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COMPASS, INC. GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS GROUP SHORT TERM DISABILITY BENEFITS GROUP TERM LIFE BENEFITS PLAN 401k Plan overview

Plan NameCOMPASS, INC. GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS GROUP SHORT TERM DISABILITY BENEFITS GROUP TERM LIFE BENEFITS PLAN
Plan identification number 511

COMPASS, INC. GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS GROUP SHORT TERM DISABILITY BENEFITS GROUP TERM LIFE BENEFITS PLAN Benefits

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

401k Sponsoring company profile

COMPASS INC has sponsored the creation of one or more 401k plans.

Company Name:COMPASS INC
Employer identification number (EIN):522112412
NAIC Classification:621610
NAIC Description:Home Health Care Services

Additional information about COMPASS INC

Jurisdiction of Incorporation: State of Delaware Division of Corporations
Incorporation Date:
Company Identification Number: 2401574

More information about COMPASS INC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan COMPASS, INC. GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS GROUP SHORT TERM DISABILITY BENEFITS GROUP TERM LIFE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5112022-02-01JOAN WHITNEY2023-08-09
5112021-02-01JOAN WHITNEY2022-08-11
5112020-02-01JOAN WHITNEY2021-08-17
5112019-02-01JOAN WHITNEY2020-08-28
5112018-02-01JOAN WHITNEY2019-08-27
5112017-02-01
5112016-02-01JOAN WHITNEY
5112015-02-01JOAN WHITNEY
5112014-02-01MARIE JANSEN
5112013-02-01MARIE JANSEN
5112012-02-01MARIE JANSEN MARIE JANSEN2013-08-13
5112011-02-01MARIE NEFF
5112010-02-01MARIE NEFF

Plan Statistics for COMPASS, INC. GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS GROUP SHORT TERM DISABILITY BENEFITS GROUP TERM LIFE BENEFITS PLAN

401k plan membership statisitcs for COMPASS, INC. GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS GROUP SHORT TERM DISABILITY BENEFITS GROUP TERM LIFE BENEFITS PLAN

