J H INDUSTRY, INC has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan J H INDUSTRY, INC. D/B/A WOOSHIN USA
401k plan membership statisitcs for J H INDUSTRY, INC. D/B/A WOOSHIN USA
| Measure | Date | Value |
|---|
| 2022: J H INDUSTRY, INC. D/B/A WOOSHIN USA 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-03-01 | 86 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-03-01 | 80 |
| Number of retired or separated participants receiving benefits | 2022-03-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2022-03-01 | 0 |
| Total of all active and inactive participants | 2022-03-01 | 80 |
| 2021: J H INDUSTRY, INC. D/B/A WOOSHIN USA 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-03-01 | 116 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-03-01 | 86 |
| Number of retired or separated participants receiving benefits | 2021-03-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-03-01 | 0 |
| Total of all active and inactive participants | 2021-03-01 | 86 |
| 2020: J H INDUSTRY, INC. D/B/A WOOSHIN USA 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-03-01 | 107 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-03-01 | 116 |
| Number of retired or separated participants receiving benefits | 2020-03-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2020-03-01 | 0 |
| Total of all active and inactive participants | 2020-03-01 | 116 |
| 2019: J H INDUSTRY, INC. D/B/A WOOSHIN USA 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-10-01 | 110 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-10-01 | 107 |
| Number of retired or separated participants receiving benefits | 2019-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-10-01 | 0 |
| Total of all active and inactive participants | 2019-10-01 | 107 |
| Total participants | 2019-10-01 | 107 |
| 2018: J H INDUSTRY, INC. D/B/A WOOSHIN USA 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-10-01 | 675 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-10-01 | 620 |
| Number of retired or separated participants receiving benefits | 2018-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-10-01 | 0 |
| Total of all active and inactive participants | 2018-10-01 | 620 |
| Total participants | 2018-10-01 | 620 |
| 2017: J H INDUSTRY, INC. D/B/A WOOSHIN USA 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-10-01 | 675 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-10-01 | 620 |
| Number of retired or separated participants receiving benefits | 2017-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-10-01 | 0 |
| Total of all active and inactive participants | 2017-10-01 | 620 |
| 2016: J H INDUSTRY, INC. D/B/A WOOSHIN USA 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-10-01 | 573 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-10-01 | 675 |
| Number of retired or separated participants receiving benefits | 2016-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2016-10-01 | 0 |
| Total of all active and inactive participants | 2016-10-01 | 675 |
| 2015: J H INDUSTRY, INC. D/B/A WOOSHIN USA 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-10-01 | 199 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-10-01 | 573 |
| Number of retired or separated participants receiving benefits | 2015-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2015-10-01 | 0 |
| Total of all active and inactive participants | 2015-10-01 | 573 |
| 2014: J H INDUSTRY, INC. D/B/A WOOSHIN USA 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-10-01 | 135 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-10-01 | 199 |
| Number of retired or separated participants receiving benefits | 2014-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2014-10-01 | 0 |
| Total of all active and inactive participants | 2014-10-01 | 199 |
| 2013: J H INDUSTRY, INC. D/B/A WOOSHIN USA 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-10-01 | 135 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-10-01 | 135 |
| Number of retired or separated participants receiving benefits | 2013-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2013-10-01 | 0 |
| Total of all active and inactive participants | 2013-10-01 | 135 |
| 2012: J H INDUSTRY, INC. D/B/A WOOSHIN USA 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-10-01 | 154 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-10-01 | 533 |
| Number of retired or separated participants receiving benefits | 2012-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2012-10-01 | 0 |
| Total of all active and inactive participants | 2012-10-01 | 533 |
| 2011: J H INDUSTRY, INC. D/B/A WOOSHIN USA 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-10-01 | 0 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-10-01 | 154 |
| Number of retired or separated participants receiving benefits | 2011-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2011-10-01 | 0 |
| Total of all active and inactive participants | 2011-10-01 | 154 |
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E5773353 |
| Policy instance | 8 |
