GATEWAY SUPPLY CO INC has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan GATEWAY SUPPLY COMPANY, INC. SINGLE HEALTH EMPLOYER PLAN
401k plan membership statisitcs for GATEWAY SUPPLY COMPANY, INC. SINGLE HEALTH EMPLOYER PLAN
| Measure | Date | Value |
|---|
| 2022: GATEWAY SUPPLY COMPANY, INC. SINGLE HEALTH EMPLOYER PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 167 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 187 |
| Total of all active and inactive participants | 2022-01-01 | 187 |
| 2021: GATEWAY SUPPLY COMPANY, INC. SINGLE HEALTH EMPLOYER PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 170 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 167 |
| Total of all active and inactive participants | 2021-01-01 | 167 |
| 2020: GATEWAY SUPPLY COMPANY, INC. SINGLE HEALTH EMPLOYER PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 152 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 170 |
| Total of all active and inactive participants | 2020-01-01 | 170 |
| 2019: GATEWAY SUPPLY COMPANY, INC. SINGLE HEALTH EMPLOYER PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 139 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 152 |
| Total of all active and inactive participants | 2019-01-01 | 152 |
| 2018: GATEWAY SUPPLY COMPANY, INC. SINGLE HEALTH EMPLOYER PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 144 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 139 |
| Total of all active and inactive participants | 2018-01-01 | 139 |
| 2017: GATEWAY SUPPLY COMPANY, INC. SINGLE HEALTH EMPLOYER PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 138 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 144 |
| Total of all active and inactive participants | 2017-01-01 | 144 |
| 2016: GATEWAY SUPPLY COMPANY, INC. SINGLE HEALTH EMPLOYER PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 112 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 138 |
| Total of all active and inactive participants | 2016-01-01 | 138 |
| 2015: GATEWAY SUPPLY COMPANY, INC. SINGLE HEALTH EMPLOYER PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 129 |
| Number of retired or separated participants receiving benefits | 2015-01-01 | 112 |
| Total of all active and inactive participants | 2015-01-01 | 112 |
| 2014: GATEWAY SUPPLY COMPANY, INC. SINGLE HEALTH EMPLOYER PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 123 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 129 |
| Total of all active and inactive participants | 2014-01-01 | 129 |
| 2013: GATEWAY SUPPLY COMPANY, INC. SINGLE HEALTH EMPLOYER PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 123 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 123 |
| Total of all active and inactive participants | 2013-01-01 | 123 |
| 2012: GATEWAY SUPPLY COMPANY, INC. SINGLE HEALTH EMPLOYER PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 111 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 123 |
| Total of all active and inactive participants | 2012-01-01 | 123 |
| 2011: GATEWAY SUPPLY COMPANY, INC. SINGLE HEALTH EMPLOYER PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-01-01 | 111 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 111 |
| Total of all active and inactive participants | 2011-01-01 | 111 |
| 2010: GATEWAY SUPPLY COMPANY, INC. SINGLE HEALTH EMPLOYER PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-01-01 | 133 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-01-01 | 111 |
| Total of all active and inactive participants | 2010-01-01 | 111 |
| 2009: GATEWAY SUPPLY COMPANY, INC. SINGLE HEALTH EMPLOYER PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-01-01 | 131 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 133 |
| Total of all active and inactive participants | 2009-01-01 | 133 |
| 2022: GATEWAY SUPPLY COMPANY, INC. SINGLE HEALTH EMPLOYER PLAN 2022 form 5500 responses |
|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: GATEWAY SUPPLY COMPANY, INC. SINGLE HEALTH EMPLOYER PLAN 2021 form 5500 responses |
|---|
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: GATEWAY SUPPLY COMPANY, INC. SINGLE HEALTH EMPLOYER PLAN 2020 form 5500 responses |
|---|
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: GATEWAY SUPPLY COMPANY, INC. SINGLE HEALTH EMPLOYER PLAN 2019 form 5500 responses |
|---|
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: GATEWAY SUPPLY COMPANY, INC. SINGLE HEALTH EMPLOYER PLAN 2018 form 5500 responses |
|---|
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: GATEWAY SUPPLY COMPANY, INC. SINGLE HEALTH EMPLOYER PLAN 2017 form 5500 responses |
|---|
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: GATEWAY SUPPLY COMPANY, INC. SINGLE HEALTH EMPLOYER PLAN 2016 form 5500 responses |
|---|
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: GATEWAY SUPPLY COMPANY, INC. SINGLE HEALTH EMPLOYER PLAN 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: GATEWAY SUPPLY COMPANY, INC. SINGLE HEALTH EMPLOYER PLAN 2014 form 5500 responses |
|---|
| 2014-01-01 | Type of plan entity | Single employer plan |
| 2014-01-01 | Plan funding arrangement – Insurance | Yes |
| 2014-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: GATEWAY SUPPLY COMPANY, INC. SINGLE HEALTH EMPLOYER PLAN 2013 form 5500 responses |