Measure Date Value
2022: COMPASS, INC. GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS GROUP SHORT TERM DISABILITY BENEFITS GROUP TERM LIFE BENEFITS PLAN 2022 401k membership
Total participants, beginning-of-year2022-02-01213
Total number of active participants reported on line 7a of the Form 55002022-02-01244
Number of retired or separated participants receiving benefits2022-02-010
Number of other retired or separated participants entitled to future benefits2022-02-010
Total of all active and inactive participants2022-02-01244
Number of employers contributing to the scheme2022-02-010
2021: COMPASS, INC. GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS GROUP SHORT TERM DISABILITY BENEFITS GROUP TERM LIFE BENEFITS PLAN 2021 401k membership
Total participants, beginning-of-year2021-02-01217
Total number of active participants reported on line 7a of the Form 55002021-02-01213
Number of retired or separated participants receiving benefits2021-02-010
Number of other retired or separated participants entitled to future benefits2021-02-010
Total of all active and inactive participants2021-02-01213
Number of employers contributing to the scheme2021-02-010
2020: COMPASS, INC. GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS GROUP SHORT TERM DISABILITY BENEFITS GROUP TERM LIFE BENEFITS PLAN 2020 401k membership
Total participants, beginning-of-year2020-02-01229
Total number of active participants reported on line 7a of the Form 55002020-02-01217
Number of retired or separated participants receiving benefits2020-02-010
Number of other retired or separated participants entitled to future benefits2020-02-010
Total of all active and inactive participants2020-02-01217
Number of employers contributing to the scheme2020-02-010
2019: COMPASS, INC. GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS GROUP SHORT TERM DISABILITY BENEFITS GROUP TERM LIFE BENEFITS PLAN 2019 401k membership
Total participants, beginning-of-year2019-02-01263
Total number of active participants reported on line 7a of the Form 55002019-02-01229
Number of retired or separated participants receiving benefits2019-02-010
Number of other retired or separated participants entitled to future benefits2019-02-010
Total of all active and inactive participants2019-02-01229
Number of employers contributing to the scheme2019-02-010
2018: COMPASS, INC. GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS GROUP SHORT TERM DISABILITY BENEFITS GROUP TERM LIFE BENEFITS PLAN 2018 401k membership
Total participants, beginning-of-year2018-02-01281
Total number of active participants reported on line 7a of the Form 55002018-02-01263
Number of retired or separated participants receiving benefits2018-02-010
Number of other retired or separated participants entitled to future benefits2018-02-010
Total of all active and inactive participants2018-02-01263
Number of employers contributing to the scheme2018-02-010
2017: COMPASS, INC. GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS GROUP SHORT TERM DISABILITY BENEFITS GROUP TERM LIFE BENEFITS PLAN 2017 401k membership
Total participants, beginning-of-year2017-02-01209
Total number of active participants reported on line 7a of the Form 55002017-02-01281
Number of retired or separated participants receiving benefits2017-02-010
Number of other retired or separated participants entitled to future benefits2017-02-010
Total of all active and inactive participants2017-02-01281
2016: COMPASS, INC. GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS GROUP SHORT TERM DISABILITY BENEFITS GROUP TERM LIFE BENEFITS PLAN 2016 401k membership
Total participants, beginning-of-year2016-02-01193
Total number of active participants reported on line 7a of the Form 55002016-02-01209
Number of retired or separated participants receiving benefits2016-02-010
Number of other retired or separated participants entitled to future benefits2016-02-010
Total of all active and inactive participants2016-02-01209
2015: COMPASS, INC. GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS GROUP SHORT TERM DISABILITY BENEFITS GROUP TERM LIFE BENEFITS PLAN 2015 401k membership
Total participants, beginning-of-year2015-02-01168
Total number of active participants reported on line 7a of the Form 55002015-02-01193
Number of retired or separated participants receiving benefits2015-02-010
Number of other retired or separated participants entitled to future benefits2015-02-010
Total of all active and inactive participants2015-02-01193
2014: COMPASS, INC. GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS GROUP SHORT TERM DISABILITY BENEFITS GROUP TERM LIFE BENEFITS PLAN 2014 401k membership
Total participants, beginning-of-year2014-02-01193
Total number of active participants reported on line 7a of the Form 55002014-02-01200
Number of retired or separated participants receiving benefits2014-02-010
Number of other retired or separated participants entitled to future benefits2014-02-010
Total of all active and inactive participants2014-02-01200
2013: COMPASS, INC. GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS GROUP SHORT TERM DISABILITY BENEFITS GROUP TERM LIFE BENEFITS PLAN 2013 401k membership
Total participants, beginning-of-year2013-02-01191
Total number of active participants reported on line 7a of the Form 55002013-02-01194
Number of retired or separated participants receiving benefits2013-02-010
Number of other retired or separated participants entitled to future benefits2013-02-010
Total of all active and inactive participants2013-02-01194
2012: COMPASS, INC. GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS GROUP SHORT TERM DISABILITY BENEFITS GROUP TERM LIFE BENEFITS PLAN 2012 401k membership
Total participants, beginning-of-year2012-02-01161
Total number of active participants reported on line 7a of the Form 55002012-02-01190
Number of retired or separated participants receiving benefits2012-02-011
Total of all active and inactive participants2012-02-01191
Total participants2012-02-01191
2011: COMPASS, INC. GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS GROUP SHORT TERM DISABILITY BENEFITS GROUP TERM LIFE BENEFITS PLAN 2011 401k membership
Total participants, beginning-of-year2011-02-01143
Total number of active participants reported on line 7a of the Form 55002011-02-01161
Number of retired or separated participants receiving benefits2011-02-010
Total of all active and inactive participants2011-02-01161
Total participants2011-02-01161
2010: COMPASS, INC. GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS GROUP SHORT TERM DISABILITY BENEFITS GROUP TERM LIFE BENEFITS PLAN 2010 401k membership
Total participants, beginning-of-year2010-02-01117
Total number of active participants reported on line 7a of the Form 55002010-02-01143
Total of all active and inactive participants2010-02-01143
Total participants2010-02-01143

Form 5500 Responses for COMPASS, INC. GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS GROUP SHORT TERM DISABILITY BENEFITS GROUP TERM LIFE BENEFITS PLAN

