CREDIT MANAGEMENT SERVICES, INC. has sponsored the creation of one or more 401k plans.
Additional information about CREDIT MANAGEMENT SERVICES, INC.
Submission information for form 5500 for 401k plan GROUP HEALTH PLAN FOR CREDIT MANAGEMENT SERVICES, INC.
401k plan membership statisitcs for GROUP HEALTH PLAN FOR CREDIT MANAGEMENT SERVICES, INC.
| Measure | Date | Value |
|---|
| 2022: GROUP HEALTH PLAN FOR CREDIT MANAGEMENT SERVICES, INC. 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 143 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 145 |
| Number of retired or separated participants receiving benefits | 2022-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2022-01-01 | 0 |
| Total of all active and inactive participants | 2022-01-01 | 145 |
| 2021: GROUP HEALTH PLAN FOR CREDIT MANAGEMENT SERVICES, INC. 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 138 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 143 |
| Number of retired or separated participants receiving benefits | 2021-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-01-01 | 0 |
| Total of all active and inactive participants | 2021-01-01 | 143 |
| 2020: GROUP HEALTH PLAN FOR CREDIT MANAGEMENT SERVICES, INC. 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 152 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 138 |
| Number of retired or separated participants receiving benefits | 2020-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2020-01-01 | 0 |
| Total of all active and inactive participants | 2020-01-01 | 138 |
| 2019: GROUP HEALTH PLAN FOR CREDIT MANAGEMENT SERVICES, INC. 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 138 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 152 |
| Number of retired or separated participants receiving benefits | 2019-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-01-01 | 0 |
| Total of all active and inactive participants | 2019-01-01 | 152 |
| 2018: GROUP HEALTH PLAN FOR CREDIT MANAGEMENT SERVICES, INC. 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 127 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 138 |
| Number of retired or separated participants receiving benefits | 2018-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-01-01 | 0 |
| Total of all active and inactive participants | 2018-01-01 | 138 |
| 2017: GROUP HEALTH PLAN FOR CREDIT MANAGEMENT SERVICES, INC. 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 0 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 0 |
| Number of retired or separated participants receiving benefits | 2017-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-01-01 | 0 |
| Total of all active and inactive participants | 2017-01-01 | 0 |
| 2016: GROUP HEALTH PLAN FOR CREDIT MANAGEMENT SERVICES, INC. 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 0 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 0 |
| Number of retired or separated participants receiving benefits | 2016-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2016-01-01 | 0 |
| Total of all active and inactive participants | 2016-01-01 | 0 |
| 2015: GROUP HEALTH PLAN FOR CREDIT MANAGEMENT SERVICES, INC. 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 132 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 0 |
| Number of retired or separated participants receiving benefits | 2015-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2015-01-01 | 0 |
| Total of all active and inactive participants | 2015-01-01 | 0 |
| Total participants | 2015-01-01 | 0 |
| 2014: GROUP HEALTH PLAN FOR CREDIT MANAGEMENT SERVICES, INC. 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 128 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 132 |
| Number of retired or separated participants receiving benefits | 2014-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2014-01-01 | 0 |
| Total of all active and inactive participants | 2014-01-01 | 132 |
| Total participants | 2014-01-01 | 132 |
| 2012: GROUP HEALTH PLAN FOR CREDIT MANAGEMENT SERVICES, INC. 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 123 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 119 |
| Number of retired or separated participants receiving benefits | 2012-01-01 | 0 |
| Total of all active and inactive participants | 2012-01-01 | 119 |
| 2011: GROUP HEALTH PLAN FOR CREDIT MANAGEMENT SERVICES, INC. 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-01-01 | 119 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 121 |
| Number of retired or separated participants receiving benefits | 2011-01-01 | 2 |
| Total of all active and inactive participants | 2011-01-01 | 123 |
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 169750 |
| Policy instance | 9 |
| Insurance contract or identification number | 169750 | | Number of Individuals Covered | 110 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $2,191 | | Life 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 $2,191 | | Additional information about fees paid to insurance broker | LIFE INSURANCE | | Insurance broker organization code? | 3 |
|
| EMC NATIONAL LIFE COMPANY (National Association of Insurance Commissioners NAIC id number: 62928 ) |
| Policy contract number | GL0777 |
| Policy instance | 1 |
| Insurance contract or identification number | GL0777 | | Number of Individuals Covered | 21 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $554 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,537 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $554 | | Additional information about fees paid to insurance broker | GROUP TERM LIFE INSURANCE | | Insurance broker organization code? | 3 |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | 1072540 |
