GOMACO CORPORATION has sponsored the creation of one or more 401k plans.
| Measure | Date | Value |
|---|
| 2022: GOMACO INSURANCE BENEFIT PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-08-01 | 515 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-08-01 | 464 |
| Number of retired or separated participants receiving benefits | 2022-08-01 | 3 |
| Number of other retired or separated participants entitled to future benefits | 2022-08-01 | 12 |
| Total of all active and inactive participants | 2022-08-01 | 479 |
| 2021: GOMACO INSURANCE BENEFIT PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-08-01 | 599 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-08-01 | 515 |
| Number of retired or separated participants receiving benefits | 2021-08-01 | 3 |
| Number of other retired or separated participants entitled to future benefits | 2021-08-01 | 18 |
| Total of all active and inactive participants | 2021-08-01 | 536 |
| 2020: GOMACO INSURANCE BENEFIT PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-08-01 | 546 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-08-01 | 599 |
| Number of retired or separated participants receiving benefits | 2020-08-01 | 2 |
| Number of other retired or separated participants entitled to future benefits | 2020-08-01 | 6 |
| Total of all active and inactive participants | 2020-08-01 | 607 |
| 2019: GOMACO INSURANCE BENEFIT PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-08-01 | 573 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-08-01 | 546 |
| Number of retired or separated participants receiving benefits | 2019-08-01 | 7 |
| Number of other retired or separated participants entitled to future benefits | 2019-08-01 | 9 |
| Total of all active and inactive participants | 2019-08-01 | 562 |
| 2018: GOMACO INSURANCE BENEFIT PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-08-01 | 573 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-08-01 | 573 |
| Number of retired or separated participants receiving benefits | 2018-08-01 | 3 |
| Number of other retired or separated participants entitled to future benefits | 2018-08-01 | 12 |
| Total of all active and inactive participants | 2018-08-01 | 588 |
| 2017: GOMACO INSURANCE BENEFIT PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-08-01 | 560 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-08-01 | 573 |
| Number of retired or separated participants receiving benefits | 2017-08-01 | 8 |
| Number of other retired or separated participants entitled to future benefits | 2017-08-01 | 10 |
| Total of all active and inactive participants | 2017-08-01 | 591 |
| 2016: GOMACO INSURANCE BENEFIT PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-08-01 | 533 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-08-01 | 560 |
| Number of retired or separated participants receiving benefits | 2016-08-01 | 5 |
| Number of other retired or separated participants entitled to future benefits | 2016-08-01 | 12 |
| Total of all active and inactive participants | 2016-08-01 | 577 |
| 2015: GOMACO INSURANCE BENEFIT PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-08-01 | 502 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-08-01 | 533 |
| Number of retired or separated participants receiving benefits | 2015-08-01 | 4 |
| Number of other retired or separated participants entitled to future benefits | 2015-08-01 | 11 |
| Total of all active and inactive participants | 2015-08-01 | 548 |
| 2014: GOMACO INSURANCE BENEFIT PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-08-01 | 451 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-08-01 | 480 |
| Number of retired or separated participants receiving benefits | 2014-08-01 | 6 |
| Number of other retired or separated participants entitled to future benefits | 2014-08-01 | 16 |
| Total of all active and inactive participants | 2014-08-01 | 502 |
| 2013: GOMACO INSURANCE BENEFIT PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-08-01 | 424 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-08-01 | 424 |
| Number of retired or separated participants receiving benefits | 2013-08-01 | 4 |
| Number of other retired or separated participants entitled to future benefits | 2013-08-01 | 23 |
| Total of all active and inactive participants | 2013-08-01 | 451 |
| 2012: GOMACO INSURANCE BENEFIT PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-08-01 | 508 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-08-01 | 371 |
| Number of retired or separated participants receiving benefits | 2012-08-01 | 4 |
| Number of other retired or separated participants entitled to future benefits | 2012-08-01 | 49 |
| Total of all active and inactive participants | 2012-08-01 | 424 |
| 2011: GOMACO INSURANCE BENEFIT PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-08-01 | 493 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-08-01 | 492 |
| Number of retired or separated participants receiving benefits | 2011-08-01 | 1 |
| Number of other retired or separated participants entitled to future benefits | 2011-08-01 | 15 |
| Total of all active and inactive participants | 2011-08-01 | 508 |
| 2009: GOMACO INSURANCE BENEFIT PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-08-01 | 476 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-08-01 | 441 |
| Number of retired or separated participants receiving benefits | 2009-08-01 | 9 |
| Number of other retired or separated participants entitled to future benefits | 2009-08-01 | 15 |
| Total of all active and inactive participants | 2009-08-01 | 465 |
| 2022: GOMACO INSURANCE BENEFIT PLAN 2022 form 5500 responses |
|---|
| 2022-08-01 | Type of plan entity | Single employer plan |
