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H E WILLIAMS INC EMPLOYEE HEALTHCARE PLAN 401k Plan overview

Plan NameH E WILLIAMS INC EMPLOYEE HEALTHCARE PLAN
Plan identification number 501

H E WILLIAMS INC EMPLOYEE HEALTHCARE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)
  • Other welfare benefit cover

401k Sponsoring company profile

H E WILLIAMS INC has sponsored the creation of one or more 401k plans.

Company Name:H E WILLIAMS INC
Employer identification number (EIN):440491260
NAIC Classification:332900

Additional information about H E WILLIAMS INC

Jurisdiction of Incorporation: Georgia Department of States Corporations Division
Incorporation Date: 2004-07-13
Company Identification Number: 290617
Legal Registered Office Address: P.O. BOX 837

CARTHAGE
United States of America (USA)
64836

More information about H E WILLIAMS INC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan H E WILLIAMS INC EMPLOYEE HEALTHCARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01
5012021-01-01
5012020-01-01
5012019-01-01
5012018-01-01MIKE GRAY2019-09-23
5012017-01-01BRITT BURR
5012016-01-01BRITT BURR
5012015-01-01BRITT BURR
5012014-01-01BRITT BURR
5012013-01-01BRITT BURR
5012012-01-01BRITT BURR
5012011-01-01PHIL SLINKARD
5012010-01-01MICHAEL GRAY
5012009-01-01MICHAEL GRAY

Plan Statistics for H E WILLIAMS INC EMPLOYEE HEALTHCARE PLAN

401k plan membership statisitcs for H E WILLIAMS INC EMPLOYEE HEALTHCARE PLAN

Measure Date Value
2022: H E WILLIAMS INC EMPLOYEE HEALTHCARE PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01235
Total number of active participants reported on line 7a of the Form 55002022-01-01219
Number of retired or separated participants receiving benefits2022-01-013
Total of all active and inactive participants2022-01-01222
Total participants2022-01-01222
2021: H E WILLIAMS INC EMPLOYEE HEALTHCARE PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01228
Total number of active participants reported on line 7a of the Form 55002021-01-01235
Total of all active and inactive participants2021-01-01235
Total participants2021-01-01235
2020: H E WILLIAMS INC EMPLOYEE HEALTHCARE PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01244
Total number of active participants reported on line 7a of the Form 55002020-01-01225
Number of retired or separated participants receiving benefits2020-01-013
Total of all active and inactive participants2020-01-01228
Total participants2020-01-01228
2019: H E WILLIAMS INC EMPLOYEE HEALTHCARE PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01248
Total number of active participants reported on line 7a of the Form 55002019-01-01242
Number of retired or separated participants receiving benefits2019-01-012
Total of all active and inactive participants2019-01-01244
Total participants2019-01-01244
2018: H E WILLIAMS INC EMPLOYEE HEALTHCARE PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01236
Total number of active participants reported on line 7a of the Form 55002018-01-01247
Number of retired or separated participants receiving benefits2018-01-011
Total of all active and inactive participants2018-01-01248
Total participants2018-01-01248
2017: H E WILLIAMS INC EMPLOYEE HEALTHCARE PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01271
Total number of active participants reported on line 7a of the Form 55002017-01-01235
Number of retired or separated participants receiving benefits2017-01-011
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-01236
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-01236
2016: H E WILLIAMS INC EMPLOYEE HEALTHCARE PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01263
Total number of active participants reported on line 7a of the Form 55002016-01-01268
Number of retired or separated participants receiving benefits2016-01-013
Total of all active and inactive participants2016-01-01271
Total participants2016-01-01271
2015: H E WILLIAMS INC EMPLOYEE HEALTHCARE PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01270
Total number of active participants reported on line 7a of the Form 55002015-01-01260
Number of retired or separated participants receiving benefits2015-01-013
Total of all active and inactive participants2015-01-01263
Total participants2015-01-01263
2014: H E WILLIAMS INC EMPLOYEE HEALTHCARE PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01271
Total number of active participants reported on line 7a of the Form 55002014-01-01269
Number of retired or separated participants receiving benefits2014-01-011
Total of all active and inactive participants2014-01-01270
Total participants2014-01-01270
2013: H E WILLIAMS INC EMPLOYEE HEALTHCARE PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01255
Total number of active participants reported on line 7a of the Form 55002013-01-01269
Number of retired or separated participants receiving benefits2013-01-012
Total of all active and inactive participants2013-01-01271
Total participants2013-01-01271
2012: H E WILLIAMS INC EMPLOYEE HEALTHCARE PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01256
Total number of active participants reported on line 7a of the Form 55002012-01-01253
Number of retired or separated participants receiving benefits2012-01-012
Total of all active and inactive participants2012-01-01255
Total participants2012-01-01255
2011: H E WILLIAMS INC EMPLOYEE HEALTHCARE PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01285
Total number of active participants reported on line 7a of the Form 55002011-01-01254
Number of retired or separated participants receiving benefits2011-01-012
Total of all active and inactive participants2011-01-01256
Total participants2011-01-01256
2010: H E WILLIAMS INC EMPLOYEE HEALTHCARE PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-01232
Total number of active participants reported on line 7a of the Form 55002010-01-01282
Number of retired or separated participants receiving benefits2010-01-013
Total of all active and inactive participants2010-01-01285
Total participants2010-01-01285
2009: H E WILLIAMS INC EMPLOYEE HEALTHCARE PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01253
Total number of active participants reported on line 7a of the Form 55002009-01-01228
Number of retired or separated participants receiving benefits2009-01-014
Total of all active and inactive participants2009-01-01232
Total participants2009-01-01232