2022: COMPASS, INC. GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS GROUP SHORT TERM DISABILITY BENEFITS GROUP TERM LIFE BENEFITS PLAN 2022 form 5500 responses
2022-02-01Type of plan entitySingle employer plan
2022-02-01Plan funding arrangement – InsuranceYes
2022-02-01Plan benefit arrangement – InsuranceYes
2021: COMPASS, INC. GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS GROUP SHORT TERM DISABILITY BENEFITS GROUP TERM LIFE BENEFITS PLAN 2021 form 5500 responses
2021-02-01Type of plan entitySingle employer plan
2021-02-01Plan funding arrangement – InsuranceYes
2021-02-01Plan benefit arrangement – InsuranceYes
2020: COMPASS, INC. GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS GROUP SHORT TERM DISABILITY BENEFITS GROUP TERM LIFE BENEFITS PLAN 2020 form 5500 responses
2020-02-01Type of plan entitySingle employer plan
2020-02-01Plan funding arrangement – InsuranceYes
2020-02-01Plan benefit arrangement – InsuranceYes
2019: COMPASS, INC. GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS GROUP SHORT TERM DISABILITY BENEFITS GROUP TERM LIFE BENEFITS PLAN 2019 form 5500 responses
2019-02-01Type of plan entitySingle employer plan
2019-02-01Plan funding arrangement – InsuranceYes
2019-02-01Plan benefit arrangement – InsuranceYes
2018: COMPASS, INC. GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS GROUP SHORT TERM DISABILITY BENEFITS GROUP TERM LIFE BENEFITS PLAN 2018 form 5500 responses
2018-02-01Type of plan entitySingle employer plan
2018-02-01Plan funding arrangement – InsuranceYes
2018-02-01Plan benefit arrangement – InsuranceYes
2017: COMPASS, INC. GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS GROUP SHORT TERM DISABILITY BENEFITS GROUP TERM LIFE BENEFITS PLAN 2017 form 5500 responses
2017-02-01Type of plan entitySingle employer plan
2017-02-01Plan funding arrangement – InsuranceYes
2017-02-01Plan benefit arrangement – InsuranceYes
2016: COMPASS, INC. GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS GROUP SHORT TERM DISABILITY BENEFITS GROUP TERM LIFE BENEFITS PLAN 2016 form 5500 responses
2016-02-01Type of plan entitySingle employer plan
2016-02-01Submission has been amendedNo
2016-02-01This submission is the final filingNo
2016-02-01This return/report is a short plan year return/report (less than 12 months)No
2016-02-01Plan is a collectively bargained planNo
2016-02-01Plan funding arrangement – InsuranceYes
2016-02-01Plan benefit arrangement – InsuranceYes
2015: COMPASS, INC. GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS GROUP SHORT TERM DISABILITY BENEFITS GROUP TERM LIFE BENEFITS PLAN 2015 form 5500 responses
2015-02-01Type of plan entitySingle employer plan
2015-02-01Submission has been amendedNo
2015-02-01This submission is the final filingNo
2015-02-01This return/report is a short plan year return/report (less than 12 months)No
2015-02-01Plan is a collectively bargained planNo
2015-02-01Plan funding arrangement – InsuranceYes
2015-02-01Plan benefit arrangement – InsuranceYes
2014: COMPASS, INC. GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS GROUP SHORT TERM DISABILITY BENEFITS GROUP TERM LIFE BENEFITS PLAN 2014 form 5500 responses
2014-02-01Type of plan entitySingle employer plan
2014-02-01Submission has been amendedNo
2014-02-01This submission is the final filingNo
2014-02-01This return/report is a short plan year return/report (less than 12 months)No
2014-02-01Plan is a collectively bargained planNo
2014-02-01Plan funding arrangement – InsuranceYes
2014-02-01Plan benefit arrangement – InsuranceYes
2013: COMPASS, INC. GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS GROUP SHORT TERM DISABILITY BENEFITS GROUP TERM LIFE BENEFITS PLAN 2013 form 5500 responses
2013-02-01Type of plan entitySingle employer plan
2013-02-01Submission has been amendedNo
2013-02-01This submission is the final filingNo
2013-02-01This return/report is a short plan year return/report (less than 12 months)No
2013-02-01Plan is a collectively bargained planNo
2013-02-01Plan funding arrangement – InsuranceYes
2013-02-01Plan benefit arrangement – InsuranceYes
2012: COMPASS, INC. GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS GROUP SHORT TERM DISABILITY BENEFITS GROUP TERM LIFE BENEFITS PLAN 2012 form 5500 responses
2012-02-01Type of plan entitySingle employer plan
2012-02-01Submission has been amendedNo
2012-02-01This submission is the final filingNo
2012-02-01This return/report is a short plan year return/report (less than 12 months)No
2012-02-01Plan is a collectively bargained planNo
2012-02-01Plan funding arrangement – InsuranceYes
2012-02-01Plan benefit arrangement – InsuranceYes
2011: COMPASS, INC. GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS GROUP SHORT TERM DISABILITY BENEFITS GROUP TERM LIFE BENEFITS PLAN 2011 form 5500 responses
2011-02-01Type of plan entitySingle employer plan
2011-02-01Submission has been amendedNo
2011-02-01This submission is the final filingNo
2011-02-01This return/report is a short plan year return/report (less than 12 months)No
2011-02-01Plan is a collectively bargained planNo
2011-02-01Plan funding arrangement – InsuranceYes
2011-02-01Plan funding arrangement – General assets of the sponsorYes
2011-02-01Plan benefit arrangement – InsuranceYes
2011-02-01Plan benefit arrangement – General assets of the sponsorYes
2010: COMPASS, INC. GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS GROUP SHORT TERM DISABILITY BENEFITS GROUP TERM LIFE BENEFITS PLAN 2010 form 5500 responses
2010-02-01Type of plan entitySingle employer plan
2010-02-01Submission has been amendedNo
2010-02-01This submission is the final filingNo
2010-02-01This return/report is a short plan year return/report (less than 12 months)No
2010-02-01Plan is a collectively bargained planNo