| Policy instance | 2 |
| Insurance contract or identification number | 1072540 | | Number of Individuals Covered | 145 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $7,599 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $74,964 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,599 | | Additional information about fees paid to insurance broker | DENTAL VISION | | Insurance broker organization code? | 3 |
|
| TRUSTMARK LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62863 ) |
| Policy contract number | SM70852X |
| Policy instance | 3 |
| Insurance contract or identification number | SM70852X | | Number of Individuals Covered | 21 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $533 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $9,694 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $533 | | Additional information about fees paid to insurance broker | LIFE INSURANCE | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00565435 |
| Policy instance | 4 |
| Insurance contract or identification number | 00565435 | | Number of Individuals Covered | 22 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $1,347 | | Total amount of fees paid to insurance company | USD $839 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $13,523 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,347 | | Amount paid for insurance broker fees | 839 | | Additional information about fees paid to insurance broker | AD&D LIFE | | Insurance broker organization code? | 3 |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 889155G |
| Policy instance | 5 |
| Insurance contract or identification number | 889155G | | Number of Individuals Covered | 21 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $1,099 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD-BAS | | Welfare Benefit Premiums Paid to Carrier | USD $10,987 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,099 | | Additional information about fees paid to insurance broker | LIFE-BTRM ADD-BAS | | Insurance broker organization code? | 3 |
|
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | 41596 |
| Policy instance | 6 |
| Insurance contract or identification number | 41596 | | Number of Individuals Covered | 33 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $8,971 | | Total amount of fees paid to insurance company | USD $184 | | Health Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | CANCER | | Welfare Benefit Premiums Paid to Carrier | USD $36,603 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,742 | | Additional information about fees paid to insurance broker | DISABILITY | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 77 |
|
| MEDICA (National Association of Insurance Commissioners NAIC id number: 1259 ) |
| Policy contract number | A00022 |
| Policy instance | 7 |
| Insurance contract or identification number | A00022 | | Number of Individuals Covered | 71 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $29,365 | | Total amount of fees paid to insurance company | USD $1,693 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $591,078 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $29,365 | | Amount paid for insurance broker fees | 1693 | | Additional information about fees paid to insurance broker | BROKER INCENTIVE PROGRAM - 2020 | | Insurance broker organization code? | 3 |
|
| COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 ) |
| Policy contract number | 950-05-S2720 |
| Policy instance | 8 |
| Insurance contract or identification number | 950-05-S2720 | | Number of Individuals Covered | 22 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $1,403 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $6,804 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $935 | | Additional information about fees paid to insurance broker | GROUP TERM LIFE GROUP AD&D | | Insurance broker organization code? | 3 |
|
| EMC NATIONAL LIFE COMPANY (National Association of Insurance Commissioners NAIC id number: 62928 ) |
| Policy contract number | GL0777 |
| Policy instance | 1 |
| Insurance contract or identification number | GL0777 | | Number of Individuals Covered | 21 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $391 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,906 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $391 | | Additional information about fees paid to insurance broker | GROUP TERM LIFE INSURANCE | | Insurance broker organization code? | 3 |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | 1072540 |
| Policy instance | 2 |
| Insurance contract or identification number | 1072540 | | Number of Individuals Covered | 143 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $7,445 | | Total amount of fees paid to insurance company | USD $733 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $86,211 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,445 | | Amount paid for insurance broker fees | 733 | | Additional information about fees paid to insurance broker | DENTAL VISION | | Insurance broker organization code? | 3 |
|
| TRUSTMARK LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62863 ) |
| Policy contract number | SM70852X |
| Policy instance | 3 |
| Insurance contract or identification number | SM70852X | | Number of Individuals Covered | 22 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $487 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $8,853 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $487 | | Additional information about fees paid to insurance broker | LIFE INSURANCE | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00565435 |
| Policy instance | 4 |