Form 5500 Responses for H E WILLIAMS INC EMPLOYEE HEALTHCARE PLAN

2022: H E WILLIAMS INC EMPLOYEE HEALTHCARE PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: H E WILLIAMS INC EMPLOYEE HEALTHCARE PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: H E WILLIAMS INC EMPLOYEE HEALTHCARE PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: H E WILLIAMS INC EMPLOYEE HEALTHCARE PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – General assets of the sponsorYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – General assets of the sponsorYes
2018: H E WILLIAMS INC EMPLOYEE HEALTHCARE PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: H E WILLIAMS INC EMPLOYEE HEALTHCARE PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: H E WILLIAMS INC EMPLOYEE HEALTHCARE PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – General assets of the sponsorYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – General assets of the sponsorYes
2015: H E WILLIAMS INC EMPLOYEE HEALTHCARE PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – General assets of the sponsorYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – General assets of the sponsorYes
2014: H E WILLIAMS INC EMPLOYEE HEALTHCARE PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – General assets of the sponsorYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – General assets of the sponsorYes
2013: H E WILLIAMS INC EMPLOYEE HEALTHCARE PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – General assets of the sponsorYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – General assets of the sponsorYes
2012: H E WILLIAMS INC EMPLOYEE HEALTHCARE PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – General assets of the sponsorYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – General assets of the sponsorYes
2011: H E WILLIAMS INC EMPLOYEE HEALTHCARE PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – General assets of the sponsorYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – General assets of the sponsorYes
2010: H E WILLIAMS INC EMPLOYEE HEALTHCARE PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan funding arrangement – General assets of the sponsorYes
2010-01-01Plan benefit arrangement – InsuranceYes
2010-01-01Plan benefit arrangement – General assets of the sponsorYes
2009: H E WILLIAMS INC EMPLOYEE HEALTHCARE PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – General assets of the sponsorYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )
Policy contract numberGTU-8365147
Policy instance 4
Insurance contract or identification numberGTU-8365147
Number of Individuals Covered356
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $1,424
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $9,496
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,424
Insurance broker organization code?3
DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 )
Policy contract number81202094
Policy instance 3
Insurance contract or identification number81202094
Number of Individuals Covered357
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $16,237
Total amount of fees paid to insurance companyUSD $566
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $121,647
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,237
Amount paid for insurance broker fees566
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number632310
Policy instance 2
Insurance contract or identification number632310
Number of Individuals Covered232
Insurance policy start date2021-03-01
Insurance policy end date2022-02-28
Total amount of commissions paid to insurance brokerUSD $2,481
Total amount of fees paid to insurance companyUSD $215
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,481
Amount paid for insurance broker fees215
Additional information about fees paid to insurance brokerCONTINGENT COMPENSATION
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number632310
Policy instance 1
Insurance contract or identification number632310
Number of Individuals Covered112
Insurance policy start date2021-03-01
Insurance policy end date2022-02-28
Total amount of commissions paid to insurance brokerUSD $4,224
Total amount of fees paid to insurance companyUSD $265
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,224
Amount paid for insurance broker fees265
Additional information about fees paid to insurance brokerCONTINGENT COMPENSATION
Insurance broker organization code?3
DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 )
Policy contract number81202094
Policy instance 3
Insurance contract or identification number81202094
Number of Individuals Covered315
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $11,280
Total amount of fees paid to insurance companyUSD $590
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $112,950
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,280
Amount paid for insurance broker fees590
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )
Policy contract numberGTU-8365147-16
Policy instance 4
Insurance contract or identification numberGTU-8365147-16
Number of Individuals Covered356
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $511
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $3,408
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $511
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number632310
Policy instance 1
Insurance contract or identification number632310
Number of Individuals Covered113
Insurance policy start date2020-03-01
Insurance policy end date2021-02-28
Total amount of commissions paid to insurance brokerUSD $4,240
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,240
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number632310
Policy instance 2
Insurance contract or identification number632310
Number of Individuals Covered223
Insurance policy start date2020-03-01
Insurance policy end date2021-02-28