| 2022-08-01 | Plan funding arrangement – Insurance | Yes |
| 2022-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: GOMACO INSURANCE BENEFIT PLAN 2021 form 5500 responses |
|---|
| 2021-08-01 | Type of plan entity | Single employer plan |
| 2021-08-01 | Plan funding arrangement – Insurance | Yes |
| 2021-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: GOMACO INSURANCE BENEFIT PLAN 2020 form 5500 responses |
|---|
| 2020-08-01 | Type of plan entity | Single employer plan |
| 2020-08-01 | Plan funding arrangement – Insurance | Yes |
| 2020-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: GOMACO INSURANCE BENEFIT PLAN 2019 form 5500 responses |
|---|
| 2019-08-01 | Type of plan entity | Single employer plan |
| 2019-08-01 | Plan funding arrangement – Insurance | Yes |
| 2019-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: GOMACO INSURANCE BENEFIT PLAN 2018 form 5500 responses |
|---|
| 2018-08-01 | Type of plan entity | Single employer plan |
| 2018-08-01 | Plan funding arrangement – Insurance | Yes |
| 2018-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: GOMACO INSURANCE BENEFIT PLAN 2017 form 5500 responses |
|---|
| 2017-08-01 | Type of plan entity | Single employer plan |
| 2017-08-01 | Plan funding arrangement – Insurance | Yes |
| 2017-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: GOMACO INSURANCE BENEFIT PLAN 2016 form 5500 responses |
|---|
| 2016-08-01 | Type of plan entity | Single employer plan |
| 2016-08-01 | Plan funding arrangement – Insurance | Yes |
| 2016-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: GOMACO INSURANCE BENEFIT PLAN 2015 form 5500 responses |
|---|
| 2015-08-01 | Type of plan entity | Single employer plan |
| 2015-08-01 | Plan funding arrangement – Insurance | Yes |
| 2015-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: GOMACO INSURANCE BENEFIT PLAN 2014 form 5500 responses |
|---|
| 2014-08-01 | Type of plan entity | Single employer plan |
| 2014-08-01 | Plan funding arrangement – Insurance | Yes |
| 2014-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: GOMACO INSURANCE BENEFIT PLAN 2013 form 5500 responses |
|---|
| 2013-08-01 | Type of plan entity | Single employer plan |
| 2013-08-01 | Plan funding arrangement – Insurance | Yes |
| 2013-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: GOMACO INSURANCE BENEFIT PLAN 2012 form 5500 responses |
|---|
| 2012-08-01 | Type of plan entity | Single employer plan |
| 2012-08-01 | Plan funding arrangement – Insurance | Yes |
| 2012-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: GOMACO INSURANCE BENEFIT PLAN 2011 form 5500 responses |
|---|
| 2011-08-01 | Type of plan entity | Single employer plan |
| 2011-08-01 | Plan funding arrangement – Insurance | Yes |
| 2011-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: GOMACO INSURANCE BENEFIT PLAN 2009 form 5500 responses |
|---|
| 2009-08-01 | Type of plan entity | Single employer plan |
| 2009-08-01 | Submission has been amended | Yes |
| 2009-08-01 | This submission is the final filing | No |
| 2009-08-01 | Plan funding arrangement – Insurance | Yes |
| 2009-08-01 | Plan benefit arrangement – Insurance | Yes |
| GRAVIE, INC (National Association of Insurance Commissioners NAIC id number: 52429 ) |
| Policy contract number | 408KNJV0KY5N |
| Policy instance | 7 |
| Insurance contract or identification number | 408KNJV0KY5N | | Number of Individuals Covered | 450 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $74,884 | | 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 $74,884 | | Insurance broker organization code? | 3 |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 60790-6229 |
| Policy instance | 1 |
| Insurance contract or identification number | 60790-6229 | | Number of Individuals Covered | 458 | | Insurance policy start date | 2021-10-01 | | Insurance policy end date | 2022-09-30 | | Total amount of commissions paid to insurance broker | USD $17,672 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $84,153 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,257 | | Insurance broker organization code? | 3 |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | 1127820 |
| Policy instance | 2 |
| Insurance contract or identification number | 1127820 | | Number of Individuals Covered | 228 | | Insurance policy start date | 2022-05-01 | | Insurance policy end date | 2023-04-30 | | Total amount of commissions paid to insurance broker | USD $9,916 | | Total amount of fees paid to insurance company | USD $2,104 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $60,228 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,917 | | Amount paid for insurance broker fees | 1814 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000BS45 |
| Policy instance | 3 |
| Insurance contract or identification number | G000BS45 | | Number of Individuals Covered | 147 | | Insurance policy start date | 2021-10-01 | | Insurance policy end date | 2022-10-01 | | Total amount of commissions paid to insurance broker | USD $3,268 | | Total amount of fees paid to insurance company | USD $1,135 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $25,366 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,268 | | Amount paid for insurance broker fees | 1135 | | 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 | G000BS45 |
| Policy instance | 4 |
| Insurance contract or identification number | G000BS45 | | Number of Individuals Covered | 489 | | Insurance policy start date | 2021-10-01 | | Insurance policy end date | 2022-10-01 | | Total amount of commissions paid to insurance broker | USD $4,130 | | Total amount of fees paid to insurance company | USD $2,451 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $55,182 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,130 | | Amount paid for insurance broker fees | 2451 | | 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 | G000BS45 |
