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TINDALL CORPORATION WELFARE BENEFITS PLAN 401k Plan overview

Plan NameTINDALL CORPORATION WELFARE BENEFITS PLAN
Plan identification number 501

TINDALL CORPORATION WELFARE BENEFITS PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Other welfare benefit cover

401k Sponsoring company profile

TINDALL CORPORATION has sponsored the creation of one or more 401k plans.

Company Name:TINDALL CORPORATION
Employer identification number (EIN):570762671
NAIC Classification:238100

Additional information about TINDALL CORPORATION

Jurisdiction of Incorporation: State of Delaware Division of Corporations
Incorporation Date:
Company Identification Number: 2059163

More information about TINDALL CORPORATION

Form 5500 Filing Information

Submission information for form 5500 for 401k plan TINDALL CORPORATION WELFARE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-04-01
5012021-04-01
5012020-04-01
5012019-04-01
5012019-04-01CHERYL O LANG2020-10-21
5012018-04-01
5012018-04-01
5012017-04-01CHERYL O. LANG
5012016-04-01CHERYL O. LANG
5012015-04-01CHERYL O. LANG
5012014-04-01CHERYL O. LANG
5012013-04-01CHERYL O. LANG
5012012-04-01CHERYL O. LANG
5012011-04-01CHERYL O. LANG
5012010-04-01CHERYL O. LANG
5012009-04-01LEE C BROWN

Plan Statistics for TINDALL CORPORATION WELFARE BENEFITS PLAN

401k plan membership statisitcs for TINDALL CORPORATION WELFARE BENEFITS PLAN

Measure Date Value
2022: TINDALL CORPORATION WELFARE BENEFITS PLAN 2022 401k membership
Total participants, beginning-of-year2022-04-011,098
Total number of active participants reported on line 7a of the Form 55002022-04-011,168
Total of all active and inactive participants2022-04-011,168
2021: TINDALL CORPORATION WELFARE BENEFITS PLAN 2021 401k membership
Total participants, beginning-of-year2021-04-011,112
Total number of active participants reported on line 7a of the Form 55002021-04-011,098
Total of all active and inactive participants2021-04-011,098
2020: TINDALL CORPORATION WELFARE BENEFITS PLAN 2020 401k membership
Total participants, beginning-of-year2020-04-011,230
Total number of active participants reported on line 7a of the Form 55002020-04-011,112
Total of all active and inactive participants2020-04-011,112
2019: TINDALL CORPORATION WELFARE BENEFITS PLAN 2019 401k membership
Total participants, beginning-of-year2019-04-011,217
Total number of active participants reported on line 7a of the Form 55002019-04-011,230
Total of all active and inactive participants2019-04-011,230
Number of retired or separated participants receiving benefits2019-04-010
Number of other retired or separated participants entitled to future benefits2019-04-010
2018: TINDALL CORPORATION WELFARE BENEFITS PLAN 2018 401k membership
Total participants, beginning-of-year2018-04-011,158
Total number of active participants reported on line 7a of the Form 55002018-04-011,217
Total of all active and inactive participants2018-04-011,217
Total participants2018-04-011,217
2017: TINDALL CORPORATION WELFARE BENEFITS PLAN 2017 401k membership
Total participants, beginning-of-year2017-04-011,008
Total number of active participants reported on line 7a of the Form 55002017-04-011,157
Number of retired or separated participants receiving benefits2017-04-011
Total of all active and inactive participants2017-04-011,158
Total participants2017-04-011,158
2016: TINDALL CORPORATION WELFARE BENEFITS PLAN 2016 401k membership
Total participants, beginning-of-year2016-04-01759
Total number of active participants reported on line 7a of the Form 55002016-04-011,005
Number of retired or separated participants receiving benefits2016-04-013
Total of all active and inactive participants2016-04-011,008
Total participants2016-04-011,008
2015: TINDALL CORPORATION WELFARE BENEFITS PLAN 2015 401k membership
Total participants, beginning-of-year2015-04-01860
Total number of active participants reported on line 7a of the Form 55002015-04-01757
Number of retired or separated participants receiving benefits2015-04-012
Total of all active and inactive participants2015-04-01759
Total participants2015-04-01759
2014: TINDALL CORPORATION WELFARE BENEFITS PLAN 2014 401k membership
Total participants, beginning-of-year2014-04-01747
Total number of active participants reported on line 7a of the Form 55002014-04-01857
Number of retired or separated participants receiving benefits2014-04-013
Total of all active and inactive participants2014-04-01860
Total participants2014-04-01860
2013: TINDALL CORPORATION WELFARE BENEFITS PLAN 2013 401k membership
Total participants, beginning-of-year2013-04-01724
Total number of active participants reported on line 7a of the Form 55002013-04-01747
Total of all active and inactive participants2013-04-01747
Total participants2013-04-01747
2012: TINDALL CORPORATION WELFARE BENEFITS PLAN 2012 401k membership
Total participants, beginning-of-year2012-04-01707
Total number of active participants reported on line 7a of the Form 55002012-04-01724
Total of all active and inactive participants2012-04-01724
Total participants2012-04-01724
2011: TINDALL CORPORATION WELFARE BENEFITS PLAN 2011 401k membership
Total participants, beginning-of-year2011-04-01857
Total number of active participants reported on line 7a of the Form 55002011-04-01707
Total of all active and inactive participants2011-04-01707
Total participants2011-04-01707
2010: TINDALL CORPORATION WELFARE BENEFITS PLAN 2010 401k membership
Total participants, beginning-of-year2010-04-01976
Total number of active participants reported on line 7a of the Form 55002010-04-01857
Total of all active and inactive participants2010-04-01857
Total participants2010-04-01857
2009: TINDALL CORPORATION WELFARE BENEFITS PLAN 2009 401k membership
Total participants, beginning-of-year2009-04-011,134
Total number of active participants reported on line 7a of the Form 55002009-04-01976
Total of all active and inactive participants2009-04-01976
Total participants2009-04-01976