2010-02-01Plan funding arrangement – InsuranceYes
2010-02-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0BHZF
Policy instance 1
Insurance contract or identification numberGLUG0BHZF
Number of Individuals Covered244
Insurance policy start date2022-02-01
Insurance policy end date2023-01-31
Total amount of commissions paid to insurance brokerUSD $19,055
Total amount of fees paid to insurance companyUSD $14,741
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $131,829
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,055
Amount paid for insurance broker fees5593
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0BHZF
Policy instance 1
Insurance contract or identification numberGLUG0BHZF
Number of Individuals Covered213
Insurance policy start date2021-02-01
Insurance policy end date2022-01-31
Total amount of commissions paid to insurance brokerUSD $15,674
Total amount of fees paid to insurance companyUSD $10,828
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $104,496
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,674
Amount paid for insurance broker fees3363
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0BHZF
Policy instance 1
Insurance contract or identification numberGLUG0BHZF
Number of Individuals Covered217
Insurance policy start date2020-02-01
Insurance policy end date2021-01-31
Total amount of commissions paid to insurance brokerUSD $10,383
Total amount of fees paid to insurance companyUSD $7,316
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $69,215
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,383
Amount paid for insurance broker fees2076
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0BHZF
Policy instance 1
Insurance contract or identification numberGLUG0BHZF
Number of Individuals Covered229
Insurance policy start date2019-02-01
Insurance policy end date2020-01-31
Total amount of commissions paid to insurance brokerUSD $9,577
Total amount of fees paid to insurance companyUSD $3,335
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $66,700
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,577
Amount paid for insurance broker fees3335
Additional information about fees paid to insurance brokerADMINISTRATION
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberTS05469665
Policy instance 1
Insurance contract or identification numberTS05469665
Number of Individuals Covered281
Insurance policy start date2017-02-01
Insurance policy end date2018-01-31
Total amount of commissions paid to insurance brokerUSD $3,542
Total amount of fees paid to insurance companyUSD $3,612
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $44,985
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,542
Amount paid for insurance broker fees2480
Additional information about fees paid to insurance brokerADMINISTRATIVE FEES
Insurance broker organization code?5
Insurance broker nameSILBERSTEIN INSURANCE GROUP
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0737H
Policy instance 1
Insurance contract or identification numberGLUG0737H
Number of Individuals Covered205
Insurance policy start date2015-02-01
Insurance policy end date2016-01-31
Total amount of commissions paid to insurance brokerUSD $6,853
Total amount of fees paid to insurance companyUSD $454
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
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 CarrierUSD $63,047
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,498
Insurance broker organization code?3
Amount paid for insurance broker fees454
Additional information about fees paid to insurance brokerADMINISTRATION
Insurance broker nameKELLY AND ASSOC. INS. GROUP, INC.
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000737H
Policy instance 1
Insurance contract or identification numberG000737H
Number of Individuals Covered200
Insurance policy start date2014-02-01
Insurance policy end date2015-01-31
Total amount of commissions paid to insurance brokerUSD $1,457
Total amount of fees paid to insurance companyUSD $110
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D
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 CarrierUSD $14,571
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,457
Insurance broker organization code?3
Amount paid for insurance broker fees110
Additional information about fees paid to insurance brokerADMINISTRATION
Insurance broker nameBENEFITMALL INC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000737H
Policy instance 2
Insurance contract or identification numberG000737H
Number of Individuals Covered32
Insurance policy start date2014-02-01
Insurance policy end date2015-01-31
Total amount of commissions paid to insurance brokerUSD $1,768
Total amount of fees paid to insurance companyUSD $98
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedVOLUNTARY LIFE AND ACCIDENTAL DEATH & DISMEMBERMENT
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 CarrierUSD $11,788
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,768
Insurance broker organization code?3
Amount paid for insurance broker fees98
Additional information about fees paid to insurance brokerADMINISTRATION
Insurance broker nameBENEFITMALL INC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000737H
Policy instance 3
Insurance contract or identification numberG000737H
Number of Individuals Covered200
Insurance policy start date2014-02-01
Insurance policy end date2015-01-31
Total amount of commissions paid to insurance brokerUSD $2,589
Total amount of fees paid to insurance companyUSD $194
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $25,888
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,589
Insurance broker organization code?3
Amount paid for insurance broker fees194
Additional information about fees paid to insurance brokerADMINISTRATION