| Insurance contract or identification number | E5773353 | | Number of Individuals Covered | 43 | | Insurance policy start date | 2022-03-01 | | Insurance policy end date | 2023-02-28 | | Total amount of commissions paid to insurance broker | USD $10,154 | | Total amount of fees paid to insurance company | USD $6,932 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $26,205 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,968 | | Amount paid for insurance broker fees | 1410 | | Additional information about fees paid to insurance broker | AGENT/PRODUCER | | Insurance broker organization code? | 3 |
|
| BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 ) |
| Policy contract number | 0087003 |
| Policy instance | 1 |
| Insurance contract or identification number | 0087003 | | Number of Individuals Covered | 80 | | Insurance policy start date | 2022-03-01 | | Insurance policy end date | 2023-02-28 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Other welfare benefits provided | BABY YOURSELF, AIR MEDICAL SERVICES | | 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 | G000BBLQ |
| Policy instance | 2 |
| Insurance contract or identification number | G000BBLQ | | Number of Individuals Covered | 77 | | Insurance policy start date | 2022-03-01 | | Insurance policy end date | 2023-02-28 | | Total amount of commissions paid to insurance broker | USD $1,020 | | Total amount of fees paid to insurance company | USD $615 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,198 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,020 | | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 615 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000BBLQ |
| Policy instance | 3 |
| Insurance contract or identification number | G000BBLQ | | Number of Individuals Covered | 77 | | Insurance policy start date | 2022-03-01 | | Insurance policy end date | 2023-02-28 | | Total amount of commissions paid to insurance broker | USD $2,132 | | Total amount of fees paid to insurance company | USD $852 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERENT | | Welfare Benefit Premiums Paid to Carrier | USD $14,212 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,132 | | Additional information about fees paid to insurance broker | AGENT OR BROKER OF THE RECORD | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 852 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000BBLQ |
| Policy instance | 4 |
| Insurance contract or identification number | G000BBLQ | | Number of Individuals Covered | 38 | | Insurance policy start date | 2022-03-01 | | Insurance policy end date | 2023-02-28 | | Total amount of commissions paid to insurance broker | USD $4,810 | | Total amount of fees paid to insurance company | USD $1,755 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $32,067 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,810 | | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 1755 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000BBLQ |
| Policy instance | 5 |
| Insurance contract or identification number | G000BBLQ | | Insurance policy start date | 2022-03-01 | | Insurance policy end date | 2023-02-28 | | Total amount of fees paid to insurance company | USD $545 | | Other welfare benefits provided | CRITICAL ILLNESS VOLUNTARY | | Welfare Benefit Premiums Paid to Carrier | USD $-2 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 545 | | 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 | G000BBLQ |
| Policy instance | 6 |
| Insurance contract or identification number | G000BBLQ | | Number of Individuals Covered | 37 | | Insurance policy start date | 2022-03-01 | | Insurance policy end date | 2023-02-28 | | Total amount of commissions paid to insurance broker | USD $2,070 | | Total amount of fees paid to insurance company | USD $891 | | Other welfare benefits provided | TERM LIFE - VOLUNTARY | | Welfare Benefit Premiums Paid to Carrier | USD $13,798 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,070 | | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 891 |
|
| SHELTERPOINT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 89958 ) |
| Policy contract number | 81001 |
| Policy instance | 7 |
| Insurance contract or identification number | 81001 | | Number of Individuals Covered | 142 | | Insurance policy start date | 2022-03-01 | | Insurance policy end date | 2023-02-28 | | Total amount of commissions paid to insurance broker | USD $37,942 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $161,453 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $22,603 | | Additional information about fees paid to insurance broker | AGENT | | Insurance broker organization code? | 3 |
|
| BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 ) |
| Policy contract number | 0087003 |
| Policy instance | 1 |
| Insurance contract or identification number | 0087003 | | Number of Individuals Covered | 86 | | Insurance policy start date | 2021-03-01 | | Insurance policy end date | 2022-02-28 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Other welfare benefits provided | BABY YOURSELF, AIR MEDICAL SERVICES | | 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 | G000BBLQ |
| Policy instance | 2 |