|---|
| 2013-01-01 | Type of plan entity | Single employer plan |
| 2013-01-01 | Submission has been amended | Yes |
| 2013-01-01 | Plan funding arrangement – Insurance | Yes |
| 2013-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2012: GATEWAY SUPPLY COMPANY, INC. SINGLE HEALTH EMPLOYER PLAN 2012 form 5500 responses |
|---|
| 2012-01-01 | Type of plan entity | Single employer plan |
| 2012-01-01 | Plan funding arrangement – Insurance | Yes |
| 2012-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2011: GATEWAY SUPPLY COMPANY, INC. SINGLE HEALTH EMPLOYER PLAN 2011 form 5500 responses |
|---|
| 2011-01-01 | Type of plan entity | Single employer plan |
| 2011-01-01 | Plan funding arrangement – Insurance | Yes |
| 2011-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2011-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2010: GATEWAY SUPPLY COMPANY, INC. SINGLE HEALTH EMPLOYER PLAN 2010 form 5500 responses |
|---|
| 2010-01-01 | Type of plan entity | Single employer plan |
| 2010-01-01 | Plan funding arrangement – Insurance | Yes |
| 2010-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2010-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2010-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2009: GATEWAY SUPPLY COMPANY, INC. SINGLE HEALTH EMPLOYER PLAN 2009 form 5500 responses |
|---|
| 2009-01-01 | Type of plan entity | Single employer plan |
| 2009-01-01 | Submission has been amended | Yes |
| 2009-01-01 | This submission is the final filing | No |
| 2009-01-01 | Plan funding arrangement – Insurance | Yes |
| 2009-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2009-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AZDH |
| Policy instance | 2 |
| Insurance contract or identification number | G000AZDH | | Number of Individuals Covered | 231 | | Insurance policy start date | 2021-02-01 | | Insurance policy end date | 2022-02-01 | | Total amount of commissions paid to insurance broker | USD $674 | | Total amount of fees paid to insurance company | USD $175 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $6,739 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $674 | | Amount paid for insurance broker fees | 175 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| STARMOUNT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68985 ) |
| Policy contract number | GATS216 |
| Policy instance | 6 |
| Insurance contract or identification number | GATS216 | | Number of Individuals Covered | 154 | | Insurance policy start date | 2021-02-01 | | Insurance policy end date | 2022-01-31 | | Total amount of commissions paid to insurance broker | USD $2,286 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $19,047 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,286 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AZDH |
| Policy instance | 5 |
| Insurance contract or identification number | G000AZDH | | Number of Individuals Covered | 146 | | Insurance policy start date | 2021-02-01 | | Insurance policy end date | 2022-02-01 | | Total amount of commissions paid to insurance broker | USD $2,971 | | Total amount of fees paid to insurance company | USD $518 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D VOLUNTARY | | Welfare Benefit Premiums Paid to Carrier | USD $19,806 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,971 | | Amount paid for insurance broker fees | 518 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AZDH |
| Policy instance | 4 |
| Insurance contract or identification number | G000AZDH | | Number of Individuals Covered | 100 | | Insurance policy start date | 2021-02-01 | | Insurance policy end date | 2022-02-01 | | Total amount of commissions paid to insurance broker | USD $2,702 | | Total amount of fees paid to insurance company | USD $847 | | Other welfare benefits provided | SHORT-TERM DISABILITY | | Welfare Benefit Premiums Paid to Carrier | USD $27,022 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,702 | | Amount paid for insurance broker fees | 847 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AZDH |
| Policy instance | 3 |
| Insurance contract or identification number | G000AZDH | | Number of Individuals Covered | 171 | | Insurance policy start date | 2021-02-01 | | Insurance policy end date | 2022-02-01 | | Total amount of commissions paid to insurance broker | USD $2,990 | | Total amount of fees paid to insurance company | USD $1,173 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $75,120 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,990 | | Amount paid for insurance broker fees | 1173 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 ) |
| Policy contract number | CRU-0052-01-17- |
| Policy instance | 7 |
| Insurance contract or identification number | CRU-0052-01-17- | | Number of Individuals Covered | 187 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $87,760 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $344,227 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $87,760 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AZDH |
| Policy instance | 1 |
