UNIFIED SCHOOL DISTRICT 443 has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan UNIFIED SCHOOL DISTRICT NO 443 SELF FUNDED HEALTH PLAN
401k plan membership statisitcs for UNIFIED SCHOOL DISTRICT NO 443 SELF FUNDED HEALTH PLAN
| Measure | Date | Value |
|---|
| 2022 : UNIFIED SCHOOL DISTRICT NO 443 SELF FUNDED HEALTH PLAN 2022 401k financial data |
|---|
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2022-09-30 | No |
| Was this plan covered by a fidelity bond | 2022-09-30 | No |
| If this is an individual account plan, was there a blackout period | 2022-09-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2022-09-30 | No |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2022-09-30 | No |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2022-09-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2022-09-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2022-09-30 | No |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2022-09-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2022-09-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2022-09-30 | No |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2022-09-30 | No |
| Did the plan have assets held for investment | 2022-09-30 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2022-09-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2022-09-30 | No |
| 2021 : UNIFIED SCHOOL DISTRICT NO 443 SELF FUNDED HEALTH PLAN 2021 401k financial data |
|---|
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2021-09-30 | No |
| Was this plan covered by a fidelity bond | 2021-09-30 | No |
| If this is an individual account plan, was there a blackout period | 2021-09-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2021-09-30 | No |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2021-09-30 | No |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2021-09-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2021-09-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2021-09-30 | No |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2021-09-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2021-09-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2021-09-30 | No |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2021-09-30 | No |
| Did the plan have assets held for investment | 2021-09-30 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2021-09-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2021-09-30 | No |
| 2020 : UNIFIED SCHOOL DISTRICT NO 443 SELF FUNDED HEALTH PLAN 2020 401k financial data |
|---|
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2020-09-30 | No |
| Was this plan covered by a fidelity bond | 2020-09-30 | No |
| If this is an individual account plan, was there a blackout period | 2020-09-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2020-09-30 | No |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-09-30 | No |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2020-09-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2020-09-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2020-09-30 | No |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2020-09-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2020-09-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2020-09-30 | No |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2020-09-30 | No |
| Did the plan have assets held for investment | 2020-09-30 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-09-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2020-09-30 | No |
| 2019 : UNIFIED SCHOOL DISTRICT NO 443 SELF FUNDED HEALTH PLAN 2019 401k financial data |
|---|
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2019-09-30 | No |
| Was this plan covered by a fidelity bond | 2019-09-30 | No |
| If this is an individual account plan, was there a blackout period | 2019-09-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2019-09-30 | No |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-09-30 | No |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2019-09-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2019-09-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2019-09-30 | No |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2019-09-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2019-09-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2019-09-30 | No |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2019-09-30 | No |
| Did the plan have assets held for investment | 2019-09-30 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-09-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2019-09-30 | No |
| 2018 : UNIFIED SCHOOL DISTRICT NO 443 SELF FUNDED HEALTH PLAN 2018 401k financial data |
|---|
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2018-09-30 | No |
| Was this plan covered by a fidelity bond | 2018-09-30 | No |
| If this is an individual account plan, was there a blackout period | 2018-09-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2018-09-30 | No |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-09-30 | No |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2018-09-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2018-09-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2018-09-30 | No |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2018-09-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2018-09-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2018-09-30 | No |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2018-09-30 | No |
| Did the plan have assets held for investment | 2018-09-30 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-09-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2018-09-30 | No |
| 2017 : UNIFIED SCHOOL DISTRICT NO 443 SELF FUNDED HEALTH PLAN 2017 401k financial data |
|---|
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2017-09-30 | No |
| Was this plan covered by a fidelity bond | 2017-09-30 | No |
| If this is an individual account plan, was there a blackout period | 2017-09-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2017-09-30 | No |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2017-09-30 | No |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2017-09-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2017-09-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2017-09-30 | No |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2017-09-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2017-09-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2017-09-30 | No |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2017-09-30 | No |