| Insurance contract or identification number | G000BBLQ | | Number of Individuals Covered | 84 | | Insurance policy start date | 2021-03-01 | | Insurance policy end date | 2022-02-28 | | Total amount of commissions paid to insurance broker | USD $997 | | Total amount of fees paid to insurance company | USD $972 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $9,971 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $997 | | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 648 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000BBLQ |
| Policy instance | 3 |
| Insurance contract or identification number | G000BBLQ | | Number of Individuals Covered | 84 | | Insurance policy start date | 2021-03-01 | | Insurance policy end date | 2022-02-28 | | Total amount of commissions paid to insurance broker | USD $2,072 | | Total amount of fees paid to insurance company | USD $1,348 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERENT | | Welfare Benefit Premiums Paid to Carrier | USD $13,814 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,072 | | Additional information about fees paid to insurance broker | AGENT OR BROKER OF THE RECORD | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 899 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000BBLQ |
| Policy instance | 4 |
| Insurance contract or identification number | G000BBLQ | | Number of Individuals Covered | 37 | | Insurance policy start date | 2021-03-01 | | Insurance policy end date | 2022-02-28 | | Total amount of commissions paid to insurance broker | USD $4,304 | | Total amount of fees paid to insurance company | USD $2,807 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $28,692 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,304 | | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 1871 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000BBLQ |
| Policy instance | 5 |
| Insurance contract or identification number | G000BBLQ | | Number of Individuals Covered | 20 | | Insurance policy start date | 2021-03-01 | | Insurance policy end date | 2022-02-28 | | Total amount of commissions paid to insurance broker | USD $2,234 | | Total amount of fees paid to insurance company | USD $872 | | Other welfare benefits provided | CRITICAL ILLNESS VOLUNTARY | | Welfare Benefit Premiums Paid to Carrier | USD $8,936 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,234 | | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 581 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000BBLQ |
| Policy instance | 6 |
| Insurance contract or identification number | G000BBLQ | | Number of Individuals Covered | 28 | | Insurance policy start date | 2021-03-01 | | Insurance policy end date | 2022-02-28 | | Total amount of commissions paid to insurance broker | USD $1,348 | | Total amount of fees paid to insurance company | USD $961 | | Other welfare benefits provided | ACCIDENT ONLY VOLUNTARY | | Welfare Benefit Premiums Paid to Carrier | USD $8,989 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,348 | | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 641 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000BBLQ |
| Policy instance | 7 |
| Insurance contract or identification number | G000BBLQ | | Number of Individuals Covered | 39 | | Insurance policy start date | 2021-03-01 | | Insurance policy end date | 2022-02-28 | | Total amount of commissions paid to insurance broker | USD $2,203 | | Total amount of fees paid to insurance company | USD $1,380 | | Other welfare benefits provided | TERM LIFE - VOLUNTARY | | Welfare Benefit Premiums Paid to Carrier | USD $14,684 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,203 | | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 920 |
|
| ACE AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 22667 ) |
| Policy contract number | 40041 |
| Policy instance | 8 |
| Insurance contract or identification number | 40041 | | Number of Individuals Covered | 159 | | Insurance policy start date | 2021-03-01 | | Insurance policy end date | 2022-02-28 | | Total amount of commissions paid to insurance broker | USD $3,204 | | 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 $1,602 | | Additional information about fees paid to insurance broker | AGENT | | Insurance broker organization code? | 3 |
|
| BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 ) |
| Policy contract number | 0087003 |
| Policy instance | 1 |
| Insurance contract or identification number | 0087003 | | Number of Individuals Covered | 116 | | Insurance policy start date | 2020-03-01 | | Insurance policy end date | 2021-02-28 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Other welfare benefits provided | BABY YOURSELF, AIR MEDICAL SERVICES | | 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 | G000BBLQ |
| Policy instance | 2 |
| Insurance contract or identification number | G000BBLQ | | Number of Individuals Covered | 114 | | Insurance policy start date | 2020-03-01 | | Insurance policy end date | 2021-02-28 | | Total amount of commissions paid to insurance broker | USD $1,192 | | Total amount of fees paid to insurance company | USD $1,011 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $11,922 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,192 | | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 674 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000BBLQ |
| Policy instance | 4 |