| Insurance contract or identification number | 00565435 | | Number of Individuals Covered | 21 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $1,413 | | Total amount of fees paid to insurance company | USD $231 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $14,126 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,525 | | Additional information about fees paid to insurance broker | AD&D LIFE | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 231 |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 889155G |
| Policy instance | 5 |
| Insurance contract or identification number | 889155G | | Number of Individuals Covered | 21 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $948 | | Total amount of fees paid to insurance company | USD $141 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,297 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $948 | | Additional information about fees paid to insurance broker | LIFE-BTRM | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 141 |
|
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | 41596 |
| Policy instance | 6 |
| Insurance contract or identification number | 41596 | | Number of Individuals Covered | 26 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $8,223 | | Total amount of fees paid to insurance company | USD $6 | | Health Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | CANCER | | Welfare Benefit Premiums Paid to Carrier | USD $36,339 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,454 | | Additional information about fees paid to insurance broker | DISABILITY | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 4 |
|
| MEDICA (National Association of Insurance Commissioners NAIC id number: 1259 ) |
| Policy contract number | A00022 |
| Policy instance | 7 |
| Insurance contract or identification number | A00022 | | Number of Individuals Covered | 71 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $30,135 | | Total amount of fees paid to insurance company | USD $1,939 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $662,126 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $30,135 | | Amount paid for insurance broker fees | 1939 | | Additional information about fees paid to insurance broker | BROKER INCENTIVE PROGRAM - 2020 | | Insurance broker organization code? | 3 |
|
| COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 ) |
| Policy contract number | 950-05-S2720 |
| Policy instance | 8 |
| Insurance contract or identification number | 950-05-S2720 | | Number of Individuals Covered | 21 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $1,528 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $7,422 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,019 | | Additional information about fees paid to insurance broker | GROUP TERM LIFE | | Insurance broker organization code? | 3 |
|
| EMC NATIONAL LIFE COMPANY (National Association of Insurance Commissioners NAIC id number: 62928 ) |
| Policy contract number | GL0777 |
| Policy instance | 1 |
| Insurance contract or identification number | GL0777 | | Number of Individuals Covered | 22 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $377 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,766 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $377 | | Additional information about fees paid to insurance broker | GROUP TERM LIFE INSURANCE | | Insurance broker organization code? | 3 |
|
| BLUE CROSS BLUE SHIELD OF NEBRASKA (National Association of Insurance Commissioners NAIC id number: 77780 ) |
| Policy contract number | 101989 |
| Policy instance | 2 |
| Insurance contract or identification number | 101989 | | Number of Individuals Covered | 91 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Additional information about fees paid to insurance broker | GROUP HEALTH INSURANCE | | Insurance broker organization code? | 3 |
|
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | FAE03089 |
| Policy instance | 3 |
| Insurance contract or identification number | FAE03089 | | Number of Individuals Covered | 109 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $5,447 | | Total amount of fees paid to insurance company | USD $1,574 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $30,820 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,447 | | Additional information about fees paid to insurance broker | LIFE INSURANCE | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 1242 |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | 1072540 |
| Policy instance | 4 |
| Insurance contract or identification number | 1072540 | | Number of Individuals Covered | 138 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $7,080 | | Total amount of fees paid to insurance company | USD $1,410 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $67,498 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,182 | | Amount paid for insurance broker fees | 1410 | | Additional information about fees paid to insurance broker | DENTAL INSURANCE VISION INSURANCE | | Insurance broker organization code? | 3 |
|
| TRUSTMARK LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62863 ) |
| Policy contract number | SM70852X |
| Policy instance | 5 |
| Insurance contract or identification number | SM70852X | | Number of Individuals Covered | 22 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $447 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $8,135 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $447 | | Additional information about fees paid to insurance broker | LIFE INSURANCE | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 565435 |
| Policy instance | 6 |