Form 5500 Responses for TINDALL CORPORATION WELFARE BENEFITS PLAN

2022: TINDALL CORPORATION WELFARE BENEFITS PLAN 2022 form 5500 responses
2022-04-01Type of plan entitySingle employer plan
2022-04-01Plan funding arrangement – InsuranceYes
2022-04-01Plan funding arrangement – General assets of the sponsorYes
2022-04-01Plan benefit arrangement – InsuranceYes
2022-04-01Plan benefit arrangement – General assets of the sponsorYes
2021: TINDALL CORPORATION WELFARE BENEFITS PLAN 2021 form 5500 responses
2021-04-01Type of plan entitySingle employer plan
2021-04-01Plan funding arrangement – InsuranceYes
2021-04-01Plan funding arrangement – General assets of the sponsorYes
2021-04-01Plan benefit arrangement – InsuranceYes
2021-04-01Plan benefit arrangement – General assets of the sponsorYes
2020: TINDALL CORPORATION WELFARE BENEFITS PLAN 2020 form 5500 responses
2020-04-01Type of plan entitySingle employer plan
2020-04-01Plan funding arrangement – InsuranceYes
2020-04-01Plan funding arrangement – General assets of the sponsorYes
2020-04-01Plan benefit arrangement – InsuranceYes
2020-04-01Plan benefit arrangement – General assets of the sponsorYes
2019: TINDALL CORPORATION WELFARE BENEFITS PLAN 2019 form 5500 responses
2019-04-01Type of plan entitySingle employer plan
2019-04-01Submission has been amendedNo
2019-04-01This submission is the final filingNo
2019-04-01This return/report is a short plan year return/report (less than 12 months)No
2019-04-01Plan is a collectively bargained planNo
2019-04-01Plan funding arrangement – InsuranceYes
2019-04-01Plan funding arrangement – General assets of the sponsorYes
2019-04-01Plan benefit arrangement – InsuranceYes
2019-04-01Plan benefit arrangement – General assets of the sponsorYes
2018: TINDALL CORPORATION WELFARE BENEFITS PLAN 2018 form 5500 responses
2018-04-01Type of plan entitySingle employer plan
2018-04-01First time form 5500 has been submittedYes
2018-04-01Submission has been amendedNo
2018-04-01This submission is the final filingNo
2018-04-01This return/report is a short plan year return/report (less than 12 months)No
2018-04-01Plan is a collectively bargained planNo
2018-04-01Plan funding arrangement – InsuranceYes
2018-04-01Plan funding arrangement – General assets of the sponsorYes
2018-04-01Plan benefit arrangement – InsuranceYes
2018-04-01Plan benefit arrangement – General assets of the sponsorYes
2017: TINDALL CORPORATION WELFARE BENEFITS PLAN 2017 form 5500 responses
2017-04-01Type of plan entitySingle employer plan
2017-04-01Plan funding arrangement – InsuranceYes
2017-04-01Plan funding arrangement – General assets of the sponsorYes
2017-04-01Plan benefit arrangement – InsuranceYes
2017-04-01Plan benefit arrangement – General assets of the sponsorYes
2016: TINDALL CORPORATION WELFARE BENEFITS PLAN 2016 form 5500 responses
2016-04-01Type of plan entitySingle employer plan
2016-04-01Plan funding arrangement – InsuranceYes
2016-04-01Plan funding arrangement – General assets of the sponsorYes
2016-04-01Plan benefit arrangement – InsuranceYes
2016-04-01Plan benefit arrangement – General assets of the sponsorYes
2015: TINDALL CORPORATION WELFARE BENEFITS PLAN 2015 form 5500 responses
2015-04-01Type of plan entitySingle employer plan
2015-04-01Plan funding arrangement – InsuranceYes
2015-04-01Plan funding arrangement – General assets of the sponsorYes
2015-04-01Plan benefit arrangement – InsuranceYes
2015-04-01Plan benefit arrangement – General assets of the sponsorYes
2014: TINDALL CORPORATION WELFARE BENEFITS PLAN 2014 form 5500 responses
2014-04-01Type of plan entitySingle employer plan
2014-04-01Plan funding arrangement – InsuranceYes
2014-04-01Plan funding arrangement – General assets of the sponsorYes
2014-04-01Plan benefit arrangement – InsuranceYes
2014-04-01Plan benefit arrangement – General assets of the sponsorYes
2013: TINDALL CORPORATION WELFARE BENEFITS PLAN 2013 form 5500 responses
2013-04-01Type of plan entitySingle employer plan
2013-04-01Plan funding arrangement – InsuranceYes
2013-04-01Plan benefit arrangement – InsuranceYes
2012: TINDALL CORPORATION WELFARE BENEFITS PLAN 2012 form 5500 responses
2012-04-01Type of plan entitySingle employer plan
2012-04-01Plan funding arrangement – InsuranceYes
2012-04-01Plan benefit arrangement – InsuranceYes
2011: TINDALL CORPORATION WELFARE BENEFITS PLAN 2011 form 5500 responses
2011-04-01Type of plan entitySingle employer plan
2011-04-01Submission has been amendedYes
2011-04-01Plan funding arrangement – InsuranceYes
2011-04-01Plan benefit arrangement – InsuranceYes
2010: TINDALL CORPORATION WELFARE BENEFITS PLAN 2010 form 5500 responses
2010-04-01Type of plan entitySingle employer plan
2010-04-01Plan funding arrangement – InsuranceYes
2010-04-01Plan benefit arrangement – InsuranceYes
2009: TINDALL CORPORATION WELFARE BENEFITS PLAN 2009 form 5500 responses
2009-04-01Type of plan entitySingle employer plan
2009-04-01This submission is the final filingNo
2009-04-01Plan funding arrangement – InsuranceYes
2009-04-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLTD0AL7A
Policy instance 2
Insurance contract or identification numberGLTD0AL7A
Number of Individuals Covered339
Insurance policy start date2022-04-01
Insurance policy end date2023-03-31
Total amount of commissions paid to insurance brokerUSD $17,005
Total amount of fees paid to insurance companyUSD $13,879
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $113,368
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,005
Amount paid for insurance broker fees10196
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 numberGLUG0AL7A
Policy instance 1
Insurance contract or identification numberGLUG0AL7A
Number of Individuals Covered1168
Insurance policy start date2022-04-01
Insurance policy end date2023-03-31
Total amount of commissions paid to insurance brokerUSD $51,207
Total amount of fees paid to insurance companyUSD $31,819
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD & D
Welfare Benefit Premiums Paid to CarrierUSD $341,381
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $51,207
Amount paid for insurance broker fees22575
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 numberGUPR0AL7A
Policy instance 3
Insurance contract or identification numberGUPR0AL7A
Number of Individuals Covered369
Insurance policy start date2022-04-01
Insurance policy end date2023-03-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $14,765
Other welfare benefits providedVOLUNTARY LONG-TERM DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $123,443
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees10974
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 numberGUC 0AL7A
Policy instance 4
Insurance contract or identification numberGUC 0AL7A
Number of Individuals Covered444
Insurance policy start date2022-04-01
Insurance policy end date2023-03-31
Total amount of commissions paid to insurance brokerUSD $14,946
Total amount of fees paid to insurance companyUSD $23,525
Other welfare benefits providedVOLUNTARY SHORT-TERM DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $99,638
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,946
Amount paid for insurance broker fees8763
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 numberGVTL0AL7A
Policy instance 5
Insurance contract or identification numberGVTL0AL7A
Number of Individuals Covered470
Insurance policy start date2022-04-01
Insurance policy end date2023-03-31
Total amount of commissions paid to insurance brokerUSD $56,427
Total amount of fees paid to insurance companyUSD $32,196
Other welfare benefits providedVOLUNTARY TERM LIFE
Welfare Benefit Premiums Paid to CarrierUSD $282,137
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $56,427
Amount paid for insurance broker fees23592
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number010-031740
Policy instance 6