| Insurance contract or identification number | G000BBLQ | | Number of Individuals Covered | 52 | | Insurance policy start date | 2020-03-01 | | Insurance policy end date | 2021-02-28 | | Total amount of commissions paid to insurance broker | USD $6,817 | | Total amount of fees paid to insurance company | USD $3,076 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $34,083 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,817 | | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 2051 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000BBLQ |
| Policy instance | 3 |
| Insurance contract or identification number | G000BBLQ | | Number of Individuals Covered | 114 | | Insurance policy start date | 2020-03-01 | | Insurance policy end date | 2021-02-28 | | Total amount of commissions paid to insurance broker | USD $2,481 | | Total amount of fees paid to insurance company | USD $1,407 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERENT | | Welfare Benefit Premiums Paid to Carrier | USD $16,537 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,481 | | Additional information about fees paid to insurance broker | AGENT OR BROKER OF THE RECORD | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 938 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000BBLQ |
| Policy instance | 5 |
| Insurance contract or identification number | G000BBLQ | | Number of Individuals Covered | 27 | | Insurance policy start date | 2020-03-01 | | Insurance policy end date | 2021-02-28 | | Total amount of commissions paid to insurance broker | USD $2,661 | | Total amount of fees paid to insurance company | USD $951 | | Other welfare benefits provided | CRITICAL ILLNESS VOLUNTARY | | Welfare Benefit Premiums Paid to Carrier | USD $10,643 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,661 | | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 634 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000BBLQ |
| Policy instance | 6 |
| Insurance contract or identification number | G000BBLQ | | Number of Individuals Covered | 38 | | Insurance policy start date | 2020-03-01 | | Insurance policy end date | 2021-02-28 | | Total amount of commissions paid to insurance broker | USD $1,740 | | Total amount of fees paid to insurance company | USD $1,078 | | Other welfare benefits provided | ACCIDENT ONLY VOLUNTARY | | Welfare Benefit Premiums Paid to Carrier | USD $11,600 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,740 | | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 719 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000BBLQ |
| Policy instance | 7 |
| Insurance contract or identification number | G000BBLQ | | Number of Individuals Covered | 51 | | Insurance policy start date | 2020-03-01 | | Insurance policy end date | 2021-02-28 | | Total amount of commissions paid to insurance broker | USD $3,384 | | Total amount of fees paid to insurance company | USD $1,457 | | Other welfare benefits provided | TERM LIFE - VOLUNTARY | | Welfare Benefit Premiums Paid to Carrier | USD $16,920 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,384 | | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 971 |
|
| ACE AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 22667 ) |
| Policy contract number | |
| Policy instance | 8 |
| Number of Individuals Covered | 207 | | Insurance policy start date | 2020-03-01 | | Insurance policy end date | 2021-02-28 | | Total amount of commissions paid to insurance broker | USD $50,088 | | 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 $25,044 | | Additional information about fees paid to insurance broker | AGENT | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000BBLQ |
| Policy instance | 3 |
| Insurance contract or identification number | G000BBLQ | | Number of Individuals Covered | 107 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-02-29 | | Total amount of commissions paid to insurance broker | USD $2,394 | | Total amount of fees paid to insurance company | USD $1,144 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERENT | | Welfare Benefit Premiums Paid to Carrier | USD $15,041 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,394 | | Additional information about fees paid to insurance broker | AGENT OR BROKER OF THE RECORD | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 616 |
|
| ACE AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 22667 ) |
| Policy contract number | |
| Policy instance | 8 |
| Number of Individuals Covered | 201 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-02-29 | | Total amount of commissions paid to insurance broker | USD $50,906 | | 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 $25,453 | | Additional information about fees paid to insurance broker | AGENT | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000BBLQ |
| Policy instance | 7 |
| Insurance contract or identification number | G000BBLQ | | Number of Individuals Covered | 61 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-02-29 | | Total amount of commissions paid to insurance broker | USD $3,278 | | Total amount of fees paid to insurance company | USD $1,102 | | Other welfare benefits provided | TERM LIFE - VOLUNTARY | | Welfare Benefit Premiums Paid to Carrier | USD $14,662 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,278 | | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 593 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000BBLQ |