| Did the plan have assets held for investment | 2017-09-30 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2017-09-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2017-09-30 | No |
| 2016 : UNIFIED SCHOOL DISTRICT NO 443 SELF FUNDED HEALTH PLAN 2016 401k financial data |
|---|
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2016-09-30 | No |
| Was this plan covered by a fidelity bond | 2016-09-30 | No |
| If this is an individual account plan, was there a blackout period | 2016-09-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2016-09-30 | No |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-09-30 | No |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2016-09-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2016-09-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2016-09-30 | No |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2016-09-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2016-09-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2016-09-30 | No |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2016-09-30 | No |
| Did the plan have assets held for investment | 2016-09-30 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-09-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2016-09-30 | No |
| 2015 : UNIFIED SCHOOL DISTRICT NO 443 SELF FUNDED HEALTH PLAN 2015 401k financial data |
|---|
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2015-09-30 | No |
| Was this plan covered by a fidelity bond | 2015-09-30 | No |
| If this is an individual account plan, was there a blackout period | 2015-09-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2015-09-30 | No |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-09-30 | No |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2015-09-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2015-09-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2015-09-30 | No |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2015-09-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2015-09-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2015-09-30 | No |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2015-09-30 | No |
| Did the plan have assets held for investment | 2015-09-30 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-09-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2015-09-30 | No |
| 2014 : UNIFIED SCHOOL DISTRICT NO 443 SELF FUNDED HEALTH PLAN 2014 401k financial data |
|---|
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2014-09-30 | No |
| Was this plan covered by a fidelity bond | 2014-09-30 | No |
| If this is an individual account plan, was there a blackout period | 2014-09-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2014-09-30 | No |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-09-30 | No |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2014-09-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2014-09-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2014-09-30 | No |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2014-09-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2014-09-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2014-09-30 | No |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2014-09-30 | No |
| Did the plan have assets held for investment | 2014-09-30 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-09-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2014-09-30 | No |
| 2013 : UNIFIED SCHOOL DISTRICT NO 443 SELF FUNDED HEALTH PLAN 2013 401k financial data |
|---|
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2013-09-30 | No |
| Was this plan covered by a fidelity bond | 2013-09-30 | No |
| If this is an individual account plan, was there a blackout period | 2013-09-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2013-09-30 | No |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-09-30 | No |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2013-09-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2013-09-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2013-09-30 | No |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2013-09-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2013-09-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2013-09-30 | No |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2013-09-30 | No |
| Did the plan have assets held for investment | 2013-09-30 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-09-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2013-09-30 | No |
| 2012 : UNIFIED SCHOOL DISTRICT NO 443 SELF FUNDED HEALTH PLAN 2012 401k financial data |
|---|
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2012-09-30 | No |
| Was this plan covered by a fidelity bond | 2012-09-30 | No |
| If this is an individual account plan, was there a blackout period | 2012-09-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2012-09-30 | No |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-09-30 | No |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2012-09-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2012-09-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2012-09-30 | No |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2012-09-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2012-09-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2012-09-30 | No |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2012-09-30 | No |
| Did the plan have assets held for investment | 2012-09-30 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-09-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2012-09-30 | No |
| 2011 : UNIFIED SCHOOL DISTRICT NO 443 SELF FUNDED HEALTH PLAN 2011 401k financial data |
|---|
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2011-09-30 | No |
| Was this plan covered by a fidelity bond | 2011-09-30 | No |
| If this is an individual account plan, was there a blackout period | 2011-09-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2011-09-30 | No |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-09-30 | No |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2011-09-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2011-09-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2011-09-30 | No |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2011-09-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2011-09-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2011-09-30 | No |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2011-09-30 | No |