Insurance contract or identification number010-031740
Number of Individuals Covered1586
Insurance policy start date2022-04-01
Insurance policy end date2023-03-31
Total amount of commissions paid to insurance brokerUSD $7,882
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $78,822
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,882
Insurance broker organization code?3
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number0011843079
Policy instance 7
Insurance contract or identification number0011843079
Number of Individuals Covered2
Insurance policy start date2022-04-01
Insurance policy end date2023-03-31
Total amount of commissions paid to insurance brokerUSD $48
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $598
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $22
Insurance broker organization code?3
PAUL REVERE VARIABLE ANNUITY INS. CO. (National Association of Insurance Commissioners NAIC id number: 67601 )
Policy contract number640365
Policy instance 11
Insurance contract or identification number640365
Number of Individuals Covered312
Insurance policy start date2022-04-01
Insurance policy end date2023-04-01
Total amount of commissions paid to insurance brokerUSD $7,548
Total amount of fees paid to insurance companyUSD $700
Other welfare benefits providedHOSPITAL EE PAID
Welfare Benefit Premiums Paid to CarrierUSD $37,744
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,548
Amount paid for insurance broker fees700
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
PAUL REVERE VARIABLE ANNUITY INS. CO. (National Association of Insurance Commissioners NAIC id number: 67601 )
Policy contract number640364
Policy instance 10
Insurance contract or identification number640364
Number of Individuals Covered585
Insurance policy start date2022-04-01
Insurance policy end date2023-04-01
Total amount of commissions paid to insurance brokerUSD $24,838
Total amount of fees paid to insurance companyUSD $2,644
Other welfare benefits providedGRP ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $70,874
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $24,838
Amount paid for insurance broker fees2644
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
PAUL REVERE VARIABLE ANNUITY INS. CO. (National Association of Insurance Commissioners NAIC id number: 67601 )
Policy contract number474587
Policy instance 9
Insurance contract or identification number474587
Number of Individuals Covered226
Insurance policy start date2022-04-01
Insurance policy end date2023-04-01
Total amount of commissions paid to insurance brokerUSD $10,952
Total amount of fees paid to insurance companyUSD $913
Other welfare benefits providedATTAINED AGE CRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $65,473
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,952
Amount paid for insurance broker fees913
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract numberR0730598
Policy instance 8
Insurance contract or identification numberR0730598
Number of Individuals Covered2
Insurance policy start date2022-04-01
Insurance policy end date2023-03-31
Total amount of commissions paid to insurance brokerUSD $21
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedACCIDENT, HOSPITAL
Welfare Benefit Premiums Paid to CarrierUSD $250
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )
Policy contract numberLBT
Policy instance 12
Insurance contract or identification numberLBT
Number of Individuals Covered122
Insurance policy start date2022-04-01
Insurance policy end date2023-04-01
Total amount of commissions paid to insurance brokerUSD $10,901
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $60,010
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,901
Insurance broker organization code?3
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number010-031740
Policy instance 6
Insurance contract or identification number010-031740
Number of Individuals Covered1520
Insurance policy start date2021-04-01
Insurance policy end date2022-03-31
Total amount of commissions paid to insurance brokerUSD $7,459
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $74,593
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,459
Amount paid for insurance broker fees0
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLTD0AL7A
Policy instance 2
Insurance contract or identification numberGLTD0AL7A
Number of Individuals Covered327
Insurance policy start date2021-04-01
Insurance policy end date2022-03-31
Total amount of commissions paid to insurance brokerUSD $17,451
Total amount of fees paid to insurance companyUSD $7,356
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $116,340
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,451
Amount paid for insurance broker fees3961
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 numberGUPR0AL7A
Policy instance 3
Insurance contract or identification numberGUPR0AL7A
Number of Individuals Covered382
Insurance policy start date2021-04-01
Insurance policy end date2022-03-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $8,819
Other welfare benefits providedVOLUNTARY LONG-TERM DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $133,420
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees4749
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 numberGUC 0AL7A
Policy instance 4
Insurance contract or identification numberGUC 0AL7A
Number of Individuals Covered481
Insurance policy start date2021-04-01
Insurance policy end date2022-03-31
Total amount of commissions paid to insurance brokerUSD $15,895
Total amount of fees paid to insurance companyUSD $26,879
Other welfare benefits providedVOLUNTARY SHORT-TERM DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $105,967
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees19883
Additional information about fees paid to insurance brokerADMINISTRATION
Insurance broker organization code?5
Commission paid to Insurance BrokerUSD $15,895
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGVTL0AL7A
Policy instance 5
Insurance contract or identification numberGVTL0AL7A
Number of Individuals Covered469
Insurance policy start date2021-04-01
Insurance policy end date2022-03-31
Total amount of commissions paid to insurance brokerUSD $60,352
Total amount of fees paid to insurance companyUSD $17,956
Other welfare benefits providedVOLUNTARY TERM LIFE
Welfare Benefit Premiums Paid to CarrierUSD $301,762
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $60,352
Amount paid for insurance broker fees8750
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number0011843079
Policy instance 7
Insurance contract or identification number0011843079
Number of Individuals Covered73
Insurance policy start date2021-04-01
Insurance policy end date2022-03-31
Total amount of commissions paid to insurance brokerUSD $148
Total amount of fees paid to insurance companyUSD $5
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,320
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $50
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerOTHER COMPENSATION
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0AL7A
Policy instance 1
Insurance contract or identification numberGLUG0AL7A
Number of Individuals Covered1098
Insurance policy start date2021-04-01
Insurance policy end date2022-03-31
Total amount of commissions paid to insurance brokerUSD $37,392
Total amount of fees paid to insurance companyUSD $15,916
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD & D
Welfare Benefit Premiums Paid to CarrierUSD $249,280
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $37,392
Amount paid for insurance broker fees8570
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
PAUL REVERE VARIABLE ANNUITY INS. CO. (National Association of Insurance Commissioners NAIC id number: 67601 )
Policy contract number640365
Policy instance 11
Insurance contract or identification number640365