| Policy instance | 6 |
| Insurance contract or identification number | G000BBLQ | | Number of Individuals Covered | 36 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-02-29 | | Total amount of commissions paid to insurance broker | USD $1,802 | | Total amount of fees paid to insurance company | USD $905 | | Other welfare benefits provided | ACCIDENT ONLY VOLUNTARY | | Welfare Benefit Premiums Paid to Carrier | USD $9,603 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,802 | | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 487 |
|
| BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 ) |
| Policy contract number | 0087003 |
| Policy instance | 1 |
| Insurance contract or identification number | 0087003 | | Number of Individuals Covered | 107 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-02-29 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Other welfare benefits provided | BABY YOURSELF, AIR MEDICAL SERVICES | | 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 | G000BBLQ |
| Policy instance | 5 |
| Insurance contract or identification number | G000BBLQ | | Number of Individuals Covered | 22 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-02-29 | | Total amount of commissions paid to insurance broker | USD $2,636 | | Total amount of fees paid to insurance company | USD $783 | | Other welfare benefits provided | CRITICAL ILLNESS VOLUNTARY | | Welfare Benefit Premiums Paid to Carrier | USD $6,204 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,636 | | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 422 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000BBLQ |
| Policy instance | 4 |
| Insurance contract or identification number | G000BBLQ | | Number of Individuals Covered | 65 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-02-29 | | Total amount of commissions paid to insurance broker | USD $6,883 | | Total amount of fees paid to insurance company | USD $2,703 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $39,952 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,883 | | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 1455 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000BBLQ |
| Policy instance | 2 |
| Insurance contract or identification number | G000BBLQ | | Number of Individuals Covered | 107 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-02-29 | | Total amount of commissions paid to insurance broker | USD $1,147 | | Total amount of fees paid to insurance company | USD $822 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $11,017 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,147 | | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 443 |
|
| BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 ) |
| Policy contract number | 0087003 |
| Policy instance | 1 |
| Insurance contract or identification number | 0087003 | | Number of Individuals Covered | 470 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | AIR MEDICAL SERVICES (AIRMED) | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | 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 | G000BBLQ |
| Policy instance | 3 |
| Insurance contract or identification number | G000BBLQ | | Number of Individuals Covered | 182 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-09-30 | | Total amount of commissions paid to insurance broker | USD $8,877 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $59,178 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,877 | | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000BBLQ |
| Policy instance | 2 |
| Insurance contract or identification number | G000BBLQ | | Number of Individuals Covered | 461 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-09-30 | | Total amount of commissions paid to insurance broker | USD $5,437 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $54,372 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,437 | | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD | | Insurance broker organization code? | 3 |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E3838901 |
| Policy instance | 4 |
| Insurance contract or identification number | E3838901 | | Number of Individuals Covered | 126 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-09-30 | | Total amount of commissions paid to insurance broker | USD $7,442 | | Total amount of fees paid to insurance company | USD $513 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,943 | | Additional information about fees paid to insurance broker | INS. COMMISSION | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 174 | | Insurance broker name | KELLIE WELLS |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010179941 |
| Policy instance | 3 |
| Insurance contract or identification number | 000010179941 | | Number of Individuals Covered | 198 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-09-30 | | Total amount of commissions paid to insurance broker | USD $1,998 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMB. | | Welfare Benefit Premiums Paid to Carrier | USD $19,984 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,998 | | Additional information about fees paid to insurance broker | INS COMMISSION | | Insurance broker organization code? | 3 | | Insurance broker name | HARMON DENNIS BRADSHAW INC |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010179942 |