Insurance broker nameBENEFITMALL INC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000737H
Policy instance 3
Insurance contract or identification numberG000737H
Number of Individuals Covered34
Insurance policy start date2013-02-01
Insurance policy end date2014-01-31
Total amount of commissions paid to insurance brokerUSD $1,607
Total amount of fees paid to insurance companyUSD $52
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedVOLUNTARY LIFE AND AD&D
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 CarrierUSD $10,712
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,112
Insurance broker organization code?3
Amount paid for insurance broker fees52
Additional information about fees paid to insurance brokerADMINISTRATION
Insurance broker nameBENEFIT DESIGN GROUP INC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000737H
Policy instance 1
Insurance contract or identification numberG000737H
Number of Individuals Covered194
Insurance policy start date2013-02-01
Insurance policy end date2014-01-31
Total amount of commissions paid to insurance brokerUSD $1,404
Total amount of fees paid to insurance companyUSD $69
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D
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 CarrierUSD $14,033
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $921
Insurance broker organization code?3
Amount paid for insurance broker fees69
Additional information about fees paid to insurance brokerADMINISTRATION
Insurance broker nameBENEFIT DESIGN GROUP INC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000737H
Policy instance 2
Insurance contract or identification numberG000737H
Number of Individuals Covered194
Insurance policy start date2013-02-01
Insurance policy end date2014-01-31
Total amount of commissions paid to insurance brokerUSD $2,480
Total amount of fees paid to insurance companyUSD $123
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $24,801
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,623
Insurance broker organization code?3
Amount paid for insurance broker fees123
Additional information about fees paid to insurance brokerADMINISTRATION
Insurance broker nameBENEFIT DESIGN GROUP INC
DENTAQUEST MID-ATLANTIC, INC. (National Association of Insurance Commissioners NAIC id number: 52040 )
Policy contract number0251110001
Policy instance 2
Insurance contract or identification number0251110001
Number of Individuals Covered142
Insurance policy start date2012-02-01
Insurance policy end date2013-01-31
Total amount of commissions paid to insurance brokerUSD $2,521
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $38,334
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,521
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameRICHARD J PRINCINSKY & ASSOC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000737H
Policy instance 3
Insurance contract or identification numberG000737H
Number of Individuals Covered190
Insurance policy start date2012-02-01
Insurance policy end date2013-01-31
Total amount of commissions paid to insurance brokerUSD $5,029
Total amount of fees paid to insurance companyUSD $316
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $44,639
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,029
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerADMINISTRATION
Insurance broker nameBENEFIT MALL, INC
KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 )
Policy contract number18872
Policy instance 1
Insurance contract or identification number18872
Number of Individuals Covered125
Insurance policy start date2012-02-01
Insurance policy end date2013-01-31
Total amount of commissions paid to insurance brokerUSD $28,002
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $471,833
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,358
Amount paid for insurance broker fees0
Insurance broker organization code?5
Insurance broker nameRICHARD J PRINCINSKY & ASSOC.
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000737H
Policy instance 3
Insurance contract or identification numberG000737H
Number of Individuals Covered161
Insurance policy start date2011-02-01
Insurance policy end date2012-01-31
Total amount of commissions paid to insurance brokerUSD $4,481
Total amount of fees paid to insurance companyUSD $407
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $39,220
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 )
Policy contract number18872
Policy instance 1
Insurance contract or identification number18872
Number of Individuals Covered110
Insurance policy start date2011-02-01
Insurance policy end date2012-01-31
Total amount of commissions paid to insurance brokerUSD $26,445
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $421,667
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DENTAQUEST MID-ATLANTIC, INC. (National Association of Insurance Commissioners NAIC id number: 52040 )
Policy contract number0251110001
Policy instance 2
Insurance contract or identification number0251110001
Number of Individuals Covered102
Insurance policy start date2011-02-01
Insurance policy end date2012-01-31
Total amount of commissions paid to insurance brokerUSD $2,998
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $24,978
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 numberG000737H
Policy instance 1
Insurance contract or identification numberG000737H
Number of Individuals Covered143
Insurance policy start date2010-02-01
Insurance policy end date2011-01-31
Total amount of commissions paid to insurance brokerUSD $4,062
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $35,122
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,062
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameRICHARD J PRINCINSKY & ASSOC, INC

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