| Policy instance | 5 |
| Insurance contract or identification number | G000BS45 | | Number of Individuals Covered | 489 | | Insurance policy start date | 2021-10-01 | | Insurance policy end date | 2022-10-01 | | Total amount of commissions paid to insurance broker | USD $4,983 | | Total amount of fees paid to insurance company | USD $3,985 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $89,313 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,983 | | Amount paid for insurance broker fees | 3985 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | ABL654790 |
| Policy instance | 6 |
| Insurance contract or identification number | ABL654790 | | Number of Individuals Covered | 187 | | Insurance policy start date | 2022-04-01 | | Insurance policy end date | 2023-04-01 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | ACCIDENTAL DEATH | | Welfare Benefit Premiums Paid to Carrier | USD $7,995 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 60790-6229 |
| Policy instance | 1 |
| Insurance contract or identification number | 60790-6229 | | Number of Individuals Covered | 442 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2021-09-30 | | Total amount of commissions paid to insurance broker | USD $17,932 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $85,394 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,393 | | Insurance broker organization code? | 3 |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | 1127820 |
| Policy instance | 2 |
| Insurance contract or identification number | 1127820 | | Number of Individuals Covered | 235 | | Insurance policy start date | 2021-05-01 | | Insurance policy end date | 2022-04-30 | | Total amount of commissions paid to insurance broker | USD $7,764 | | Total amount of fees paid to insurance company | USD $1,217 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $60,535 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,787 | | Amount paid for insurance broker fees | 1217 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 |
|
| STHEALTH/CHARTIS (National Association of Insurance Commissioners NAIC id number: 77828 ) |
| Policy contract number | 417005411553 |
| Policy instance | 3 |
| Insurance contract or identification number | 417005411553 | | Number of Individuals Covered | 461 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2021-10-01 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $1,417,397 | | 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 | G000BS45 |
| Policy instance | 4 |
| Insurance contract or identification number | G000BS45 | | Number of Individuals Covered | 150 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2021-10-01 | | Total amount of commissions paid to insurance broker | USD $3,241 | | Total amount of fees paid to insurance company | USD $202 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $24,911 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,241 | | Amount paid for insurance broker fees | 202 | | 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 | G000BS45 |
| Policy instance | 5 |
| Insurance contract or identification number | G000BS45 | | Number of Individuals Covered | 468 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2021-10-01 | | Total amount of commissions paid to insurance broker | USD $4,115 | | Total amount of fees paid to insurance company | USD $477 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $54,581 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,115 | | Amount paid for insurance broker fees | 477 | | 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 | G000BS45 |
| Policy instance | 6 |
| Insurance contract or identification number | G000BS45 | | Number of Individuals Covered | 468 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2021-10-01 | | Total amount of commissions paid to insurance broker | USD $4,955 | | Total amount of fees paid to insurance company | USD $750 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $88,197 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,955 | | Amount paid for insurance broker fees | 750 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | ABL654790 |
| Policy instance | 7 |
| Insurance contract or identification number | ABL654790 | | Number of Individuals Covered | 187 | | Insurance policy start date | 2021-04-01 | | Insurance policy end date | 2022-04-01 | | Total amount of commissions paid to insurance broker | USD $1,199 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | ACCIDENTAL DEATH | | Welfare Benefit Premiums Paid to Carrier | USD $7,995 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,199 | | Insurance broker organization code? | 3 |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | 1127820 |
| Policy instance | 6 |
| Insurance contract or identification number | 1127820 | | Number of Individuals Covered | 234 | | Insurance policy start date | 2020-05-01 | | Insurance policy end date | 2021-04-30 | | Total amount of commissions paid to insurance broker | USD $6,691 | | Total amount of fees paid to insurance company | USD $4,184 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $65,093 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,691 | | Amount paid for insurance broker fees | 3610 | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | LTD 129116 |
| Policy instance | 5 |