| Policy instance | 2 |
| Insurance contract or identification number | 000010179942 | | Number of Individuals Covered | 195 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-09-30 | | Total amount of commissions paid to insurance broker | USD $1,162 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $11,616 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,162 | | Additional information about fees paid to insurance broker | INS COMMISSION | | Insurance broker organization code? | 3 | | Insurance broker name | HARMON DENNIS BRADSHAW INC |
|
| BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 ) |
| Policy contract number | 87003 |
| Policy instance | 1 |
| Insurance contract or identification number | 87003 | | Number of Individuals Covered | 1135 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-09-30 | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | Yes | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | OTHER-EPS | | Welfare Benefit Premiums Paid to Carrier | USD $54,001 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 ) |
| Policy contract number | 87003 |
| Policy instance | 1 |
| Insurance contract or identification number | 87003 | | Number of Individuals Covered | 1049 | | Insurance policy start date | 2015-10-01 | | Insurance policy end date | 2016-09-30 | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | Yes | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | OTHER-EPS | | Welfare Benefit Premiums Paid to Carrier | USD $38,215 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010179942 |
| Policy instance | 2 |
| Insurance contract or identification number | 000010179942 | | Number of Individuals Covered | 103 | | Insurance policy start date | 2015-10-01 | | Insurance policy end date | 2016-09-30 | | Total amount of commissions paid to insurance broker | USD $1,468 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $14,684 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,468 | | Additional information about fees paid to insurance broker | INS COMMISSION | | Insurance broker organization code? | 3 | | Insurance broker name | HARMON DENNIS BRADSHAW INC |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010179941 |
| Policy instance | 3 |
| Insurance contract or identification number | 000010179941 | | Number of Individuals Covered | 149 | | Insurance policy start date | 2015-10-01 | | Insurance policy end date | 2016-09-30 | | Total amount of commissions paid to insurance broker | USD $2,149 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMB. | | Welfare Benefit Premiums Paid to Carrier | USD $21,490 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,149 | | Additional information about fees paid to insurance broker | INS COMMISSION | | Insurance broker organization code? | 3 | | Insurance broker name | HARMON DENNIS BRADSHAW INC |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E3838901 |
| Policy instance | 4 |
| Insurance contract or identification number | E3838901 | | Number of Individuals Covered | 135 | | Insurance policy start date | 2015-10-01 | | Insurance policy end date | 2016-09-30 | | Total amount of commissions paid to insurance broker | USD $21,192 | | Total amount of fees paid to insurance company | USD $5,239 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,425 | | Amount paid for insurance broker fees | 769 | | Additional information about fees paid to insurance broker | INS. COMMISSION | | Insurance broker organization code? | 3 | | Insurance broker name | TIMOTHY ALLEN WALKER |
|
| BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 ) |
| Policy contract number | 77956 |
| Policy instance | 1 |
| Insurance contract or identification number | 77956 | | Number of Individuals Covered | 154 | | Insurance policy start date | 2014-10-01 | | Insurance policy end date | 2015-09-30 | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | Yes | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Other welfare benefits provided | OTHER-AIRMED | | Welfare Benefit Premiums Paid to Carrier | USD $8,541 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010179942 |
| Policy instance | 2 |
| Insurance contract or identification number | 000010179942 | | Number of Individuals Covered | 103 | | Insurance policy start date | 2014-10-01 | | Insurance policy end date | 2015-09-30 | | Total amount of commissions paid to insurance broker | USD $689 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,887 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $689 | | Additional information about fees paid to insurance broker | INS COMMISSION | | Insurance broker organization code? | 3 | | Insurance broker name | HARMON DENNIS BRADSHAW INC |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010179941 |
| Policy instance | 3 |