| Did the plan have assets held for investment | 2011-09-30 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-09-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2011-09-30 | No |
| DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 ) |
| Policy contract number | 52983-000-00002 |
| Policy instance | 3 |
| Insurance contract or identification number | 52983-000-00002 | | Number of Individuals Covered | 199 | | Insurance policy start date | 2021-10-01 | | Insurance policy end date | 2022-09-30 | | Total amount of commissions paid to insurance broker | USD $153 | | Total amount of fees paid to insurance company | USD $0 | | 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 $153 | | Insurance broker organization code? | 4 |
|
| DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 ) |
| Policy contract number | 52983-000-00001 |
| Policy instance | 2 |
| Insurance contract or identification number | 52983-000-00001 | | Number of Individuals Covered | 533 | | Insurance policy start date | 2021-10-01 | | Insurance policy end date | 2022-09-30 | | Total amount of commissions paid to insurance broker | USD $772 | | Total amount of fees paid to insurance company | USD $0 | | 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 $772 | | Insurance broker organization code? | 4 |
|
| MERITAIN HEALTH (National Association of Insurance Commissioners NAIC id number: 77828 ) |
| Policy contract number | UP-738J |
| Policy instance | 1 |
| Insurance contract or identification number | UP-738J | | Number of Individuals Covered | 687 | | Insurance policy start date | 2021-10-01 | | Insurance policy end date | 2022-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $503,262 | | 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 | | Amount paid for insurance broker fees | 503262 | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 ) |
| Policy contract number | 52983-000-00005 |
| Policy instance | 5 |
| Insurance contract or identification number | 52983-000-00005 | | Number of Individuals Covered | 4 | | Insurance policy start date | 2021-10-01 | | Insurance policy end date | 2022-09-30 | | Total amount of commissions paid to insurance broker | USD $4 | | Total amount of fees paid to insurance company | USD $0 | | 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 $4 | | Insurance broker organization code? | 4 |
|
| DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 ) |
| Policy contract number | 52983-000-00003 |
| Policy instance | 4 |
| Insurance contract or identification number | 52983-000-00003 | | Number of Individuals Covered | 6 | | Insurance policy start date | 2021-10-01 | | Insurance policy end date | 2022-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | 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 $0 | | Insurance broker organization code? | 4 |
|
| MERITAIN HEALTH (National Association of Insurance Commissioners NAIC id number: 77828 ) |
| Policy contract number | UP-738J |
| Policy instance | 1 |
| Insurance contract or identification number | UP-738J | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2021-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $559,997 | | 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 | | Amount paid for insurance broker fees | 559997 | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 ) |
| Policy contract number | 52983-000-00001 |
| Policy instance | 2 |
| Insurance contract or identification number | 52983-000-00001 | | Number of Individuals Covered | 567 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2021-09-30 | | Total amount of commissions paid to insurance broker | USD $878 | | Total amount of fees paid to insurance company | USD $0 | | 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 $878 | | Insurance broker organization code? | 4 |
|
| DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 ) |
| Policy contract number | 52983-000-00002 |
| Policy instance | 3 |
| Insurance contract or identification number | 52983-000-00002 | | Number of Individuals Covered | 227 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2021-09-30 | | Total amount of commissions paid to insurance broker | USD $48 | | Total amount of fees paid to insurance company | USD $0 | | 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 $48 | | Insurance broker organization code? | 4 |
|
| DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 ) |
| Policy contract number | 52983-000-00003 |
| Policy instance | 4 |
| Insurance contract or identification number | 52983-000-00003 | | Number of Individuals Covered | 6 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2021-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | 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 $0 | | Insurance broker organization code? | 4 |
|
| DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 ) |
| Policy contract number | 52983-000-00005 |
| Policy instance | 5 |
| Insurance contract or identification number | 52983-000-00005 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2021-09-30 | | Total amount of commissions paid to insurance broker | USD $1 | | Total amount of fees paid to insurance company | USD $0 | | 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 $1 | | Insurance broker organization code? | 4 |
|
| MERITAIN HEALTH (National Association of Insurance Commissioners NAIC id number: 77828 ) |
| Policy contract number | UP-738J |
| Policy instance | 1 |
| Insurance contract or identification number | UP-738J | | Number of Individuals Covered | 673 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $470,915 | | 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 | | Amount paid for insurance broker fees | 470915 | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 ) |
| Policy contract number | 52983-000-00001 |
| Policy instance | 2 |
| Insurance contract or identification number | 52983-000-00001 | | Number of Individuals Covered | 556 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-09-30 | | Total amount of commissions paid to insurance broker | USD $191 | | Total amount of fees paid to insurance company | USD $0 | | 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 $191 | | Insurance broker organization code? | 4 |
|
| DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 ) |
| Policy contract number | 52983-000-00002 |
| Policy instance | 3 |
| Insurance contract or identification number | 52983-000-00002 | | Number of Individuals Covered | 210 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-09-30 | | Total amount of commissions paid to insurance broker | USD $99 | | Total amount of fees paid to insurance company | USD $0 | | 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 $99 | | Insurance broker organization code? | 4 |
