Type of plan entity | Single employer plan |
| 2010-01-01 | First time form 5500 has been submitted | Yes |
| 2010-01-01 | Plan funding arrangement – Insurance | Yes |
| 2010-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2010-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2010-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2009: HARDING'S MARKETS-WEST, INC. PRE-TAX PREMIUM 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 funding arrangement – General assets of the sponsor | Yes |
| 2009-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 ) |
| Policy contract number | 783565 |
| Policy instance | 3 |
| Insurance contract or identification number | 783565 | | Number of Individuals Covered | 128 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $28,268 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $942,278 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $28,268 | | Additional information about fees paid to insurance broker | PLACEMENT OF INSURANCE | | Insurance broker organization code? | 3 |
|
| KANSAS CITY LIFE (National Association of Insurance Commissioners NAIC id number: 65129 ) |
| Policy contract number | 65129 |
| Policy instance | 2 |
| Insurance contract or identification number | 65129 | | Number of Individuals Covered | 136 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $11,421 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $103,133 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,421 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30015097 |
| Policy instance | 1 |
| Insurance contract or identification number | 30015097 | | Number of Individuals Covered | 87 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of fees paid to insurance company | USD $2,359 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $15,220 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 2359 | | Additional information about fees paid to insurance broker | PLACEMENT | | Insurance broker organization code? | 3 |
|
| PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 ) |
| Policy contract number | 783565 |
| Policy instance | 3 |
| Insurance contract or identification number | 783565 | | Number of Individuals Covered | 149 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $35,105 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,157,880 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $35,105 | | Additional information about fees paid to insurance broker | PLACEMENT OF INSURANCE | | Insurance broker organization code? | 3 |
|
| KANSAS CITY LIFE (National Association of Insurance Commissioners NAIC id number: 65129 ) |
| Policy contract number | 65129 |
| Policy instance | 2 |
| Insurance contract or identification number | 65129 | | Number of Individuals Covered | 130 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $12,339 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $113,227 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $12,339 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30015097 |
| Policy instance | 1 |
| Insurance contract or identification number | 30015097 | | Number of Individuals Covered | 109 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of fees paid to insurance company | USD $2,231 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $17,833 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 2231 | | Additional information about fees paid to insurance broker | PLACEMENT | | Insurance broker organization code? | 3 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30015097 |
| Policy instance | 1 |
| Insurance contract or identification number | 30015097 | | Number of Individuals Covered | 83 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of fees paid to insurance company | USD $1,494 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $14,232 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 1494 | | Additional information about fees paid to insurance broker | PLACEMENT | | Insurance broker organization code? | 3 |
|
| KANSAS CITY LIFE (National Association of Insurance Commissioners NAIC id number: 65129 ) |
| Policy contract number | 65129 |
| Policy instance | 2 |
| Insurance contract or identification number | 65129 | | Number of Individuals Covered | 274 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $11,541 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $106,362 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,541 |
|
| PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 ) |
| Policy contract number | 783565 |
| Policy instance | 3 |
| Insurance contract or identification number | 783565 | | Number of Individuals Covered | 171 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $29,435 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $981,179 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $29,435 | | Additional information about fees paid to insurance broker | PLACEMENT OF INSURANCE | | Insurance broker organization code? | 3 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30015097 |
| Policy instance | 4 |
| Insurance contract or identification number | 30015097 | | Number of Individuals Covered | 83 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of fees paid to insurance company | USD $1,494 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $14,232 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 1494 | | Additional information about fees paid to insurance broker | PLACEMENT INSURANCE | | Insurance broker organization code? | 3 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30015097 |
| Policy instance | 1 |
| Insurance contract or identification number | 30015097 | | Number of Individuals Covered | 114 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of fees paid to insurance company | USD $1,850 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $17,146 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 1850 | | Additional information about fees paid to insurance broker | PLACEMENT | | Insurance broker organization code? | 3 |
|
| KANSAS CITY LIFE (National Association of Insurance Commissioners NAIC id number: 65129 ) |
| Policy contract number | 65129 |
| Policy instance | 2 |
| Insurance contract or identification number | 65129 | | Number of Individuals Covered | 149 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $11,951 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $110,218 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,951 |