| Insurance contract or identification number | 000010179941 | | Number of Individuals Covered | 102 | | Insurance policy start date | 2014-10-01 | | Insurance policy end date | 2015-09-30 | | Total amount of commissions paid to insurance broker | USD $1,048 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMB. | | Welfare Benefit Premiums Paid to Carrier | USD $10,484 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,048 | | Additional information about fees paid to insurance broker | INS COMMISSION | | Insurance broker organization code? | 3 | | Insurance broker name | HARMON DENNIS BRADSHAW INC |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000400179943 |
| Policy instance | 4 |
| Insurance contract or identification number | 000400179943 | | Number of Individuals Covered | 27 | | Insurance policy start date | 2014-10-01 | | Insurance policy end date | 2015-09-30 | | Total amount of commissions paid to insurance broker | USD $804 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,359 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $804 | | Additional information about fees paid to insurance broker | INS COMMISSION | | Insurance broker organization code? | 3 | | Insurance broker name | HARMON DENNIS BRADSHAW INC |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E3838901 |
| Policy instance | 5 |
| Insurance contract or identification number | E3838901 | | Number of Individuals Covered | 114 | | Insurance policy start date | 2014-10-01 | | Insurance policy end date | 2015-09-30 | | Total amount of commissions paid to insurance broker | USD $11,467 | | Total amount of fees paid to insurance company | USD $1,620 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $195 | | Amount paid for insurance broker fees | 44 | | Additional information about fees paid to insurance broker | INS. COMMISSION | | Insurance broker organization code? | 3 | | Insurance broker name | HARMON DENNIS BRADSHAW INC |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010179941 |
| Policy instance | 3 |
| Insurance contract or identification number | 000010179941 | | Number of Individuals Covered | 98 | | Insurance policy start date | 2013-10-01 | | Insurance policy end date | 2014-09-30 | | Total amount of commissions paid to insurance broker | USD $1,109 | | Welfare Benefit Premiums Paid to Carrier | USD $11,095 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,109 | | Additional information about fees paid to insurance broker | INS COMMISSION | | Insurance broker organization code? | 3 | | Insurance broker name | HARMON DENNIS BRADSHAW INC |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E3838901 |
| Policy instance | 2 |
| Insurance contract or identification number | E3838901 | | Number of Individuals Covered | 72 | | Insurance policy start date | 2013-10-01 | | Insurance policy end date | 2014-09-30 | | Total amount of commissions paid to insurance broker | USD $6,461 | | Total amount of fees paid to insurance company | USD $333 | | 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 $2,479 | | Amount paid for insurance broker fees | 333 | | Additional information about fees paid to insurance broker | INS COMMISSION | | Insurance broker organization code? | 3 | | Insurance broker name | BRITTANY TINDAL |
|
| BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 ) |
| Policy contract number | 77956 |
| Policy instance | 1 |
| Insurance contract or identification number | 77956 | | Number of Individuals Covered | 154 | | Insurance policy start date | 2013-10-01 | | Insurance policy end date | 2014-09-30 | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | Yes | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Other welfare benefits provided | OTHER-AIRMED | | Welfare Benefit Premiums Paid to Carrier | USD $7,294 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 11374 |
| Policy instance | 2 |
| Insurance contract or identification number | 11374 | | Number of Individuals Covered | 390 | | Insurance policy start date | 2012-10-01 | | Insurance policy end date | 2013-09-30 | | Total amount of commissions paid to insurance broker | USD $1,913 | | Total amount of fees paid to insurance company | USD $28 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $27,141 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $195 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMMISSIONS | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 28 | | Insurance broker name | AXA ASSISTANCE USA |
|
| BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 ) |
| Policy contract number | 77956 |
| Policy instance | 1 |
| Insurance contract or identification number | 77956 | | Number of Individuals Covered | 143 | | Insurance policy start date | 2012-10-01 | | Insurance policy end date | 2013-09-30 | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | Yes | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Other welfare benefits provided | OTHER-AIRMED | | Welfare Benefit Premiums Paid to Carrier | USD $1,256 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 ) |
| Policy contract number | 77956 |
| Policy instance | 1 |
| Insurance contract or identification number | 77956 | | Number of Individuals Covered | 154 | | Insurance policy start date | 2011-10-01 | | Insurance policy end date | 2012-09-30 | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | Yes | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Other welfare benefits provided | OTHER SPECIFY | | Welfare Benefit Premiums Paid to Carrier | USD $7,613 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