Number of Individuals Covered348
Insurance policy start date2021-04-01
Insurance policy end date2022-04-01
Total amount of commissions paid to insurance brokerUSD $5,989
Total amount of fees paid to insurance companyUSD $751
Other welfare benefits providedHOSPITAL EE PAID
Welfare Benefit Premiums Paid to CarrierUSD $29,940
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,989
Amount paid for insurance broker fees751
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
PAUL REVERE VARIABLE ANNUITY INS. CO. (National Association of Insurance Commissioners NAIC id number: 67601 )
Policy contract number640364
Policy instance 10
Insurance contract or identification number640364
Number of Individuals Covered593
Insurance policy start date2021-04-01
Insurance policy end date2022-04-01
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedGRP ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $53,342
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PAUL REVERE VARIABLE ANNUITY INS. CO. (National Association of Insurance Commissioners NAIC id number: 67601 )
Policy contract number474587
Policy instance 9
Insurance contract or identification number474587
Number of Individuals Covered238
Insurance policy start date2021-04-01
Insurance policy end date2022-04-01
Total amount of commissions paid to insurance brokerUSD $12,552
Total amount of fees paid to insurance companyUSD $1,231
Other welfare benefits providedATTAINED AGE CRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $85,119
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,552
Amount paid for insurance broker fees1231
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract numberR0730598
Policy instance 8
Insurance contract or identification numberR0730598
Number of Individuals Covered1078
Insurance policy start date2021-04-01
Insurance policy end date2022-03-31
Total amount of commissions paid to insurance brokerUSD $7,028
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedACCIDENT, HOSPITAL
Welfare Benefit Premiums Paid to CarrierUSD $73,070
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,830
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0AL7A
Policy instance 1
Insurance contract or identification numberGLUG0AL7A
Number of Individuals Covered1112
Insurance policy start date2020-04-01
Insurance policy end date2021-03-31
Total amount of commissions paid to insurance brokerUSD $36,993
Total amount of fees paid to insurance companyUSD $22,836
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $246,622
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $36,993
Amount paid for insurance broker fees15207
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 numberGLTD0AL7A
Policy instance 2
Insurance contract or identification numberGLTD0AL7A
Number of Individuals Covered307
Insurance policy start date2020-04-01
Insurance policy end date2021-03-31
Total amount of commissions paid to insurance brokerUSD $16,584
Total amount of fees paid to insurance companyUSD $9,628
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $110,557
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,584
Amount paid for insurance broker fees6317
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 numberGUPR0AL7A
Policy instance 3
Insurance contract or identification numberGUPR0AL7A
Number of Individuals Covered443
Insurance policy start date2020-04-01
Insurance policy end date2021-03-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $12,417
Other welfare benefits providedVOLUNTARY LONG-TERM DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $138,390
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees8235
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 numberGUC 0AL7A
Policy instance 4
Insurance contract or identification numberGUC 0AL7A
Number of Individuals Covered565
Insurance policy start date2020-04-01
Insurance policy end date2021-03-31
Total amount of commissions paid to insurance brokerUSD $16,687
Total amount of fees paid to insurance companyUSD $30,188
Other welfare benefits providedVOLUNTARY SHORT-TERM DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $111,247
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,687
Amount paid for insurance broker fees6862
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 numberGVTL0AL7A
Policy instance 5
Insurance contract or identification numberGVTL0AL7A
Number of Individuals Covered502
Insurance policy start date2020-04-01
Insurance policy end date2021-03-31
Total amount of commissions paid to insurance brokerUSD $62,649
Total amount of fees paid to insurance companyUSD $25,987
Other welfare benefits providedVOLUNTARY LIFE
Welfare Benefit Premiums Paid to CarrierUSD $313,247
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $62,649
Amount paid for insurance broker fees16551
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number010-031740
Policy instance 6
Insurance contract or identification number010-031740
Number of Individuals Covered1485
Insurance policy start date2020-04-01
Insurance policy end date2021-03-31
Total amount of commissions paid to insurance brokerUSD $7,862
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $78,619
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,862
Amount paid for insurance broker fees0
Insurance broker organization code?3
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number0011843079
Policy instance 7
Insurance contract or identification number0011843079
Number of Individuals Covered199
Insurance policy start date2020-04-01
Insurance policy end date2021-03-31
Total amount of commissions paid to insurance brokerUSD $11,289
Total amount of fees paid to insurance companyUSD $474
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $86,581
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,948
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerOTHER COMPENSATION
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract numberR0730598
Policy instance 8
Insurance contract or identification numberR0730598
Number of Individuals Covered1667
Insurance policy start date2020-04-01
Insurance policy end date2021-03-31
Total amount of commissions paid to insurance brokerUSD $27,290
Total amount of fees paid to insurance companyUSD $595
Other welfare benefits providedCRIT ILLNESS, ACCIDENT, HOSPITA
Welfare Benefit Premiums Paid to CarrierUSD $245,362
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $18,997
Amount paid for insurance broker fees335
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
PAUL REVERE VARIABLE ANNUITY INS. CO. (National Association of Insurance Commissioners NAIC id number: 67601 )
Policy contract number474587
Policy instance 9
Insurance contract or identification number474587
Number of Individuals Covered266
Insurance policy start date2020-04-01
Insurance policy end date2021-04-01
Total amount of commissions paid to insurance brokerUSD $7,401
Total amount of fees paid to insurance companyUSD $1,200
Other welfare benefits providedATTAINED AGE CRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $48,005
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,401
Amount paid for insurance broker fees1200
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 numberGLUG0AL7A
Policy instance 1
Insurance contract or identification numberGLUG0AL7A
Number of Individuals Covered1230
Insurance policy start date2019-04-01
Insurance policy end date2020-03-31
Total amount of commissions paid to insurance brokerUSD $39,283
Total amount of fees paid to insurance companyUSD $16,498
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $261,889
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $39,283
Amount paid for insurance broker fees8750
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 numberGLTD0AL7A
Policy instance 2
Insurance contract or identification numberGLTD0AL7A