|
| PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 ) |
| Policy contract number | 783565 |
| Policy instance | 3 |
| Insurance contract or identification number | 783565 | | Number of Individuals Covered | 148 | | Insurance policy start date | 2018-11-01 | | Insurance policy end date | 2019-10-31 | | Total amount of commissions paid to insurance broker | USD $28,914 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $963,806 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $28,914 | | Additional information about fees paid to insurance broker | PLACEMENT OF INSURANCE | | Insurance broker organization code? | 3 |
|
| PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 12208 ) |
| Policy contract number | 783565 |
| Policy instance | 4 |
| Insurance contract or identification number | 783565 | | Number of Individuals Covered | 22 | | Insurance policy start date | 2018-11-01 | | Insurance policy end date | 2019-10-31 | | Total amount of commissions paid to insurance broker | USD $4,806 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $160,211 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,806 | | Additional information about fees paid to insurance broker | PLACEMENT OF INSURANCE | | Insurance broker organization code? | 3 |
|
| BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) |
| Policy contract number | 282368 |
| Policy instance | 2 |
| Insurance contract or identification number | 282368 | | Number of Individuals Covered | 21 | | Insurance policy start date | 2017-11-01 | | Insurance policy end date | 2018-10-31 | | Total amount of commissions paid to insurance broker | USD $4,448 | | Welfare Benefit Premiums Paid to Carrier | USD $174,096 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,448 | | Additional information about fees paid to insurance broker | PLACEMENT OF INSURANCE | | Insurance broker organization code? | 3 |
|
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) |
| Policy contract number | 00282368 |
| Policy instance | 1 |
| Insurance contract or identification number | 00282368 | | Number of Individuals Covered | 166 | | Insurance policy start date | 2017-11-01 | | Insurance policy end date | 2018-10-31 | | Total amount of commissions paid to insurance broker | USD $24,197 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $994,047 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $24,197 | | Additional information about fees paid to insurance broker | PLACEMENT OF INSURANCE | | Insurance broker organization code? | 3 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30015097 |
| Policy instance | 3 |
| Insurance contract or identification number | 30015097 | | Number of Individuals Covered | 96 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of fees paid to insurance company | USD $1,527 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $13,879 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 1527 | | Additional information about fees paid to insurance broker | PLACEMENT | | Insurance broker organization code? | 3 |
|
| KANSAS CITY LIFE (National Association of Insurance Commissioners NAIC id number: 65129 ) |
| Policy contract number | 65129 |
| Policy instance | 4 |
| Insurance contract or identification number | 65129 | | Number of Individuals Covered | 162 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $12,224 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $110,475 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $12,224 |
|
| PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 ) |
| Policy contract number | 783565 |
| Policy instance | 5 |
| Insurance contract or identification number | 783565 | | Number of Individuals Covered | 160 | | Insurance policy start date | 2018-11-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $5,160 | | Welfare Benefit Premiums Paid to Carrier | USD $172,010 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,160 | | Additional information about fees paid to insurance broker | PLACEMENT OF INSURANCE | | Insurance broker organization code? | 3 |
|
| PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 12208 ) |
| Policy contract number | 783565 |
| Policy instance | 6 |
| Insurance contract or identification number | 783565 | | Number of Individuals Covered | 23 | | Insurance policy start date | 2018-11-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $749 | | Welfare Benefit Premiums Paid to Carrier | USD $24,974 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $749 | | Additional information about fees paid to insurance broker | PLACEMENT OF INSURANCE | | Insurance broker organization code? | 3 |
|
| KANSAS CITY LIFE (National Association of Insurance Commissioners NAIC id number: 65129 ) |
| Policy contract number | 65129 |
| Policy instance | 4 |
| Insurance contract or identification number | 65129 | | Number of Individuals Covered | 149 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2017-10-31 | | Total amount of commissions paid to insurance broker | USD $3,781 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $34,678 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,781 | | Insurance broker name | THE BUURSMA AGENCY |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30015097 |
| Policy instance | 3 |
| Insurance contract or identification number | 30015097 | | Number of Individuals Covered | 103 | | Insurance policy start date | 2016-11-01 | | Insurance policy end date | 2017-10-31 | | Total amount of fees paid to insurance company | USD $1,448 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $15,802 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 1448 | | Additional information about fees paid to insurance broker | PLACEMENT | | Insurance broker organization code? | 3 | | Insurance broker name | BUURSMA AGENCY |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010173844 |
| Policy instance | 2 |
| Insurance contract or identification number | 000010173844 | | Number of Individuals Covered | 153 | | Insurance policy start date | 2016-11-01 | | Insurance policy end date | 2017-06-30 | | Total amount of commissions paid to insurance broker | USD $8,086 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $67,743 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,086 | | Additional information about fees paid to insurance broker | PLACEMENT OF INSURANCE | | Insurance broker organization code? | 3 | | Insurance broker name | THE BUURSMA AGENCY |