| Insurance contract or identification number | G000AZDH | | Number of Individuals Covered | 99 | | Insurance policy start date | 2021-02-01 | | Insurance policy end date | 2022-02-01 | | Total amount of commissions paid to insurance broker | USD $3,606 | | Total amount of fees paid to insurance company | USD $985 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $32,127 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,606 | | Amount paid for insurance broker fees | 985 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 ) |
| Policy contract number | CRU-0052-01-17- |
| Policy instance | 7 |
| Insurance contract or identification number | CRU-0052-01-17- | | Number of Individuals Covered | 167 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $77,360 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $277,127 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 77360 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AZDH |
| Policy instance | 1 |
| Insurance contract or identification number | G000AZDH | | Number of Individuals Covered | 105 | | Insurance policy start date | 2020-02-01 | | Insurance policy end date | 2021-02-01 | | Total amount of commissions paid to insurance broker | USD $3,537 | | Total amount of fees paid to insurance company | USD $0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $30,736 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,537 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 0 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AZDH |
| Policy instance | 2 |
| Insurance contract or identification number | G000AZDH | | Number of Individuals Covered | 226 | | Insurance policy start date | 2020-02-01 | | Insurance policy end date | 2021-02-01 | | Total amount of commissions paid to insurance broker | USD $552 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $5,516 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $552 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 0 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AZDH |
| Policy instance | 3 |
| Insurance contract or identification number | G000AZDH | | Number of Individuals Covered | 159 | | Insurance policy start date | 2020-02-01 | | Insurance policy end date | 2021-02-01 | | Total amount of commissions paid to insurance broker | USD $2,954 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $73,077 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,954 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AZDH |
| Policy instance | 4 |
| Insurance contract or identification number | G000AZDH | | Number of Individuals Covered | 111 | | Insurance policy start date | 2020-02-01 | | Insurance policy end date | 2021-02-01 | | Total amount of commissions paid to insurance broker | USD $2,638 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | SHORT-TERM DISABILITY | | Welfare Benefit Premiums Paid to Carrier | USD $26,380 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,638 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AZDH |
| Policy instance | 5 |
| Insurance contract or identification number | G000AZDH | | Number of Individuals Covered | 138 | | Insurance policy start date | 2020-02-01 | | Insurance policy end date | 2021-02-01 | | Total amount of commissions paid to insurance broker | USD $2,414 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D VOLUNTARY | | Welfare Benefit Premiums Paid to Carrier | USD $16,097 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,414 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION |
|
| STARMOUNT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68985 ) |
| Policy contract number | GATS216 |
| Policy instance | 6 |
| Insurance contract or identification number | GATS216 | | Number of Individuals Covered | 153 | | Insurance policy start date | 2020-02-01 | | Insurance policy end date | 2021-01-31 | | Total amount of commissions paid to insurance broker | USD $2,124 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $17,698 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,124 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AZDH |
| Policy instance | 1 |
| Insurance contract or identification number | G000AZDH | | Number of Individuals Covered | 108 | | Insurance policy start date | 2019-02-01 | | Insurance policy end date | 2020-02-01 | | Total amount of commissions paid to insurance broker | USD $3,580 | | Total amount of fees paid to insurance company | USD $1,113 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $31,605 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,580 | | Amount paid for insurance broker fees | 866 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AZDH |
| Policy instance | 2 |
| Insurance contract or identification number | G000AZDH | | Number of Individuals Covered | 207 | | Insurance policy start date | 2019-02-01 | | Insurance policy end date | 2020-02-01 | | Total amount of commissions paid to insurance broker | USD $566 | | Total amount of fees paid to insurance company | USD $228 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $5,663 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $566 | | Amount paid for insurance broker fees | 177 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AZDH |
| Policy instance | 3 |