Total amount of commissions paid to insurance brokerUSD $2,487
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,487
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number632310
Policy instance 1
Insurance contract or identification number632310
Number of Individuals Covered111
Insurance policy start date2019-03-01
Insurance policy end date2020-02-29
Total amount of commissions paid to insurance brokerUSD $3,973
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,898
Insurance broker organization code?3
DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 )
Policy contract number81202094
Policy instance 3
Insurance contract or identification number81202094
Number of Individuals Covered295
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $11,976
Total amount of fees paid to insurance companyUSD $306
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $113,599
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,976
Amount paid for insurance broker fees306
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )
Policy contract numberGTU-8365147-16
Policy instance 4
Insurance contract or identification numberGTU-8365147-16
Number of Individuals Covered356
Insurance policy start date2019-10-19
Insurance policy end date2020-10-18
Total amount of commissions paid to insurance brokerUSD $511
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $3,408
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $511
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number632310
Policy instance 2
Insurance contract or identification number632310
Number of Individuals Covered251
Insurance policy start date2019-03-01
Insurance policy end date2020-02-29
Total amount of commissions paid to insurance brokerUSD $2,549
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,731
Insurance broker organization code?3
DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 )
Policy contract number81202094
Policy instance 3
Insurance contract or identification number81202094
Number of Individuals Covered332
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $12,679
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $123,277
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,679
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number632310
Policy instance 2
Insurance contract or identification number632310
Number of Individuals Covered248
Insurance policy start date2018-03-01
Insurance policy end date2019-02-28
Total amount of commissions paid to insurance brokerUSD $2,905
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,905
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number632310
Policy instance 1
Insurance contract or identification number632310
Number of Individuals Covered101
Insurance policy start date2018-03-01
Insurance policy end date2019-02-28
Total amount of commissions paid to insurance brokerUSD $4,104
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,104
Insurance broker organization code?3
ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )
Policy contract numberGTU-8365147-15
Policy instance 4
Insurance contract or identification numberGTU-8365147-15
Number of Individuals Covered355
Insurance policy start date2018-10-19
Insurance policy end date2019-10-18
Total amount of commissions paid to insurance brokerUSD $499
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $3,327
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $499
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number632310
Policy instance 2
Insurance contract or identification number632310
Number of Individuals Covered267
Insurance policy start date2017-03-01
Insurance policy end date2018-02-28
Total amount of commissions paid to insurance brokerUSD $2,310
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,310
Insurance broker organization code?3
GREAT MIDWEST INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 18694 )
Policy contract numberCMSL 2018 10260
Policy instance 5
Insurance contract or identification numberCMSL 2018 10260
Number of Individuals Covered247
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $18,391
Total amount of fees paid to insurance companyUSD $39,150
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $331,023
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $18,391
Amount paid for insurance broker fees39150
Additional information about fees paid to insurance brokerADMINISTRATIVE FEES
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number632310
Policy instance 1
Insurance contract or identification number632310
Number of Individuals Covered97
Insurance policy start date2017-03-01
Insurance policy end date2018-02-28
Total amount of commissions paid to insurance brokerUSD $3,770
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,770
Insurance broker organization code?3
ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )
Policy contract numberGTU-8365147-15
Policy instance 4
Insurance contract or identification numberGTU-8365147-15
Number of Individuals Covered355
Insurance policy start date2017-10-19
Insurance policy end date2018-10-19
Total amount of commissions paid to insurance brokerUSD $499
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $3,327
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $499
Insurance broker organization code?3
DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 )
Policy contract number81202094
Policy instance 3
Insurance contract or identification number81202094
Number of Individuals Covered360
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $12,058
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $125,874
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,058
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number632310
Policy instance 1
Insurance contract or identification number632310
Number of Individuals Covered107
Insurance policy start date2016-03-01
Insurance policy end date2017-02-28