| Insurance contract or identification number | 565435 | | Number of Individuals Covered | 22 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $3,386 | | Total amount of fees paid to insurance company | USD $123 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $13,862 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,386 | | Amount paid for insurance broker fees | 123 | | Additional information about fees paid to insurance broker | AD&D LIFE | | Insurance broker organization code? | 3 |
|
| HARTFORD LIFE AND ACCIDENT (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 889155G |
| Policy instance | 7 |
| Insurance contract or identification number | 889155G | | Number of Individuals Covered | 22 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $1,004 | | Total amount of fees paid to insurance company | USD $12 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,080 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,004 | | Additional information about fees paid to insurance broker | ADD-BAS LIFE-BTRM | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 12 |
|
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | 41596 |
| Policy instance | 8 |
| Insurance contract or identification number | 41596 | | Number of Individuals Covered | 19 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $10,889 | | Total amount of fees paid to insurance company | USD $1,259 | | Health Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | CANCER | | Welfare Benefit Premiums Paid to Carrier | USD $26,471 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,894 | | Additional information about fees paid to insurance broker | ACCIDENT | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 368 |
|
| TRUSTMARK LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62863 ) |
| Policy contract number | SM70852X |
| Policy instance | 5 |
| Insurance contract or identification number | SM70852X | | Number of Individuals Covered | 22 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $424 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $7,712 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $424 | | Additional information about fees paid to insurance broker | LIFE INSURANCE | | Insurance broker organization code? | 3 |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | 1072540 |
| Policy instance | 4 |
| Insurance contract or identification number | 1072540 | | Number of Individuals Covered | 152 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $7,841 | | Total amount of fees paid to insurance company | USD $2,020 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $78,905 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,841 | | Amount paid for insurance broker fees | 2020 | | Additional information about fees paid to insurance broker | DENTAL INSURANCE VISION INSURANCE | | Insurance broker organization code? | 3 |
|
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | FAE03089 |
| Policy instance | 3 |
| Insurance contract or identification number | FAE03089 | | Number of Individuals Covered | 113 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $5,702 | | Total amount of fees paid to insurance company | USD $361 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $32,108 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,702 | | Additional information about fees paid to insurance broker | LIFE INSURANCE | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 361 |
|
| BLUE CROSS BLUE SHIELD OF NEBRASKA (National Association of Insurance Commissioners NAIC id number: 77780 ) |
| Policy contract number | 101989 |
| Policy instance | 2 |
| Insurance contract or identification number | 101989 | | Number of Individuals Covered | 91 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $41,747 | | 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 $41,747 | | Additional information about fees paid to insurance broker | GROUP HEALTH INSURANCE | | Insurance broker organization code? | 3 |
|
| EMC NATIONAL LIFE COMPANY (National Association of Insurance Commissioners NAIC id number: 62928 ) |
| Policy contract number | GL0777 |
| Policy instance | 1 |
| Insurance contract or identification number | GL0777 | | Number of Individuals Covered | 23 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $459 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,592 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $459 | | Additional information about fees paid to insurance broker | GROUP TERM LIFE INSURANCE | | Insurance broker organization code? | 3 |
|
| TRUSTMARK LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62863 ) |
| Policy contract number | SM70852X |
| Policy instance | 5 |
| Insurance contract or identification number | SM70852X | | Number of Individuals Covered | 23 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $408 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $7,425 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $408 | | Additional information about fees paid to insurance broker | LIFE INSURANCE | | Insurance broker organization code? | 3 |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | 1072540 |
| Policy instance | 4 |
| Insurance contract or identification number | 1072540 | | Number of Individuals Covered | 138 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $6,924 | | Total amount of fees paid to insurance company | USD $4,451 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $74,728 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,924 | | Amount paid for insurance broker fees | 4451 | | Additional information about fees paid to insurance broker | DENTAL INSURANCE VISION INSURANCE | | Insurance broker organization code? | 3 |
|
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | FAE03089 |
| Policy instance | 3 |