Number of Individuals Covered305
Insurance policy start date2019-04-01
Insurance policy end date2020-03-31
Total amount of commissions paid to insurance brokerUSD $16,031
Total amount of fees paid to insurance companyUSD $6,381
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $106,876
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,031
Amount paid for insurance broker fees3436
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 numberGUPR0AL7A
Policy instance 3
Insurance contract or identification numberGUPR0AL7A
Number of Individuals Covered508
Insurance policy start date2019-04-01
Insurance policy end date2020-03-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $8,727
Other welfare benefits providedVOLUNTARY LONG-TERM DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $136,764
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees4699
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 numberGUC 0AL7A
Policy instance 4
Insurance contract or identification numberGUC 0AL7A
Number of Individuals Covered668
Insurance policy start date2019-04-01
Insurance policy end date2020-03-31
Total amount of commissions paid to insurance brokerUSD $17,397
Total amount of fees paid to insurance companyUSD $17,340
Other welfare benefits providedVOLUNTARY SHORT-TERM DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $115,980
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,397
Amount paid for insurance broker fees3984
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 numberGVTL0AL7A
Policy instance 5
Insurance contract or identification numberGVTL0AL7A
Number of Individuals Covered553
Insurance policy start date2019-04-01
Insurance policy end date2020-03-31
Total amount of commissions paid to insurance brokerUSD $62,670
Total amount of fees paid to insurance companyUSD $18,111
Other welfare benefits providedVOLUNTARY LIFE
Welfare Benefit Premiums Paid to CarrierUSD $313,348
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $62,670
Amount paid for insurance broker fees8750
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number010-031740
Policy instance 6
Insurance contract or identification number010-031740
Number of Individuals Covered1663
Insurance policy start date2019-04-01
Insurance policy end date2020-03-31
Total amount of commissions paid to insurance brokerUSD $8,231
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $82,311
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,231
Amount paid for insurance broker fees0
Insurance broker organization code?3
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number0011843079
Policy instance 7
Insurance contract or identification number0011843079
Number of Individuals Covered323
Insurance policy start date2019-04-01
Insurance policy end date2020-03-31
Total amount of commissions paid to insurance brokerUSD $34,543
Total amount of fees paid to insurance companyUSD $2,734
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $100,028
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,586
Amount paid for insurance broker fees2319
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract numberR0730598
Policy instance 8
Insurance contract or identification numberR0730598
Number of Individuals Covered2098
Insurance policy start date2019-04-01
Insurance policy end date2020-03-31
Total amount of commissions paid to insurance brokerUSD $78,714
Total amount of fees paid to insurance companyUSD $5,915
Other welfare benefits providedCRIT ILLNESS, ACCIDENT, HOSPITA
Welfare Benefit Premiums Paid to CarrierUSD $370,616
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $47,272
Amount paid for insurance broker fees3884
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract numberR0730598
Policy instance 8
Insurance contract or identification numberR0730598
Number of Individuals Covered1948
Insurance policy start date2018-04-01
Insurance policy end date2019-03-31
Total amount of commissions paid to insurance brokerUSD $219,010
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedCRIT ILLNESS, ACCIDENT, HOSPITA
Welfare Benefit Premiums Paid to CarrierUSD $330,883
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $161,742
Amount paid for insurance broker fees0
Insurance broker organization code?3
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number0011843079
Policy instance 7
Insurance contract or identification number0011843079
Number of Individuals Covered253
Insurance policy start date2018-04-01
Insurance policy end date2019-03-31
Total amount of commissions paid to insurance brokerUSD $90,824
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $90,967
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $39,657
Amount paid for insurance broker fees0
Insurance broker organization code?3
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number010-031740
Policy instance 6
Insurance contract or identification number010-031740
Number of Individuals Covered1680
Insurance policy start date2018-04-01
Insurance policy end date2019-03-31
Total amount of commissions paid to insurance brokerUSD $7,967
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $79,664
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,581
Amount paid for insurance broker fees0
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGVTL0AL7A
Policy instance 5
Insurance contract or identification numberGVTL0AL7A
Number of Individuals Covered573
Insurance policy start date2018-04-01
Insurance policy end date2019-03-31
Total amount of commissions paid to insurance brokerUSD $61,833
Total amount of fees paid to insurance companyUSD $16,486
Other welfare benefits providedVOLUNTARY LIFE
Welfare Benefit Premiums Paid to CarrierUSD $309,163
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $56,805
Amount paid for insurance broker fees16486
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 numberGUC 0AL7A
Policy instance 4
Insurance contract or identification numberGUC 0AL7A
Number of Individuals Covered647
Insurance policy start date2018-04-01
Insurance policy end date2019-03-31
Total amount of commissions paid to insurance brokerUSD $16,817
Total amount of fees paid to insurance companyUSD $6,563
Other welfare benefits providedVOLUNTARY SHORT-TERM DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $112,110
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,473
Amount paid for insurance broker fees6563
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 numberGUPR0AL7A
Policy instance 3
Insurance contract or identification numberGUPR0AL7A
Number of Individuals Covered523
Insurance policy start date2018-04-01
Insurance policy end date2019-03-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $7,802
Other welfare benefits providedVOLUNTARY LONG-TERM DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $132,358
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees7802
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 numberGLTD0AL7A
Policy instance 2
Insurance contract or identification numberGLTD0AL7A
Number of Individuals Covered304
Insurance policy start date2018-04-01
Insurance policy end date2019-03-31
Total amount of commissions paid to insurance brokerUSD $12,118
Total amount of fees paid to insurance companyUSD $4,719
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $80,783
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,088
Amount paid for insurance broker fees4719
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 numberGLUG0AL7A
Policy instance 1
Insurance contract or identification numberGLUG0AL7A
Number of Individuals Covered1217
Insurance policy start date2018-04-01
Insurance policy end date2019-03-31
Total amount of commissions paid to insurance brokerUSD $36,942
Total amount of fees paid to insurance companyUSD $14,329
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $246,282
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $33,826