|
| DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 ) |
| Policy contract number | 52983-000-00003 |
| Policy instance | 4 |
| Insurance contract or identification number | 52983-000-00003 | | Number of Individuals Covered | 3 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | 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 $0 | | Insurance broker organization code? | 4 |
|
| DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 ) |
| Policy contract number | 52983-000-00005 |
| Policy instance | 5 |
| Insurance contract or identification number | 52983-000-00005 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | 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 $0 | | Insurance broker organization code? | 4 |
|
| DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 ) |
| Policy contract number | 52983-000-00002 |
| Policy instance | 5 |
| Insurance contract or identification number | 52983-000-00002 | | Number of Individuals Covered | 56 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-09-30 | | Total amount of commissions paid to insurance broker | USD $2,408 | | Total amount of fees paid to insurance company | USD $0 | | 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 $2,408 | | Insurance broker organization code? | 4 |
|
| DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 ) |
| Policy contract number | 52983-000-00001 |
| Policy instance | 4 |
| Insurance contract or identification number | 52983-000-00001 | | Number of Individuals Covered | 108 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-09-30 | | Total amount of commissions paid to insurance broker | USD $4,749 | | Total amount of fees paid to insurance company | USD $0 | | 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 $4,749 | | Insurance broker organization code? | 4 |
|
| DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 ) |
| Policy contract number | 52984-000-00002 |
| Policy instance | 3 |
| Insurance contract or identification number | 52984-000-00002 | | Number of Individuals Covered | 44 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-09-30 | | Total amount of commissions paid to insurance broker | USD $1,516 | | Total amount of fees paid to insurance company | USD $0 | | 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 $1,516 | | Insurance broker organization code? | 4 |
|
| DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 ) |
| Policy contract number | 52984-000-00001 |
| Policy instance | 2 |
| Insurance contract or identification number | 52984-000-00001 | | Number of Individuals Covered | 130 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-09-30 | | Total amount of commissions paid to insurance broker | USD $3,276 | | Total amount of fees paid to insurance company | USD $0 | | 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 $3,276 | | Insurance broker organization code? | 4 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | UP-738J |
| Policy instance | 1 |
| Insurance contract or identification number | UP-738J | | Number of Individuals Covered | 645 | | 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 $485,869 | | 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 | | Amount paid for insurance broker fees | 485869 | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 ) |
| Policy contract number | 52983-000-00002 |
| Policy instance | 5 |
| Insurance contract or identification number | 52983-000-00002 | | Number of Individuals Covered | 53 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-09-30 | | Total amount of commissions paid to insurance broker | USD $2,479 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 ) |
| Policy contract number | 52983-000-00001 |
| Policy instance | 4 |
| Insurance contract or identification number | 52983-000-00001 | | Number of Individuals Covered | 97 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-09-30 | | Total amount of commissions paid to insurance broker | USD $3,013 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 ) |
| Policy contract number | 52984-000-00002 |
| Policy instance | 3 |
| Insurance contract or identification number | 52984-000-00002 | | Number of Individuals Covered | 37 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-09-30 | | Total amount of commissions paid to insurance broker | USD $1,337 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 ) |
| Policy contract number | 52984-000-00001 |
| Policy instance | 2 |
| Insurance contract or identification number | 52984-000-00001 | | Number of Individuals Covered | 121 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-09-30 | | Total amount of commissions paid to insurance broker | USD $2,890 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | 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 | UP-738J |
| Policy instance | 1 |
| Insurance contract or identification number | UP-738J | | Number of Individuals Covered | 613 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $477,025 | | Health Insurance Welfare Benefit | Yes | | 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 | UP-738J |
| Policy instance | 1 |
| Insurance contract or identification number | UP-738J | | Number of Individuals Covered | 527 | | Insurance policy start date | 2015-10-01 | | Insurance policy end date | 2016-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $166,604 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 166604 | | Insurance broker organization code? | 3 | | Insurance broker name | MERITAIN HEALTH |
|
| DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 ) |
| Policy contract number | 52984-000-00001 |
| Policy instance | 2 |
| Insurance contract or identification number | 52984-000-00001 | | Number of Individuals Covered | 73 | | Insurance policy start date | 2015-10-01 | | Insurance policy end date | 2016-09-30 | | Total amount of commissions paid to insurance broker | USD $1,837 | | Total amount of fees paid to insurance company | USD $0 | | 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 $1,837 | | Insurance broker organization code? | 4 | | Insurance broker name | AMERICAN FIDELITY GENERAL AGENCY IN |
|
| DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 ) |
| Policy contract number | 52984-000-00002 |
| Policy instance | 3 |