| Insurance contract or identification number | FAE03089 | | Number of Individuals Covered | 138 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $5,345 | | Total amount of fees paid to insurance company | USD $358 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $29,567 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,345 | | Additional information about fees paid to insurance broker | LIFE INSURANCE | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 358 |
|
| BLUE CROSS BLUE SHIELD OF NEBRASKA (National Association of Insurance Commissioners NAIC id number: 77780 ) |
| Policy contract number | 505699 |
| Policy instance | 2 |
| Insurance contract or identification number | 505699 | | Number of Individuals Covered | 89 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $22,830 | | 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 $22,830 | | Additional information about fees paid to insurance broker | GROUP HEALTH INSURANCE | | Insurance broker organization code? | 3 |
|
| EMC NATIONAL LIFE COMPANY (National Association of Insurance Commissioners NAIC id number: 62928 ) |
| Policy contract number | GL0777 |
| Policy instance | 1 |
| Insurance contract or identification number | GL0777 | | Number of Individuals Covered | 22 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $440 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,402 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $440 | | Additional information about fees paid to insurance broker | GROUP TERM LIFE INSURANCE | | Insurance broker organization code? | 3 |
|
| EMC NATIONAL LIFE COMPANY (National Association of Insurance Commissioners NAIC id number: 62928 ) |
| Policy contract number | GL0777 |
| Policy instance | 1 |
| Insurance contract or identification number | GL0777 | | Number of Individuals Covered | 24 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $416 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,158 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $416 | | Additional information about fees paid to insurance broker | GROUP TERM LIFE INSURANCE | | Insurance broker organization code? | 3 | | Insurance broker name | |
|
| BLUE CROSS BLUE SHIELD OF NEBRASKA (National Association of Insurance Commissioners NAIC id number: 77780 ) |
| Policy contract number | 300002 |
| Policy instance | 2 |
| Insurance contract or identification number | 300002 | | Number of Individuals Covered | 86 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Additional information about fees paid to insurance broker | GROUP HEALTH INSURANCE | | Insurance broker organization code? | 3 | | Insurance broker name | GALLAGHER BENEFIT SERVICES INC |
|
| TRUSTMARK LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62863 ) |
| Policy contract number | SM70852X |
| Policy instance | 5 |
| Insurance contract or identification number | SM70852X | | Number of Individuals Covered | 23 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $487 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $8,857 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $393 | | Additional information about fees paid to insurance broker | LIFE INSURANCE | | Insurance broker organization code? | 3 | | Insurance broker name | GALLAGHER BENEFIT SERVICES INC |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | 1072540 |
| Policy instance | 4 |
| Insurance contract or identification number | 1072540 | | Number of Individuals Covered | 125 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $7,438 | | Total amount of fees paid to insurance company | USD $79 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $85,454 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,100 | | Amount paid for insurance broker fees | 79 | | Additional information about fees paid to insurance broker | LIFE INSURANCE INDEMNITY CONTRACT | | Insurance broker organization code? | 3 | | Insurance broker name | PLATTE VALLEY INSURANCE CORP |
|
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | FAE03089 |
| Policy instance | 3 |
| Insurance contract or identification number | FAE03089 | | Number of Individuals Covered | 126 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $5,028 | | Total amount of fees paid to insurance company | USD $335 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $26,898 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,810 | | Additional information about fees paid to insurance broker | LIFE ACCIDENT | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 335 | | Insurance broker name | BLUECROSSBLUESHIELD OF NEBRASKA |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010-039293 |
| Policy instance | 1 |
| Insurance contract or identification number | 010-039293 | | Number of Individuals Covered | 154 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $1,185 | | Are there contracts with allocated funds for individual policies? | No | | 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 | Yes | | 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 $11,848 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $1,185 | | Insurance broker organization code? | 3 | | Insurance broker name | STUEHRENBERG AGENCY, INC. |
|
| EMC NATIONAL LIFE COMPANY (National Association of Insurance Commissioners NAIC id number: 62928 ) |
| Policy contract number | GL0777 |
| Policy instance | 2 |
| Insurance contract or identification number | GL0777 | | Number of Individuals Covered | 14 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $281 | | Are there contracts with allocated funds for individual policies? | No | | 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 | Yes | | 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 $2,343 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $281 | | Insurance broker organization code? | 3 | | Insurance broker name | STUEHRENBERG AGENCY, INC. |