Total amount of commissions paid to insurance brokerUSD $4,030
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,030
Insurance broker organization code?3
Insurance broker nameBEIMDIEK INS AGENCY INC
EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract numberSL20000215-171
Policy instance 5
Insurance contract or identification numberSL20000215-171
Number of Individuals Covered240
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $19,033
Total amount of fees paid to insurance companyUSD $43,048
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $342,545
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,033
Amount paid for insurance broker fees43048
Additional information about fees paid to insurance brokerADMINISTRATIVE FEES
Insurance broker organization code?3
Insurance broker nameBENEFIT MANAGEMENT, INC
DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 )
Policy contract number81202094
Policy instance 3
Insurance contract or identification number81202094
Number of Individuals Covered341
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $13,961
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $121,887
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,961
Insurance broker organization code?3
Insurance broker nameBEIMDIEK INS AGENCY
ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )
Policy contract numberGTU-8365147-15
Policy instance 4
Insurance contract or identification numberGTU-8365147-15
Number of Individuals Covered320
Insurance policy start date2016-10-19
Insurance policy end date2017-10-19
Total amount of commissions paid to insurance brokerUSD $499
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $3,327
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $499
Insurance broker organization code?3
Insurance broker nameBEIMDIEK INSURANCE AGENCY
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number632310
Policy instance 2
Insurance contract or identification number632310
Number of Individuals Covered299
Insurance policy start date2016-03-01
Insurance policy end date2017-02-28
Total amount of commissions paid to insurance brokerUSD $2,971
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,971
Insurance broker organization code?3
Insurance broker nameBEIMDIEK INS AGENCY INC
EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract numberSL20000215-151
Policy instance 6
Insurance contract or identification numberSL20000215-151
Number of Individuals Covered269
Insurance policy start date2015-08-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $7,370
Total amount of fees paid to insurance companyUSD $16,968
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $130,656
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,370
Amount paid for insurance broker fees16968
Additional information about fees paid to insurance brokerADMINISTRATIVE FEES
Insurance broker organization code?3
Insurance broker nameBENEFIT MANAGEMENT, INC
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number632310
Policy instance 1
Insurance contract or identification number632310
Number of Individuals Covered100
Insurance policy start date2014-03-01
Insurance policy end date2015-02-28
Total amount of commissions paid to insurance brokerUSD $3,429
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,429
Insurance broker organization code?3
Insurance broker nameBEIMDIEK INS AGENCY INC
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number632310
Policy instance 2
Insurance contract or identification number632310
Number of Individuals Covered299
Insurance policy start date2014-03-01
Insurance policy end date2015-02-28
Total amount of commissions paid to insurance brokerUSD $2,386
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,386
Insurance broker organization code?3
Insurance broker nameBEIMDIEK INS AGENCY INC
DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 )
Policy contract number8120-1094
Policy instance 3
Insurance contract or identification number8120-1094
Number of Individuals Covered369
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $11,276
Total amount of fees paid to insurance companyUSD $1,452
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $112,760
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,276
Amount paid for insurance broker fees1452
Additional information about fees paid to insurance brokerOTHER COMMISSION/BROKER BONUS
Insurance broker organization code?3
Insurance broker nameBEIMDIEK INS AGENCY
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberNWL0129MO-07
Policy instance 4
Insurance contract or identification numberNWL0129MO-07
Number of Individuals Covered253
Insurance policy start date2015-01-01
Insurance policy end date2015-07-31
Total amount of commissions paid to insurance brokerUSD $10,318
Total amount of fees paid to insurance companyUSD $23,756
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $188,541
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,318
Amount paid for insurance broker fees23756
Additional information about fees paid to insurance brokerADMINISTRATIVE FEES
Insurance broker organization code?3
Insurance broker nameBENEFIT MANAGEMENT, INC
ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )
Policy contract numberGTU-8365147-14
Policy instance 5
Insurance contract or identification numberGTU-8365147-14
Number of Individuals Covered320
Insurance policy start date2014-10-19
Insurance policy end date2015-10-19
Total amount of commissions paid to insurance brokerUSD $451
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $3,009
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $451
Insurance broker organization code?3
Insurance broker nameBEIMDIEK INSURANCE AGENCY
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberNWL0129MO-06
Policy instance 4
Insurance contract or identification numberNWL0129MO-06
Number of Individuals Covered268
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $19,093