Amount paid for insurance broker fees14329
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 numberGLUG0AL7A
Policy instance 1
Insurance contract or identification numberGLUG0AL7A
Number of Individuals Covered1157
Insurance policy start date2017-04-01
Insurance policy end date2018-03-31
Total amount of commissions paid to insurance brokerUSD $32,750
Total amount of fees paid to insurance companyUSD $12,477
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $218,336
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $32,750
Amount paid for insurance broker fees12477
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
Insurance broker nameCHAMPION BENEFITS APPROACH INC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLTD0AL7A
Policy instance 2
Insurance contract or identification numberGLTD0AL7A
Number of Individuals Covered280
Insurance policy start date2017-04-01
Insurance policy end date2018-03-31
Total amount of commissions paid to insurance brokerUSD $11,149
Total amount of fees paid to insurance companyUSD $4,318
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $74,323
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,149
Amount paid for insurance broker fees4318
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
Insurance broker nameCHAMPION BENEFITS APPROACH INC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUPR0AL7A
Policy instance 3
Insurance contract or identification numberGUPR0AL7A
Number of Individuals Covered520
Insurance policy start date2017-04-01
Insurance policy end date2018-03-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $7,254
Other welfare benefits providedVOLUNTARY LONG-TERM DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $121,957
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees7254
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
Insurance broker nameCHAMPION BENEFITS APPROACH INC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUC 0AL7A
Policy instance 4
Insurance contract or identification numberGUC 0AL7A
Number of Individuals Covered658
Insurance policy start date2017-04-01
Insurance policy end date2018-03-31
Total amount of commissions paid to insurance brokerUSD $14,793
Total amount of fees paid to insurance companyUSD $5,759
Other welfare benefits providedVOLUNTARY SHORT-TERM DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $98,619
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,793
Amount paid for insurance broker fees5759
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
Insurance broker nameCHAMPION BENEFITS APPROACH INC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGVTL0AL7A
Policy instance 5
Insurance contract or identification numberGVTL0AL7A
Number of Individuals Covered597
Insurance policy start date2017-04-01
Insurance policy end date2018-03-31
Total amount of commissions paid to insurance brokerUSD $61,895
Total amount of fees paid to insurance companyUSD $16,558
Other welfare benefits providedVOLUNTARY LIFE
Welfare Benefit Premiums Paid to CarrierUSD $309,475
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $61,895
Amount paid for insurance broker fees16558
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
Insurance broker nameCHAMPION BENEFITS APPROACH INC
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number010-031740
Policy instance 6
Insurance contract or identification number010-031740
Number of Individuals Covered1509
Insurance policy start date2017-04-01
Insurance policy end date2018-03-31
Total amount of commissions paid to insurance brokerUSD $7,140
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $71,398
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,140
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameCHAMPION BENEFITS APPROACH INC
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number0009G417
Policy instance 7
Insurance contract or identification number0009G417
Number of Individuals Covered624
Insurance policy start date2017-04-01
Insurance policy end date2018-03-31
Total amount of commissions paid to insurance brokerUSD $56,229
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $241,676
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $56,229
Insurance broker organization code?3
Insurance broker nameCHAMPION BENEFITS APPROACH INC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AL7A
Policy instance 2
Insurance contract or identification numberG000AL7A
Number of Individuals Covered234
Insurance policy start date2015-04-01
Insurance policy end date2016-03-31
Total amount of commissions paid to insurance brokerUSD $8,987
Total amount of fees paid to insurance companyUSD $3,532
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $59,913
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,987
Amount paid for insurance broker fees3532
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
Insurance broker nameCHAMPION BENEFITS APPROACH INC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AL7A
Policy instance 1
Insurance contract or identification numberG000AL7A
Number of Individuals Covered757
Insurance policy start date2015-04-01
Insurance policy end date2016-03-31
Total amount of commissions paid to insurance brokerUSD $21,796
Total amount of fees paid to insurance companyUSD $8,770
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $145,306
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $21,796
Amount paid for insurance broker fees8770
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
Insurance broker nameCHAMPION BENEFITS APPROACH INC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AL7A
Policy instance 3
Insurance contract or identification numberG000AL7A
Number of Individuals Covered401
Insurance policy start date2015-04-01
Insurance policy end date2016-03-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $4,708
Other welfare benefits providedVOLUNTARY LONG-TERM DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $78,465
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees4708
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
Insurance broker nameCHAMPION BENEFITS APPROACH INC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AL7A
Policy instance 4
Insurance contract or identification numberG000AL7A
Number of Individuals Covered484
Insurance policy start date2015-04-01
Insurance policy end date2016-03-31
Total amount of commissions paid to insurance brokerUSD $9,029
Total amount of fees paid to insurance companyUSD $9,710
Other welfare benefits providedVOLUNTARY SHORT-TERM DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $60,193
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,029
Amount paid for insurance broker fees9710
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
Insurance broker nameCHAMPION BENEFITS APPROACH INC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AL7A
Policy instance 5
Insurance contract or identification numberG000AL7A
Number of Individuals Covered377
Insurance policy start date2015-04-01
Insurance policy end date2016-03-31
Total amount of commissions paid to insurance brokerUSD $43,379
Total amount of fees paid to insurance companyUSD $12,956
Other welfare benefits providedVOLUNTARY LIFE
Welfare Benefit Premiums Paid to CarrierUSD $216,894
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $43,379
Amount paid for insurance broker fees12956
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
Insurance broker nameCHAMPION BENEFITS APPROACH INC
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number010-031740
Policy instance 6
Insurance contract or identification number010-031740
Number of Individuals Covered1238
Insurance policy start date2015-04-01
Insurance policy end date2016-03-31
Total amount of commissions paid to insurance brokerUSD $5,716
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $57,161