|
| BLUE CROSS BLUE SHIELD OF NEBRASKA (National Association of Insurance Commissioners NAIC id number: 77780 ) |
| Policy contract number | 300002 |
| Policy instance | 4 |
| Insurance contract or identification number | 300002 | | Number of Individuals Covered | 71 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $15,238 | | Are there contracts with allocated funds for individual policies? | No | | 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 | 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 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $15,238 | | Insurance broker organization code? | 3 | | Insurance broker name | STUEHRENBERG AGENCY, INC. |
|
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | FAE03089 |
| Policy instance | 5 |
| Insurance contract or identification number | FAE03089 | | Number of Individuals Covered | 131 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $4,852 | | Total amount of fees paid to insurance company | USD $789 | | Are there contracts with allocated funds for individual policies? | No | | 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 | Yes | | 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 $25,439 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Amount paid for insurance broker fees | 493 | | Insurance broker organization code? | 3 | | Commission paid to Insurance Broker | USD $4,852 | | Insurance broker name | BLUECROSSBLUESHIELD OF NEBRASKA |
|
| TRUSTMARK LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62863 ) |
| Policy contract number | SM70852X |
| Policy instance | 6 |
| Insurance contract or identification number | SM70852X | | Number of Individuals Covered | 15 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $304 | | Are there contracts with allocated funds for individual policies? | No | | 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 | Yes | | 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 $5,519 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $304 | | Insurance broker organization code? | 3 | | Insurance broker name | STUEHRENBERG AGENCY, INC. |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | P17017 |
| Policy instance | 3 |
| Insurance contract or identification number | P17017 | | Number of Individuals Covered | 15 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $260 | | Are there contracts with allocated funds for individual policies? | No | | 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 | Yes | | 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 $2,597 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $260 | | Insurance broker organization code? | 3 | | Insurance broker name | PREFERRED MARKETING ASSOCIATES LTD |
|
| EMC NATIONAL LIFE COMPANY (National Association of Insurance Commissioners NAIC id number: 62928 ) |
| Policy contract number | GL0777 |
| Policy instance | 2 |
| Insurance contract or identification number | GL0777 | | Number of Individuals Covered | 15 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $224 | | Welfare Benefit Premiums Paid to Carrier | USD $2,153 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $176 | | Additional information about fees paid to insurance broker | GROUP TERM LIFE INSURANCE | | Insurance broker organization code? | 3 | | Insurance broker name | PARTNERS ADVANTAGE INSURANCE SERVIC |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010-039293 |
| Policy instance | 1 |
| Insurance contract or identification number | 010-039293 | | Number of Individuals Covered | 60 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $958 | | Total amount of fees paid to insurance company | USD $72 | | Welfare Benefit Premiums Paid to Carrier | USD $9,581 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $729 | | Amount paid for insurance broker fees | 72 | | Additional information about fees paid to insurance broker | VISION LASIK | | Insurance broker organization code? | 3 | | Insurance broker name | STUEHRENBERG AGENCY INC |
|
| BLUE CROSS BLUE SHIELD OF NEBRASKA (National Association of Insurance Commissioners NAIC id number: 77780 ) |
| Policy contract number | 300002 |
| Policy instance | 3 |
| Insurance contract or identification number | 300002 | | Number of Individuals Covered | 67 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $19,639 | | Health Insurance Welfare Benefit | Yes | | Dental 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 $19,639 | | Additional information about fees paid to insurance broker | GROUP HEALTH INSURANCE | | Insurance broker organization code? | 3 | | Insurance broker name | STUEHRENBERG AGENCY INC |
|
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | FAE03089 |
| Policy instance | 4 |
| Insurance contract or identification number | FAE03089 | | Number of Individuals Covered | 130 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $4,138 | | Total amount of fees paid to insurance company | USD $292 | | Welfare Benefit Premiums Paid to Carrier | USD $22,835 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 292 | | Additional information about fees paid to insurance broker | LIFE AND ACCIDENT INSURANCE | | Insurance broker organization code? | 3 | | Commission paid to Insurance Broker | USD $676 | | Insurance broker name | PLATTE VALLEY INSURANCE CORP |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | P17017 |
| Policy instance | 5 |