| Insurance contract or identification number | G000AZDH | | Number of Individuals Covered | 157 | | Insurance policy start date | 2019-02-01 | | Insurance policy end date | 2020-02-01 | | Total amount of commissions paid to insurance broker | USD $2,924 | | Total amount of fees paid to insurance company | USD $1,754 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $71,397 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,924 | | Amount paid for insurance broker fees | 1116 | | Insurance broker organization code? | 3 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AZDH |
| Policy instance | 4 |
| Insurance contract or identification number | G000AZDH | | Number of Individuals Covered | 112 | | Insurance policy start date | 2019-02-01 | | Insurance policy end date | 2020-02-01 | | Total amount of commissions paid to insurance broker | USD $2,449 | | Total amount of fees paid to insurance company | USD $905 | | Other welfare benefits provided | SHORT-TERM DISABILITY | | Welfare Benefit Premiums Paid to Carrier | USD $24,492 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,449 | | Amount paid for insurance broker fees | 704 | | Insurance broker organization code? | 3 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AZDH |
| Policy instance | 5 |
| Insurance contract or identification number | G000AZDH | | Number of Individuals Covered | 148 | | Insurance policy start date | 2019-02-01 | | Insurance policy end date | 2020-02-01 | | Total amount of commissions paid to insurance broker | USD $2,277 | | Total amount of fees paid to insurance company | USD $854 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D VOLUNTARY | | Welfare Benefit Premiums Paid to Carrier | USD $15,180 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,277 | | Amount paid for insurance broker fees | 664 | | Insurance broker organization code? | 3 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION |
|
| STARMOUNT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68985 ) |
| Policy contract number | GATS216 |
| Policy instance | 6 |
| Insurance contract or identification number | GATS216 | | Number of Individuals Covered | 138 | | Insurance policy start date | 2019-02-01 | | Insurance policy end date | 2020-01-31 | | Total amount of commissions paid to insurance broker | USD $1,999 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $16,658 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,999 | | Insurance broker organization code? | 3 |
|
| NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 ) |
| Policy contract number | CRU-0052-01-17- |
| Policy instance | 7 |
| Insurance contract or identification number | CRU-0052-01-17- | | Number of Individuals Covered | 170 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $76,040 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $265,115 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 76040 | | Additional information about fees paid to insurance broker | BROKER FEES | | Insurance broker organization code? | 3 |
|
| NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 ) |
| Policy contract number | CRU-0052-01-17- |
| Policy instance | 7 |
| Insurance contract or identification number | CRU-0052-01-17- | | Number of Individuals Covered | 152 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $72,280 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $236,384 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 72280 | | Additional information about fees paid to insurance broker | BROKER FEES | | Insurance broker organization code? | 3 |
|
| STARMOUNT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68985 ) |
| Policy contract number | GATS216 |
| Policy instance | 6 |
| Insurance contract or identification number | GATS216 | | Number of Individuals Covered | 134 | | Insurance policy start date | 2018-02-01 | | Insurance policy end date | 2019-01-31 | | Total amount of commissions paid to insurance broker | USD $1,612 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $14,860 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,612 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AZDH |
| Policy instance | 5 |
| Insurance contract or identification number | G000AZDH | | Number of Individuals Covered | 199 | | Insurance policy start date | 2018-02-01 | | Insurance policy end date | 2019-02-01 | | Total amount of commissions paid to insurance broker | USD $506 | | Total amount of fees paid to insurance company | USD $5 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $5,057 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $506 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 5 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AZDH |
| Policy instance | 4 |
| Insurance contract or identification number | G000AZDH | | Number of Individuals Covered | 110 | | Insurance policy start date | 2018-02-01 | | Insurance policy end date | 2019-02-01 | | Total amount of commissions paid to insurance broker | USD $1,998 | | Total amount of fees paid to insurance company | USD $14 | | Other welfare benefits provided | SHORT-TERM DISABILITY | | Welfare Benefit Premiums Paid to Carrier | USD $19,979 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,998 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 14 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AZDH |