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,716
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameCHAMPION BENEFITS APPROACH INC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AL7A
Policy instance 4
Insurance contract or identification numberG000AL7A
Number of Individuals Covered431
Insurance policy start date2014-04-01
Insurance policy end date2015-03-31
Total amount of commissions paid to insurance brokerUSD $9,029
Total amount of fees paid to insurance companyUSD $3,913
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedVOLUNTARY SHORT-TERM DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $60,193
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,029
Amount paid for insurance broker fees3913
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
Insurance broker nameCHAMPION BENEFITS APPROACH INC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AL7A
Policy instance 5
Insurance contract or identification numberG000AL7A
Number of Individuals Covered409
Insurance policy start date2014-04-01
Insurance policy end date2015-03-31
Total amount of commissions paid to insurance brokerUSD $42,814
Total amount of fees paid to insurance companyUSD $13,901
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedVOLUNTARY LIFE
Welfare Benefit Premiums Paid to CarrierUSD $214,072
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $42,814
Amount paid for insurance broker fees13901
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
Insurance broker nameCHAMPION BENEFITS APPROACH INC
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number010-031740
Policy instance 6
Insurance contract or identification number010-031740
Number of Individuals Covered1091
Insurance policy start date2014-04-01
Insurance policy end date2015-03-31
Total amount of commissions paid to insurance brokerUSD $5,070
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $50,701
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,070
Insurance broker organization code?3
Insurance broker nameCHAMPION BENEFITS APPROACH INC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AL7A
Policy instance 2
Insurance contract or identification numberG000AL7A
Number of Individuals Covered387
Insurance policy start date2014-04-01
Insurance policy end date2015-03-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $5,100
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $78,465
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees5100
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
Insurance broker nameCHAMPION BENEFITS APPROACH INC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AL7A
Policy instance 1
Insurance contract or identification numberG000AL7A
Number of Individuals Covered857
Insurance policy start date2014-04-01
Insurance policy end date2015-03-31
Total amount of commissions paid to insurance brokerUSD $20,249
Total amount of fees paid to insurance companyUSD $8,535
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $134,994
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $20,249
Amount paid for insurance broker fees8535
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
Insurance broker nameCHAMPION BENEFITS APPROACH INC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AL7A
Policy instance 3
Insurance contract or identification numberG000AL7A
Number of Individuals Covered216
Insurance policy start date2014-04-01
Insurance policy end date2015-03-31
Total amount of commissions paid to insurance brokerUSD $7,782
Total amount of fees paid to insurance companyUSD $3,272
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $51,877
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,782
Amount paid for insurance broker fees3272
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
Insurance broker nameCHAMPION BENEFITS APPROACH INC
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number010-031740
Policy instance 7
Insurance contract or identification number010-031740
Number of Individuals Covered899
Insurance policy start date2013-04-01
Insurance policy end date2014-03-31
Total amount of commissions paid to insurance brokerUSD $4,601
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $46,014
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,601
Insurance broker organization code?3
Insurance broker nameCHAMPION BENEFITS APPROACH INC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AL7A
Policy instance 5
Insurance contract or identification numberG000AL7A
Number of Individuals Covered401
Insurance policy start date2013-04-01
Insurance policy end date2014-03-31
Total amount of commissions paid to insurance brokerUSD $9,029
Total amount of fees paid to insurance companyUSD $12,335
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedVOLUNTARY SHORT-TERM DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $60,193
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,029
Amount paid for insurance broker fees12335
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
Insurance broker nameCHAMPION BENEFITS APPROACH INC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AL7A
Policy instance 4
Insurance contract or identification numberG000AL7A
Number of Individuals Covered184
Insurance policy start date2013-04-01
Insurance policy end date2014-03-31
Total amount of commissions paid to insurance brokerUSD $7,297
Total amount of fees paid to insurance companyUSD $6,896
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $48,649
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,297
Amount paid for insurance broker fees6896
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
Insurance broker nameCHAMPION BENEFITS APPROACH INC
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00402651
Policy instance 1
Insurance contract or identification number00402651
Number of Individuals Covered590
Insurance policy start date2013-04-01
Insurance policy end date2014-03-31
Total amount of commissions paid to insurance brokerUSD $19,245
Total amount of fees paid to insurance companyUSD $6,832
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $237,391
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,245
Insurance broker organization code?3
Amount paid for insurance broker fees6832
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker nameCHAMPION BENEFITS APPROACH INC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AL7A
Policy instance 6
Insurance contract or identification numberG000AL7A
Number of Individuals Covered395
Insurance policy start date2013-04-01
Insurance policy end date2014-03-31
Total amount of commissions paid to insurance brokerUSD $43,101
Total amount of fees paid to insurance companyUSD $21,624
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedVOLUNTARY LIFE
Welfare Benefit Premiums Paid to CarrierUSD $215,505
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $43,101
Amount paid for insurance broker fees21624
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
Insurance broker nameCHAMPION BENEFITS APPROACH INC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AL7A
Policy instance 3
Insurance contract or identification numberG000AL7A
Number of Individuals Covered361
Insurance policy start date2013-04-01
Insurance policy end date2014-03-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $13,423
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $78,465
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees13423
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
Insurance broker nameCHAMPION BENEFITS APPROACH INC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AL7A
Policy instance 2
Insurance contract or identification numberG000AL7A
Number of Individuals Covered747
Insurance policy start date2013-04-01
Insurance policy end date2014-03-31
Total amount of commissions paid to insurance brokerUSD $19,263
Total amount of fees paid to insurance companyUSD $8,479