|
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) |
| Policy contract number | 00282368 |
| Policy instance | 1 |
| Insurance contract or identification number | 00282368 | | Number of Individuals Covered | 150 | | Insurance policy start date | 2016-11-01 | | Insurance policy end date | 2017-10-31 | | Total amount of commissions paid to insurance broker | USD $23,251 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,559,212 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $23,251 | | Additional information about fees paid to insurance broker | PLACEMENT OF INSURANCE | | Insurance broker organization code? | 3 | | Insurance broker name | THE BUURSMA AGENCY |
|
| PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 ) |
| Policy contract number | 783565 S001 |
| Policy instance | 1 |
| Insurance contract or identification number | 783565 S001 | | Number of Individuals Covered | 176 | | Insurance policy start date | 2014-11-01 | | Insurance policy end date | 2015-10-31 | | Total amount of commissions paid to insurance broker | USD $24,337 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,031,949 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $24,337 | | Additional information about fees paid to insurance broker | PLACEMENT OF INSURANCE | | Insurance broker organization code? | 3 | | Insurance broker name | THE BUURSMA AGENCY |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 00001012027 |
| Policy instance | 2 |
| Insurance contract or identification number | 00001012027 | | Number of Individuals Covered | 149 | | Insurance policy start date | 2014-11-01 | | Insurance policy end date | 2015-10-31 | | Total amount of commissions paid to insurance broker | USD $7,672 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $50,203 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,672 | | Additional information about fees paid to insurance broker | PLACEMENT OF INSURANCE | | Insurance broker organization code? | 3 | | Insurance broker name | THE BUURSMA AGENCY |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30015097 |
| Policy instance | 3 |
| Insurance contract or identification number | 30015097 | | Number of Individuals Covered | 9 | | Insurance policy start date | 2014-11-01 | | Insurance policy end date | 2015-10-31 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,740 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Additional information about fees paid to insurance broker | PLACEMENT | | Insurance broker organization code? | 3 | | Insurance broker name | BUURSMA AGENCY |
|
| PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 ) |
| Policy contract number | 783565 S001 |
| Policy instance | 1 |
| Insurance contract or identification number | 783565 S001 | | Number of Individuals Covered | 188 | | Insurance policy start date | 2013-11-01 | | Insurance policy end date | 2014-10-31 | | Total amount of commissions paid to insurance broker | USD $25,559 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $861,994 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $25,559 | | Additional information about fees paid to insurance broker | PLACEMENT OF INSURANCE | | Insurance broker organization code? | 3 | | Insurance broker name | THE BUURSMA AGENCY |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30015097 |
| Policy instance | 3 |
| Insurance contract or identification number | 30015097 | | Number of Individuals Covered | 97 | | Insurance policy start date | 2013-05-01 | | Insurance policy end date | 2014-10-31 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $9,924 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Additional information about fees paid to insurance broker | PLACEMENT | | Insurance broker organization code? | 3 | | Insurance broker name | BUURSMA AGENCY |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 00001012027 |
| Policy instance | 2 |
| Insurance contract or identification number | 00001012027 | | Number of Individuals Covered | 137 | | Insurance policy start date | 2013-11-01 | | Insurance policy end date | 2014-10-31 | | Total amount of commissions paid to insurance broker | USD $8,527 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $44,894 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,527 | | Additional information about fees paid to insurance broker | PLACEMENT OF INSURANCE | | Insurance broker organization code? | 3 | | Insurance broker name | THE BUURSMA AGENCY |
|
| PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 ) |
| Policy contract number | 783565 S001 |
| Policy instance | 1 |
| Insurance contract or identification number | 783565 S001 | | Number of Individuals Covered | 174 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $22,444 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $748,127 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $22,444 | | Additional information about fees paid to insurance broker | PLACEMENT OF INSURANCE | | Insurance broker organization code? | 3 | | Insurance broker name | THE BUURSMA AGENCY |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 00001012027 |
| Policy instance | 2 |
| Insurance contract or identification number | 00001012027 | | Number of Individuals Covered | 129 | | Insurance policy start date | 2013-04-01 | | Insurance policy end date | 2013-10-31 | | Total amount of commissions paid to insurance broker | USD $7,159 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $58,540 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,159 | | Additional information about fees paid to insurance broker | PLACEMENT OF INSURANCE | | Insurance broker organization code? | 3 | | Insurance broker name | THE BUURSMA AGENCY |
|
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | F1D0992 |
| Policy instance | 3 |
| Insurance contract or identification number | F1D0992 | | Number of Individuals Covered | 136 | | Insurance policy start date | 2013-11-01 | | Insurance policy end date | 2013-03-31 | | Total amount of commissions paid to insurance broker | USD $5,037 | | Total amount of fees paid to insurance company | USD $1,204 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $42,689 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,037 | | Amount paid for insurance broker fees | 1204 | | Additional information about fees paid to insurance broker | PLACEMENT OF INSURANCE INCENTIVE PAY | | Insurance broker organization code? | 3 | | Insurance broker name | THE BUURSMA AGENCY |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30015097 |