| Policy instance | 3 |
| Insurance contract or identification number | G000AZDH | | Number of Individuals Covered | 146 | | Insurance policy start date | 2018-02-01 | | Insurance policy end date | 2019-02-01 | | Total amount of commissions paid to insurance broker | USD $2,786 | | Total amount of fees paid to insurance company | USD $162 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $63,503 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,786 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 162 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AZDH |
| Policy instance | 2 |
| Insurance contract or identification number | G000AZDH | | Number of Individuals Covered | 147 | | Insurance policy start date | 2018-02-01 | | Insurance policy end date | 2019-02-01 | | Total amount of commissions paid to insurance broker | USD $2,747 | | Total amount of fees paid to insurance company | USD $10 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $18,312 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,747 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AZDH |
| Policy instance | 1 |
| Insurance contract or identification number | G000AZDH | | Number of Individuals Covered | 114 | | Insurance policy start date | 2018-02-01 | | Insurance policy end date | 2019-02-01 | | Total amount of commissions paid to insurance broker | USD $3,209 | | Total amount of fees paid to insurance company | USD $22 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $24,586 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,209 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AZDH |
| Policy instance | 1 |
| Insurance contract or identification number | G000AZDH | | Number of Individuals Covered | 99 | | Insurance policy start date | 2016-02-01 | | Insurance policy end date | 2017-02-01 | | Total amount of commissions paid to insurance broker | USD $3,282 | | Total amount of fees paid to insurance company | USD $0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $25,644 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,282 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Insurance broker name | GIBSON & ASSOCIATES INC |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AZDH |
| Policy instance | 2 |
| Insurance contract or identification number | G000AZDH | | Number of Individuals Covered | 178 | | Insurance policy start date | 2016-02-01 | | Insurance policy end date | 2017-02-01 | | Total amount of commissions paid to insurance broker | USD $472 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $4,718 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $472 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Insurance broker name | GIBSON & ASSOCIATES INC |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AZDH |
| Policy instance | 3 |
| Insurance contract or identification number | G000AZDH | | Number of Individuals Covered | 128 | | Insurance policy start date | 2016-02-01 | | Insurance policy end date | 2017-02-01 | | Total amount of commissions paid to insurance broker | USD $2,693 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $58,422 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,693 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Insurance broker name | GIBSON & ASSOCIATES INC |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AZDH |
| Policy instance | 4 |
| Insurance contract or identification number | G000AZDH | | Number of Individuals Covered | 92 | | Insurance policy start date | 2016-02-01 | | Insurance policy end date | 2017-02-01 | | Total amount of commissions paid to insurance broker | USD $1,992 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | SHORT-TERM DISABILITY | | Welfare Benefit Premiums Paid to Carrier | USD $19,917 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,992 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Insurance broker name | GIBSON & ASSOCIATES INC |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AZDH |
| Policy instance | 5 |
| Insurance contract or identification number | G000AZDH | | Number of Individuals Covered | 103 | | Insurance policy start date | 2016-02-01 | | Insurance policy end date | 2017-02-01 | | Total amount of commissions paid to insurance broker | USD $3,463 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $23,089 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,463 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Insurance broker name | GIBSON & ASSOCIATES INC |
|
| STARMOUNT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68985 ) |
| Policy contract number | GATS216 |
| Policy instance | 6 |
| Insurance contract or identification number | GATS216 | | Number of Individuals Covered | 116 | | Insurance policy start date | 2016-02-01 | | Insurance policy end date | 2017-01-31 | | Total amount of commissions paid to insurance broker | USD $1,519 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $12,656 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,519 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Insurance broker name | GIBSON & ASSOCIATES INC |
|
| GREAT MIDWEST INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 52429 ) |
| Policy contract number | CRU-0052-01-17- |
| Policy instance | 7 |