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $128,419
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,263
Amount paid for insurance broker fees8479
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
Insurance broker nameCHAMPION BENEFITS APPROACH INC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AL7A
Policy instance 7
Insurance contract or identification numberG000AL7A
Number of Individuals Covered445
Insurance policy start date2012-04-01
Insurance policy end date2013-03-31
Total amount of commissions paid to insurance brokerUSD $44,803
Total amount of fees paid to insurance companyUSD $4,114
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedVOLUNTARY LIFE
Welfare Benefit Premiums Paid to CarrierUSD $224,014
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $44,803
Amount paid for insurance broker fees4114
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
Insurance broker nameCHAMPION BENEFITS APPROACH INC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AL7A
Policy instance 5
Insurance contract or identification numberG000AL7A
Number of Individuals Covered186
Insurance policy start date2012-04-01
Insurance policy end date2013-03-31
Total amount of commissions paid to insurance brokerUSD $7,326
Total amount of fees paid to insurance companyUSD $903
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $48,837
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,326
Amount paid for insurance broker fees903
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
Insurance broker nameCHAMPION BENEFITS APPROACH INC
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number010-031740
Policy instance 8
Insurance contract or identification number010-031740
Number of Individuals Covered862
Insurance policy start date2011-05-01
Insurance policy end date2012-04-30
Total amount of commissions paid to insurance brokerUSD $4,431
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $44,305
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,431
Insurance broker organization code?3
Insurance broker nameCHAMPION BENEFITS APPROACH INC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AL7A
Policy instance 4
Insurance contract or identification numberG000AL7A
Number of Individuals Covered371
Insurance policy start date2012-04-01
Insurance policy end date2013-03-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $1,493
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $78,465
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees1493
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
Insurance broker nameCHAMPION BENEFITS APPROACH INC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AL7A
Policy instance 3
Insurance contract or identification numberG000AL7A
Number of Individuals Covered724
Insurance policy start date2012-04-01
Insurance policy end date2013-03-31
Total amount of commissions paid to insurance brokerUSD $17,633
Total amount of fees paid to insurance companyUSD $2,193
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $117,555
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,633
Amount paid for insurance broker fees2193
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
Insurance broker nameCHAMPION BENEFITS APPROACH INC
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number010-031740
Policy instance 2
Insurance contract or identification number010-031740
Number of Individuals Covered829
Insurance policy start date2012-05-01
Insurance policy end date2013-03-31
Total amount of commissions paid to insurance brokerUSD $3,850
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $38,501
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,850
Insurance broker organization code?3
Insurance broker nameCHAMPION BENEFITS APPROACH INC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AL7A
Policy instance 6
Insurance contract or identification numberG000AL7A
Number of Individuals Covered413
Insurance policy start date2012-04-01
Insurance policy end date2013-03-31
Total amount of commissions paid to insurance brokerUSD $9,029
Total amount of fees paid to insurance companyUSD $1,115
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedVOLUNTARY SHORT-TERM DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $60,193
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,029
Amount paid for insurance broker fees1115
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
Insurance broker nameCHAMPION BENEFITS APPROACH INC
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00402651
Policy instance 1
Insurance contract or identification number00402651
Number of Individuals Covered569
Insurance policy start date2012-04-01
Insurance policy end date2013-03-31
Total amount of commissions paid to insurance brokerUSD $23,263
Total amount of fees paid to insurance companyUSD $5,804
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $244,876
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $21,462
Amount paid for insurance broker fees5804
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
Insurance broker nameNEIL H. PHILLIPS
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number43973
Policy instance 4
Insurance contract or identification number43973
Number of Individuals Covered707
Insurance policy start date2011-05-01
Insurance policy end date2012-03-31
Total amount of commissions paid to insurance brokerUSD $43,514
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $380,267
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number43973
Policy instance 3
Insurance contract or identification number43973
Number of Individuals Covered648
Insurance policy start date2010-05-01
Insurance policy end date2011-04-30
Total amount of commissions paid to insurance brokerUSD $49,270
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $430,561
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number010-031740
Policy instance 2
Insurance contract or identification number010-031740
Number of Individuals Covered767
Insurance policy start date2010-05-01
Insurance policy end date2011-04-30
Total amount of commissions paid to insurance brokerUSD $4,713
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $47,129
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 number00402651
Policy instance 1
Insurance contract or identification number00402651
Number of Individuals Covered548
Insurance policy start date2011-04-01
Insurance policy end date2012-03-31
Total amount of commissions paid to insurance brokerUSD $18,904
Total amount of fees paid to insurance companyUSD $6,717
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $202,026
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number43973
Policy instance 3
Insurance contract or identification number43973
Number of Individuals Covered857
Insurance policy start date2009-05-01
Insurance policy end date2010-04-30
Total amount of commissions paid to insurance brokerUSD $71,559
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $531,255
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number010-031740
Policy instance 2
Insurance contract or identification number010-031740
Number of Individuals Covered737
Insurance policy start date2009-05-01
Insurance policy end date2010-04-30
Total amount of commissions paid to insurance brokerUSD $4,366
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $43,655
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 number00402651
Policy instance 1
Insurance contract or identification number00402651
Number of Individuals Covered507
Insurance policy start date2010-04-01
Insurance policy end date2011-03-31
Total amount of commissions paid to insurance brokerUSD $15,156
Total amount of fees paid to insurance companyUSD $9,320
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $201,079
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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