| Policy instance | 4 |
| Insurance contract or identification number | 30015097 | | Number of Individuals Covered | 92 | | Insurance policy start date | 2013-05-01 | | Insurance policy end date | 2013-10-31 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $7,135 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Additional information about fees paid to insurance broker | PLACEMENT | | Insurance broker organization code? | 3 | | Insurance broker name | BUURSMA AGENCY |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 00001012027 |
| Policy instance | 2 |
| Insurance contract or identification number | 00001012027 | | Number of Individuals Covered | 120 | | Insurance policy start date | 2011-11-01 | | Insurance policy end date | 2012-05-31 | | Total amount of commissions paid to insurance broker | USD $3,281 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $25,551 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,281 | | Additional information about fees paid to insurance broker | PLACEMENT OF INSURANCE | | Insurance broker organization code? | 3 | | Insurance broker name | THE BUURSMA AGENCY |
|
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | F1D0992 |
| Policy instance | 3 |
| Insurance contract or identification number | F1D0992 | | Number of Individuals Covered | 120 | | Insurance policy start date | 2011-11-01 | | Insurance policy end date | 2012-10-31 | | Total amount of commissions paid to insurance broker | USD $7,473 | | Total amount of fees paid to insurance company | USD $2,266 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $65,608 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,473 | | Amount paid for insurance broker fees | 2266 | | Additional information about fees paid to insurance broker | PLACEMENT OF INSURANCE | | Insurance broker organization code? | 3 | | Insurance broker name | THE BUURSMA AGENCY |
|
| PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 ) |
| Policy contract number | 783565 S001 |
| Policy instance | 1 |
| Insurance contract or identification number | 783565 S001 | | Number of Individuals Covered | 163 | | Insurance policy start date | 2011-11-01 | | Insurance policy end date | 2012-10-31 | | Total amount of commissions paid to insurance broker | USD $20,757 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $693,520 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $20,757 | | Additional information about fees paid to insurance broker | PLACEMENT OF INSURANCE | | Insurance broker organization code? | 3 | | Insurance broker name | THE BUURSMA AGENCY |
|
| NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 ) |
| Policy contract number | 2HAMW1109 |
| Policy instance | 3 |
| Insurance contract or identification number | 2HAMW1109 | | Insurance policy start date | 2010-11-01 | | Insurance policy end date | 2011-10-31 | | Total amount of commissions paid to insurance broker | USD $490 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $8,680 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 00001012027 |
| Policy instance | 2 |
| Insurance contract or identification number | 00001012027 | | Number of Individuals Covered | 123 | | Insurance policy start date | 2010-11-01 | | Insurance policy end date | 2011-10-31 | | Total amount of commissions paid to insurance broker | USD $5,004 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $41,904 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 ) |
| Policy contract number | 783565 S001 |
| Policy instance | 1 |
| Insurance contract or identification number | 783565 S001 | | Number of Individuals Covered | 124 | | Insurance policy start date | 2010-11-01 | | Insurance policy end date | 2011-10-31 | | Total amount of commissions paid to insurance broker | USD $19,941 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $664,695 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 ) |
| Policy contract number | 783565 S001 |
| Policy instance | 1 |
| Insurance contract or identification number | 783565 S001 | | Number of Individuals Covered | 101 | | Insurance policy start date | 2009-11-01 | | Insurance policy end date | 2010-10-31 | | Total amount of commissions paid to insurance broker | USD $25,572 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $639,295 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $25,572 | | Additional information about fees paid to insurance broker | PLACEMENT OF INSURANCE | | Insurance broker organization code? | 3 | | Insurance broker name | ASR CORPORATION |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 00001012027 |
| Policy instance | 2 |
| Insurance contract or identification number | 00001012027 | | Number of Individuals Covered | 121 | | Insurance policy start date | 2009-11-01 | | Insurance policy end date | 2010-10-31 | | Total amount of commissions paid to insurance broker | USD $4,561 | | Total amount of fees paid to insurance company | USD $214 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $38,721 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,561 | | Amount paid for insurance broker fees | 214 | | Additional information about fees paid to insurance broker | SALES SERVICE COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | ADVANTAGE BENEFITS GROUP INC. |
|
| NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 ) |
| Policy contract number | 2HAMW1109 |
| Policy instance | 3 |
| Insurance contract or identification number | 2HAMW1109 | | Number of Individuals Covered | 192 | | Insurance policy start date | 2009-09-01 | | Insurance policy end date | 2010-10-31 | | Total amount of commissions paid to insurance broker | USD $5,583 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $55,831 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,583 | | Additional information about fees paid to insurance broker | PLACEMENT OF INSURANCE | | Insurance broker organization code? | 3 | | Insurance broker name | ASR HEALTH BENEFITS |
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