| Insurance contract or identification number | LTD 129116 | | Number of Individuals Covered | 139 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-10-01 | | Total amount of commissions paid to insurance broker | USD $2,385 | | Total amount of fees paid to insurance company | USD $830 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $23,849 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,385 | | Amount paid for insurance broker fees | 353 | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | G 165789 |
| Policy instance | 4 |
| Insurance contract or identification number | G 165789 | | Number of Individuals Covered | 538 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-10-01 | | Total amount of commissions paid to insurance broker | USD $9,027 | | Total amount of fees paid to insurance company | USD $3,182 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $90,265 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,027 | | Amount paid for insurance broker fees | 1377 | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL 158145 |
| Policy instance | 3 |
| Insurance contract or identification number | GL 158145 | | Number of Individuals Covered | 539 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-10-01 | | Total amount of commissions paid to insurance broker | USD $6,150 | | Total amount of fees paid to insurance company | USD $2,148 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH | | Welfare Benefit Premiums Paid to Carrier | USD $61,500 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,150 | | Amount paid for insurance broker fees | 918 | | Insurance broker organization code? | 3 |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 933133 |
| Policy instance | 2 |
| Insurance contract or identification number | 933133 | | Number of Individuals Covered | 475 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-09-30 | | Total amount of commissions paid to insurance broker | USD $76,126 | | Total amount of fees paid to insurance company | USD $10,574 | | Welfare Benefit Premiums Paid to Carrier | USD $1,528,163 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $76,126 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 10574 |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 60790-6229 |
| Policy instance | 1 |
| Insurance contract or identification number | 60790-6229 | | Number of Individuals Covered | 456 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-09-30 | | Total amount of commissions paid to insurance broker | USD $19,205 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $91,454 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,060 | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | ABL 654790 |
| Policy instance | 1 |
| Insurance contract or identification number | ABL 654790 | | Number of Individuals Covered | 168 | | Insurance policy start date | 2019-04-01 | | Insurance policy end date | 2020-04-01 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | ACCIDENTAL DEATH | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 60790-6229 |
| Policy instance | 2 |
| Insurance contract or identification number | 60790-6229 | | Number of Individuals Covered | 502 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-09-30 | | Total amount of commissions paid to insurance broker | USD $19,633 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $93,492 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,284 | | Insurance broker organization code? | 3 |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 915134 |
| Policy instance | 3 |
| Insurance contract or identification number | 915134 | | Number of Individuals Covered | 72 | | Insurance policy start date | 2019-08-01 | | Insurance policy end date | 2020-07-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH | | Welfare Benefit Premiums Paid to Carrier | USD $37,564 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNIMERICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 91529 ) |
| Policy contract number | 417004411553 |
| Policy instance | 4 |
| Insurance contract or identification number | 417004411553 | | Number of Individuals Covered | 510 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-10-01 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $1,610,611 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL 158145 |
| Policy instance | 5 |
| Insurance contract or identification number | GL 158145 | | Number of Individuals Covered | 538 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-09-30 | | Total amount of commissions paid to insurance broker | USD $6,146 | | Total amount of fees paid to insurance company | USD $3,316 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH | | Welfare Benefit Premiums Paid to Carrier | USD $61,459 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,146 | | Amount paid for insurance broker fees | 2087 | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | G 165789 |
| Policy instance | 6 |
| Insurance contract or identification number | G 165789 | | Number of Individuals Covered | 536 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-09-30 | | Total amount of commissions paid to insurance broker | USD $9,243 | | Total amount of fees paid to insurance company | USD $4,918 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $92,427 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,243 | | Amount paid for insurance broker fees | 3069 | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | LTD 129116 |
| Policy instance | 7 |