Total amount of fees paid to insurance companyUSD $42,237
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $343,473
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,093
Amount paid for insurance broker fees42237
Additional information about fees paid to insurance brokerADMINISTRATIVE FEES
Insurance broker organization code?3
Insurance broker nameBENEFIT MANAGEMENT, INC
DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 )
Policy contract number8120-1094
Policy instance 3
Insurance contract or identification number8120-1094
Number of Individuals Covered392
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $12,575
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $116,397
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,575
Insurance broker organization code?3
Insurance broker nameBEIMDIEK INS AGENCY
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number632310
Policy instance 2
Insurance contract or identification number632310
Number of Individuals Covered305
Insurance policy start date2013-03-01
Insurance policy end date2014-02-28
Total amount of commissions paid to insurance brokerUSD $2,093
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,093
Insurance broker organization code?3
Insurance broker nameBEIMDIEK INS AGENCY INC
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number632310
Policy instance 1
Insurance contract or identification number632310
Number of Individuals Covered102
Insurance policy start date2013-03-01
Insurance policy end date2014-02-28
Total amount of commissions paid to insurance brokerUSD $3,387
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,387
Insurance broker organization code?3
Insurance broker nameBEIMDIEK INS AGENCY INC
ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )
Policy contract numberGTU-8365147-14
Policy instance 5
Insurance contract or identification numberGTU-8365147-14
Number of Individuals Covered320
Insurance policy start date2013-10-19
Insurance policy end date2014-10-19
Total amount of commissions paid to insurance brokerUSD $451
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $3,009
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $451
Insurance broker organization code?3
Insurance broker nameBEIMDIEK INSURANCE AGENCY
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number632310
Policy instance 2
Insurance contract or identification number632310
Number of Individuals Covered286
Insurance policy start date2012-03-01
Insurance policy end date2013-02-28
Total amount of commissions paid to insurance brokerUSD $2,320
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,320
Insurance broker organization code?3
Insurance broker nameBEIMDIEK INS AGENCY INC
DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 )
Policy contract number8120-1094
Policy instance 3
Insurance contract or identification number8120-1094
Number of Individuals Covered414
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $11,215
Total amount of fees paid to insurance companyUSD $515
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $104,322
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,215
Amount paid for insurance broker fees515
Additional information about fees paid to insurance brokerDELTA REWARDS
Insurance broker organization code?3
Insurance broker nameBEIMDIEK INS AGENCY
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberNWL0129MO-05
Policy instance 4
Insurance contract or identification numberNWL0129MO-05
Number of Individuals Covered263
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $21,904
Total amount of fees paid to insurance companyUSD $40,413
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $289,790
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $21,904
Amount paid for insurance broker fees40413
Additional information about fees paid to insurance brokerADMINISTRATIVE FEES
Insurance broker organization code?3
Insurance broker nameBENEFIT MANAGEMENT, INC
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number632310
Policy instance 1
Insurance contract or identification number632310
Number of Individuals Covered97
Insurance policy start date2012-03-01
Insurance policy end date2013-02-28
Total amount of commissions paid to insurance brokerUSD $3,361
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,361
Insurance broker organization code?3
Insurance broker nameBEIMDIEK INS AGENCY INC
ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )
Policy contract numberGTU-8365147-13
Policy instance 5
Insurance contract or identification numberGTU-8365147-13
Number of Individuals Covered269
Insurance policy start date2012-10-19
Insurance policy end date2013-10-19
Total amount of commissions paid to insurance brokerUSD $472
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $3,144
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $472
Insurance broker organization code?3
Insurance broker nameBEIMDIEK INSURANCE AGENCY
ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )
Policy contract numberGTU-8365147-13
Policy instance 5
Insurance contract or identification numberGTU-8365147-13
Number of Individuals Covered253
Insurance policy start date2012-10-19
Insurance policy end date2013-10-19
Total amount of commissions paid to insurance brokerUSD $472
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $3,144
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $472
Insurance broker organization code?3
Insurance broker nameBEIMDIEK INSURANCE AGENCY
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberNWL0129MO-04
Policy instance 4
Insurance contract or identification numberNWL0129MO-04
Number of Individuals Covered258
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $20,884
Total amount of fees paid to insurance companyUSD $39,547
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $276,673
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $20,884