| Insurance contract or identification number | 52984-000-00002 | | Number of Individuals Covered | 35 | | Insurance policy start date | 2015-10-01 | | Insurance policy end date | 2016-09-30 | | Total amount of commissions paid to insurance broker | USD $1,090 | | Total amount of fees paid to insurance company | USD $0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,090 | | Insurance broker organization code? | 4 | | Insurance broker name | AMERICAN FIDELITY GENERAL AGENCY IN |
|
| DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 ) |
| Policy contract number | 52983-000-00001 |
| Policy instance | 4 |
| Insurance contract or identification number | 52983-000-00001 | | Number of Individuals Covered | 81 | | Insurance policy start date | 2015-10-01 | | Insurance policy end date | 2016-09-30 | | Total amount of commissions paid to insurance broker | USD $3,210 | | Total amount of fees paid to insurance company | USD $0 | | 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 $3,210 | | Insurance broker organization code? | 4 | | Insurance broker name | AMERICAN FIDELITY GENERAL AGENCY IN |
|
| DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 ) |
| Policy contract number | 52983-000-00002 |
| Policy instance | 5 |
| Insurance contract or identification number | 52983-000-00002 | | Number of Individuals Covered | 55 | | Insurance policy start date | 2015-10-01 | | Insurance policy end date | 2016-09-30 | | Total amount of commissions paid to insurance broker | USD $2,500 | | Total amount of fees paid to insurance company | USD $0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,500 | | Insurance broker organization code? | 4 | | Insurance broker name | AMERICAN FIDELITY GENERAL AGENCY IN |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | UP-738J |
| Policy instance | 1 |
| Insurance contract or identification number | UP-738J | | Number of Individuals Covered | 525 | | Insurance policy start date | 2014-10-01 | | Insurance policy end date | 2015-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $125,069 | | 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 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 125069 | | Insurance broker organization code? | 3 | | Insurance broker name | CORP BENEFIT SERV OF AMERICA CBSA |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00363144 |
| Policy instance | 2 |
| Insurance contract or identification number | 00363144 | | Number of Individuals Covered | 191 | | Insurance policy start date | 2014-10-01 | | Insurance policy end date | 2015-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $3,082 | | 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 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 3082 | | Insurance broker organization code? | 4 | | Insurance broker name | AMERICAN FIDELITY GENERAL AGENCY IN |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | UP-738J |
| Policy instance | 1 |
| Insurance contract or identification number | UP-738J | | Number of Individuals Covered | 554 | | Insurance policy start date | 2013-10-01 | | Insurance policy end date | 2014-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $103,634 | | 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 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 103634 | | Insurance broker organization code? | 3 | | Insurance broker name | CORP BENEFIT SERV OF AMERICA CBSA |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00363144 |
| Policy instance | 2 |
| Insurance contract or identification number | 00363144 | | Number of Individuals Covered | 166 | | Insurance policy start date | 2013-10-01 | | Insurance policy end date | 2014-09-30 | | Total amount of commissions paid to insurance broker | USD $3,452 | | 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 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,452 | | Insurance broker organization code? | 4 | | Insurance broker name | AMERICAN FIDELITY GENERAL AGENCY IN |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00363144 |
| Policy instance | 2 |
| Insurance contract or identification number | 00363144 | | Number of Individuals Covered | 140 | | Insurance policy start date | 2012-10-01 | | Insurance policy end date | 2013-09-30 | | Total amount of commissions paid to insurance broker | USD $3,615 | | 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 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,619 | | Insurance broker organization code? | 4 | | Insurance broker name | REDBUD FINANCIAL GROUP LLC |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | UP-738J |
| Policy instance | 1 |
| Insurance contract or identification number | UP-738J | | Number of Individuals Covered | 553 | | Insurance policy start date | 2012-10-01 | | Insurance policy end date | 2013-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $250,087 | | 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 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 250087 | | Insurance broker organization code? | 3 | | Insurance broker name | CORP BENEFIT SERV OF AMERICA CBSA |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00363144 |
| Policy instance | 2 |
| Insurance contract or identification number | 00363144 | | Number of Individuals Covered | 134 | | Insurance policy start date | 2011-10-01 | | Insurance policy end date | 2012-09-30 | | Total amount of commissions paid to insurance broker | USD $2,925 | | 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 | | 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 | UP-738J |
| Policy instance | 1 |
| Insurance contract or identification number | UP-738J | | Number of Individuals Covered | 535 | | Insurance policy start date | 2011-10-01 | | Insurance policy end date | 2012-09-30 | | Total amount of commissions paid to insurance broker | USD $192,087 | | 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 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00363144 |
| Policy instance | 2 |
| Insurance contract or identification number | 00363144 | | Number of Individuals Covered | 164 | | Insurance policy start date | 2010-10-01 | | Insurance policy end date | 2011-09-30 | | Total amount of commissions paid to insurance broker | USD $3,985 | | 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 | | 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 | UP-738J |
| Policy instance | 1 |
| Insurance contract or identification number | UP-738J | | Number of Individuals Covered | 529 | | Insurance policy start date | 2010-10-01 | | Insurance policy end date | 2011-09-30 | | Total amount of commissions paid to insurance broker | USD $254,063 | | 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 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