| Insurance contract or identification number | LTD 129116 | | Number of Individuals Covered | 147 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-09-30 | | Total amount of commissions paid to insurance broker | USD $2,361 | | Total amount of fees paid to insurance company | USD $1,270 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $23,610 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,361 | | Amount paid for insurance broker fees | 798 | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | ABL 654790 |
| Policy instance | 1 |
| Insurance contract or identification number | ABL 654790 | | Number of Individuals Covered | 168 | | Insurance policy start date | 2018-04-01 | | Insurance policy end date | 2019-04-01 | | Total amount of commissions paid to insurance broker | USD $1,199 | | Total amount of fees paid to insurance company | USD $38 | | Other welfare benefits provided | ACCIDENTAL DEATH | | Welfare Benefit Premiums Paid to Carrier | USD $7,995 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,199 | | Amount paid for insurance broker fees | 38 | | Additional information about fees paid to insurance broker | OVERRIDE | | Insurance broker organization code? | 3 |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 60790-6229 |
| Policy instance | 2 |
| Insurance contract or identification number | 60790-6229 | | Number of Individuals Covered | 491 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-09-30 | | Total amount of commissions paid to insurance broker | USD $10,787 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $51,366 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,650 | | Insurance broker organization code? | 3 |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 915134 |
| Policy instance | 3 |
| Insurance contract or identification number | 915134 | | Number of Individuals Covered | 72 | | Insurance policy start date | 2018-08-01 | | Insurance policy end date | 2019-07-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH | | Welfare Benefit Premiums Paid to Carrier | USD $49,906 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL 158145 |
| Policy instance | 5 |
| Insurance contract or identification number | GL 158145 | | Number of Individuals Covered | 488 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-09-30 | | Total amount of commissions paid to insurance broker | USD $6,091 | | Total amount of fees paid to insurance company | USD $1,812 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH | | Welfare Benefit Premiums Paid to Carrier | USD $60,909 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,091 | | Amount paid for insurance broker fees | 594 | | Insurance broker organization code? | 3 |
|
| UNIMERICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 91529 ) |
| Policy contract number | 417004411553 |
| Policy instance | 4 |
| Insurance contract or identification number | 417004411553 | | Number of Individuals Covered | 498 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-10-01 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $1,438,020 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | G 165789 |
| Policy instance | 6 |
| Insurance contract or identification number | G 165789 | | Number of Individuals Covered | 488 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-09-30 | | Total amount of commissions paid to insurance broker | USD $9,020 | | Total amount of fees paid to insurance company | USD $2,692 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $90,200 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,020 | | Amount paid for insurance broker fees | 888 | | Insurance broker organization code? | 3 |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 241733 |
| Policy instance | 5 |
| Insurance contract or identification number | 241733 | | Number of Individuals Covered | 426 | | Insurance policy start date | 2016-10-01 | | Insurance policy end date | 2017-09-30 | | Total amount of commissions paid to insurance broker | USD $110,692 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH | | Welfare Benefit Premiums Paid to Carrier | USD $1,682,179 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 214784 |
| Policy instance | 4 |
| Insurance contract or identification number | 214784 | | Number of Individuals Covered | 483 | | Insurance policy start date | 2016-10-01 | | Insurance policy end date | 2017-09-30 | | Total amount of commissions paid to insurance broker | USD $10,656 | | Total amount of fees paid to insurance company | USD $0 | | 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 $181,151 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 60790-6229 |
| Policy instance | 3 |
| Insurance contract or identification number | 60790-6229 | | Number of Individuals Covered | 418 | | Insurance policy start date | 2016-10-01 | | Insurance policy end date | 2017-09-30 | | Total amount of commissions paid to insurance broker | USD $9,828 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $46,800 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
| Policy contract number | G#4010324 |
| Policy instance | 2 |
| Insurance contract or identification number | G#4010324 | | Number of Individuals Covered | 75 | | Insurance policy start date | 2017-08-01 | | Insurance policy end date | 2018-07-31 | | Total amount of commissions paid to insurance broker | USD $5,126 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH | | Welfare Benefit Premiums Paid to Carrier | USD $47,801 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | ABL 654790 |
| Policy instance | 1 |
| Insurance contract or identification number | ABL 654790 | | Number of Individuals Covered | 168 | | Insurance policy start date | 2017-04-01 | | Insurance policy end date | 2018-04-01 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $51 | | Other welfare benefits provided | ACCIDENTAL DEATH | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