| Insurance contract or identification number | CRU-0052-01-17- | | Number of Individuals Covered | 144 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $77,325 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $193,333 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 67240 | | Additional information about fees paid to insurance broker | BROKER FEES | | Insurance broker organization code? | 3 | | Insurance broker name | HEALTHCARE CHOICE |
|
| BLUECHOICE HEALTHPLAN (National Association of Insurance Commissioners NAIC id number: 95741 ) |
| Policy contract number | BA 864 |
| Policy instance | 1 |
| Insurance contract or identification number | BA 864 | | Number of Individuals Covered | 112 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $40,894 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | SHORT-TERM DISABILITY | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $40,894 | | Insurance broker organization code? | 3 | | Insurance broker name | GIBSON & ASSOCIATES, INC. |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00477389 |
| Policy instance | 1 |
| Insurance contract or identification number | 00477389 | | Number of Individuals Covered | 129 | | Insurance policy start date | 2013-04-01 | | Insurance policy end date | 2014-03-31 | | Total amount of commissions paid to insurance broker | USD $11,854 | | Total amount of fees paid to insurance company | USD $6,590 | | 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 | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | SHORT-TERM DISABILITY | | Welfare Benefit Premiums Paid to Carrier | USD $125,094 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,854 | | Amount paid for insurance broker fees | 6590 | | Insurance broker organization code? | 3 | | Insurance broker name | GIBSON AND ASSOCIATES, INC. |
|
| BLUECHOICE HEALTHPLAN (National Association of Insurance Commissioners NAIC id number: 95741 ) |
| Policy contract number | BA 864 |
| Policy instance | 2 |
| Insurance contract or identification number | BA 864 | | Number of Individuals Covered | 104 | | Insurance policy start date | 2013-12-01 | | Insurance policy end date | 2014-11-30 | | Total amount of commissions paid to insurance broker | USD $0 | | 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 | | 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 | 00477389 |
| Policy instance | 2 |
| Insurance contract or identification number | 00477389 | | Number of Individuals Covered | 123 | | Insurance policy start date | 2012-04-01 | | Insurance policy end date | 2013-03-31 | | Total amount of commissions paid to insurance broker | USD $11,364 | | Total amount of fees paid to insurance company | USD $5,983 | | 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 | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | SHORT-TERM DISABILITY | | Welfare Benefit Premiums Paid to Carrier | USD $114,137 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,974 | | Amount paid for insurance broker fees | 5983 | | Insurance broker organization code? | 3 | | Insurance broker name | CONSOLIDATED PLANNING HOLDINGS, INC |
|
| BLUECHOICE HEALTHPLAN (National Association of Insurance Commissioners NAIC id number: 95741 ) |
| Policy contract number | BA 864 |
| Policy instance | 3 |
| Insurance contract or identification number | BA 864 | | Number of Individuals Covered | 107 | | Insurance policy start date | 2013-04-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | 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 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MEDICAL MUTUAL (National Association of Insurance Commissioners NAIC id number: 95732 ) |
| Policy contract number | 037460000001 |
| Policy instance | 1 |
| Insurance contract or identification number | 037460000001 | | Number of Individuals Covered | 93 | | Insurance policy start date | 2012-04-01 | | Insurance policy end date | 2013-03-31 | | Total amount of commissions paid to insurance broker | USD $27,250 | | Total amount of fees paid to insurance company | USD $6,819 | | 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 | | Commission paid to Insurance Broker | USD $27,250 | | Amount paid for insurance broker fees | 6819 | | Insurance broker organization code? | 3 | | Insurance broker name | GIBSON AND ASSOCIATES, INC. |
|
| SECURITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68721 ) |
| Policy contract number | 40158 |
| Policy instance | 3 |
| Insurance contract or identification number | 40158 | | Number of Individuals Covered | 105 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-03-31 | | Total amount of commissions paid to insurance broker | USD $1,809 | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $14,733 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,809 | | Insurance broker organization code? | 3 | | Insurance broker name | GIBSON & ASSOCIATES INC |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AC6R |
| Policy instance | 6 |