| Insurance contract or identification number | P17017 | | Number of Individuals Covered | 15 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $1,308 | | Welfare Benefit Premiums Paid to Carrier | USD $13,841 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $64 | | Additional information about fees paid to insurance broker | LIFE TEMP DIS | | Insurance broker organization code? | 3 | | Insurance broker name | JOHN BRIAN HAYNES |
|
| TRUSTMARK LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62863 ) |
| Policy contract number | SM70852X |
| Policy instance | 6 |
| Insurance contract or identification number | SM70852X | | Number of Individuals Covered | 15 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $154 | | Welfare Benefit Premiums Paid to Carrier | USD $6,160 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $154 | | Additional information about fees paid to insurance broker | STOP LOSS LIFE | | Insurance broker organization code? | 3 | | Insurance broker name | RYDER ROSACKER MCCUE & HUSTON |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 550677 |
| Policy instance | 7 |
| Insurance contract or identification number | 550677 | | Number of Individuals Covered | 128 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $118 | | Welfare Benefit Premiums Paid to Carrier | USD $787 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $118 | | Additional information about fees paid to insurance broker | HEALTH | | Insurance broker organization code? | 3 | | Insurance broker name | PLATTE VALLEY INSURANCE |
|
| EMC NATIONAL LIFE COMPANY (National Association of Insurance Commissioners NAIC id number: 62928 ) |
| Policy contract number | GL0777 |
| Policy instance | 2 |
| Insurance contract or identification number | GL0777 | | Number of Individuals Covered | 121 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $587 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,865 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $587 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Insurance broker name | RYAN HANSEN |
|
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | FAE03089 |
| Policy instance | 3 |
| Insurance contract or identification number | FAE03089 | | Number of Individuals Covered | 120 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $2,409 | | Total amount of fees paid to insurance company | USD $241 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $12,038 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,215 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker name | PREFERRED MARKETING ASSOCIATES |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 550677 |
| Policy instance | 1 |
| Insurance contract or identification number | 550677 | | Number of Individuals Covered | 122 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $1,127 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $9,356 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,128 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Insurance broker name | DAVID STUEHRENBERG |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | P17017 |
| Policy instance | 4 |
| Insurance contract or identification number | P17017 | | Number of Individuals Covered | 277 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $5,632 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $72,940 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,405 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Insurance broker name | JOHN BRIAN HAYNES |
|
| TRUSTMARK LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62863 ) |
| Policy contract number | SM70852X |
| Policy instance | 5 |
| Insurance contract or identification number | SM70852X | | Number of Individuals Covered | 121 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $274 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $10,966 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $274 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Insurance broker name | |
|
| EMC NATIONAL LIFE COMPANY (National Association of Insurance Commissioners NAIC id number: 62928 ) |
| Policy contract number | GL0777 |
| Policy instance | 2 |
| Insurance contract or identification number | GL0777 | | Number of Individuals Covered | 121 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $498 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,978 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | FAE03089 |
| Policy instance | 3 |
| Insurance contract or identification number | FAE03089 | | Number of Individuals Covered | 118 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $2,238 | | Total amount of fees paid to insurance company | USD $224 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $11,319 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | P17017 |
| Policy instance | 4 |
| Insurance contract or identification number | P17017 | | Number of Individuals Covered | 121 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $4,204 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $51,055 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| TRUSTMARK LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62863 ) |
| Policy contract number | SM70852X |
| Policy instance | 5 |
| Insurance contract or identification number | SM70852X | | Number of Individuals Covered | 122 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $376 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $9,613 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 550677 |
| Policy instance | 1 |
| Insurance contract or identification number | 550677 | | Number of Individuals Covered | 119 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $2,624 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $21,208 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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