Amount paid for insurance broker fees39547
Additional information about fees paid to insurance brokerADMINISTRATIVE FEES
Insurance broker organization code?3
Insurance broker nameBENEFIT MANAGEMENT, INC
DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 )
Policy contract number8120-1094
Policy instance 3
Insurance contract or identification number8120-1094
Number of Individuals Covered402
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $11,080
Total amount of fees paid to insurance companyUSD $505
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,080
Amount paid for insurance broker fees505
Additional information about fees paid to insurance brokerDELTA REWARDS
Insurance broker organization code?3
Insurance broker nameBEIMDIEK INS AGENCY
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number632310
Policy instance 1
Insurance contract or identification number632310
Number of Individuals Covered97
Insurance policy start date2012-03-01
Insurance policy end date2013-02-28
Total amount of commissions paid to insurance brokerUSD $3,361
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,361
Insurance broker organization code?3
Insurance broker nameBEIMDIEK INS AGENCY INC
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number632310
Policy instance 2
Insurance contract or identification number632310
Number of Individuals Covered286
Insurance policy start date2012-03-01
Insurance policy end date2013-02-28
Total amount of commissions paid to insurance brokerUSD $2,320
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,320
Insurance broker organization code?3
Insurance broker nameBEIMDIEK INS AGENCY INC
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number632310
Policy instance 1
Insurance contract or identification number632310
Number of Individuals Covered105
Insurance policy start date2011-03-01
Insurance policy end date2012-02-29
Total amount of commissions paid to insurance brokerUSD $3,281
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )
Policy contract numberGTU8365147
Policy instance 5
Insurance contract or identification numberGTU8365147
Number of Individuals Covered254
Insurance policy start date2010-10-19
Insurance policy end date2011-10-19
Total amount of commissions paid to insurance brokerUSD $472
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $3,144
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 )
Policy contract number8120-1094
Policy instance 3
Insurance contract or identification number8120-1094
Number of Individuals Covered391
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $9,401
Total amount of fees paid to insurance companyUSD $453
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $94,015
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberNWL0129MO-02
Policy instance 4
Insurance contract or identification numberNWL0129MO-02
Number of Individuals Covered263
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $14,318
Total amount of fees paid to insurance companyUSD $40,513
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $257,420
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number632310
Policy instance 2
Insurance contract or identification number632310
Number of Individuals Covered286
Insurance policy start date2011-03-01
Insurance policy end date2012-02-29
Total amount of commissions paid to insurance brokerUSD $2,598
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number632310
Policy instance 2
Insurance contract or identification number632310
Number of Individuals Covered330
Insurance policy start date2010-03-01
Insurance policy end date2011-02-28
Total amount of commissions paid to insurance brokerUSD $2,049
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,049
Insurance broker organization code?3
Insurance broker nameBEIMDIEK INS AGENCY INC
ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )
Policy contract numberGTU8365147
Policy instance 5
Insurance contract or identification numberGTU8365147
Number of Individuals Covered360
Insurance policy start date2009-10-19
Insurance policy end date2010-10-19
Total amount of commissions paid to insurance brokerUSD $547
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $3,643
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $547
Insurance broker organization code?3
Insurance broker nameBEIMDIEK INSURANCE AGENCY
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberNWL0129MO-02
Policy instance 4
Insurance contract or identification numberNWL0129MO-02
Number of Individuals Covered297
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $4,068
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $203,393
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,068
Insurance broker organization code?3
Insurance broker nameBENEFIT MANAGEMENT, INC-MO
DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 )
Policy contract number8120-1094
Policy instance 3
Insurance contract or identification number8120-1094
Number of Individuals Covered394
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $9,485
Total amount of fees paid to insurance companyUSD $193
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $94,851
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,485
Amount paid for insurance broker fees193
Additional information about fees paid to insurance brokerDELTA REWARDS
Insurance broker organization code?3
Insurance broker nameBEIMDIEK INS AGENCY
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number632310
Policy instance 1
Insurance contract or identification number632310
Number of Individuals Covered96
Insurance policy start date2010-03-01
Insurance policy end date2011-02-28
Total amount of commissions paid to insurance brokerUSD $3,187
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,187
Insurance broker organization code?3
Insurance broker nameBEIMDIEK INS AGENCY INC

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