| Insurance contract or identification number | G000AC6R | | Number of Individuals Covered | 38 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-04-01 | | Total amount of commissions paid to insurance broker | USD $318 | | 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 | | Other welfare benefits provided | VOLUNTARY SHORT-TERM DISABILITY | | Welfare Benefit Premiums Paid to Carrier | USD $2,122 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $318 | | Insurance broker organization code? | 3 | | Insurance broker name | GIBSON & ASSOCIATES INC |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AC6R |
| Policy instance | 5 |
| Insurance contract or identification number | G000AC6R | | Number of Individuals Covered | 61 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-04-01 | | Total amount of commissions paid to insurance broker | USD $650 | | 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 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,336 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $650 | | Insurance broker organization code? | 3 | | Insurance broker name | GIBSON & ASSOCIATES INC |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AC6R |
| Policy instance | 4 |
| Insurance contract or identification number | G000AC6R | | Number of Individuals Covered | 112 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-04-01 | | Total amount of commissions paid to insurance broker | USD $137 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $916 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $137 | | Insurance broker organization code? | 3 | | Insurance broker name | GIBSON & ASSOCIATES INC |
|
| CONVENTRY HEALTH AND LIFE (National Association of Insurance Commissioners NAIC id number: 81973 ) |
| Policy contract number | 3181710000 |
| Policy instance | 2 |
| Insurance contract or identification number | 3181710000 | | Number of Individuals Covered | 23 | | Insurance policy start date | 2011-04-01 | | Insurance policy end date | 2012-03-31 | | Total amount of commissions paid to insurance broker | USD $2,173 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $72,442 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,173 | | Insurance broker organization code? | 3 | | Insurance broker name | GIBSON & ASSOCIATES INC |
|
| COVENTRY HEALTH CARE OF CAROLINAS, INC. (National Association of Insurance Commissioners NAIC id number: 95321 ) |
| Policy contract number | 3181710000 |
| Policy instance | 1 |
| Insurance contract or identification number | 3181710000 | | Number of Individuals Covered | 191 | | Insurance policy start date | 2011-04-01 | | Insurance policy end date | 2012-03-31 | | Total amount of commissions paid to insurance broker | USD $13,962 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $465,395 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,962 | | Insurance broker organization code? | 3 | | Insurance broker name | GIBSON & ASSOCIATES INC |
|
| BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 38520 ) |
| Policy contract number | 25-34799-00 |
| Policy instance | 3 |
| Insurance contract or identification number | 25-34799-00 | | Number of Individuals Covered | 107 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | 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 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SECURITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68721 ) |
| Policy contract number | 40158 |
| Policy instance | 1 |
| Insurance contract or identification number | 40158 | | Number of Individuals Covered | 107 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $4,519 | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $54,406 | | 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 | G000AC6R |
| Policy instance | 2 |
| Insurance contract or identification number | G000AC6R | | Number of Individuals Covered | 111 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $7,651 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $51,002 | | 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 | G000AC6R |
| Policy instance | 2 |
| Insurance contract or identification number | G000AC6R | | Number of Individuals Covered | 111 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $7,625 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $50,834 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,625 | | Insurance broker organization code? | 3 | | Insurance broker name | GIBSON & ASSOCIATES INC |
|
| BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 38520 ) |
| Policy contract number | 25-34799-00 |
| Policy instance | 3 |
| Insurance contract or identification number | 25-34799-00 | | Number of Individuals Covered | 108 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $28,302 | | 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 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $28,302 | | Insurance broker organization code? | 3 | | Insurance broker name | GIBSON & ASSOCIATES INC |
|
| SECURITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68721 ) |
| Policy contract number | 40158 |
| Policy instance | 1 |
| Insurance contract or identification number | 40158 | | Number of Individuals Covered | 110 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $5,156 | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $55,886 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,156 | | Insurance broker organization code? | 3 | | Insurance broker name | GIBSON & ASSOCIATES INC |
|
