PHOENIX AIR GROUP, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan PHOENIX AIR GROUP PRE TAX PREMIUM PLAN
EAP CONSULTANTS, LLC (National Association of Insurance Commissioners NAIC id number: 62419 ) |
Policy contract number | 8329 |
Policy instance | 2 |
Insurance contract or identification number | 8329 | Number of Individuals Covered | 314 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | EMPLOYEE ASSISTANCE PROGRAM | Welfare Benefit Premiums Paid to Carrier | USD $5,652 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GLUG0ADD1 |
Policy instance | 5 |
Insurance contract or identification number | GLUG0ADD1 | Number of Individuals Covered | 295 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $44,767 | Total amount of fees paid to insurance company | USD $20,320 | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $272,552 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $33,835 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Additional information about fees paid to insurance broker | OTHER COMPENSATION |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 ) |
Policy contract number | 30040631 |
Policy instance | 4 |
Insurance contract or identification number | 30040631 | Number of Individuals Covered | 203 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $1,253 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $24,821 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,253 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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FLEXCARE, LLC (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | GRSPAG |
Policy instance | 3 |
Insurance contract or identification number | GRSPAG | Number of Individuals Covered | 64 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | TELEHEALTH | Welfare Benefit Premiums Paid to Carrier | USD $5,944 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
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UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 8329 |
Policy instance | 2 |
Insurance contract or identification number | 8329 | Number of Individuals Covered | 295 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | EMPLOYEE ASSISTANCE PROGRAM | Welfare Benefit Premiums Paid to Carrier | USD $0 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
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BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 ) |
Policy contract number | GA6095 |
Policy instance | 1 |
Insurance contract or identification number | GA6095 | Number of Individuals Covered | 523 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $121,555 | Total amount of fees paid to insurance company | USD $2,721 | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $3,892,855 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $121,555 | Amount paid for insurance broker fees | 2721 | Additional information about fees paid to insurance broker | FEES | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000ADD1 |
Policy instance | 3 |
Insurance contract or identification number | G000ADD1 | Number of Individuals Covered | 147 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $11,710 | Total amount of fees paid to insurance company | USD $2,104 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $78,068 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $11,710 | Amount paid for insurance broker fees | 2104 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GUPR0ADD1 |
Policy instance | 4 |
Insurance contract or identification number | GUPR0ADD1 | Number of Individuals Covered | 107 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $14,503 | Total amount of fees paid to insurance company | USD $1,808 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $72,515 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $14,503 | Amount paid for insurance broker fees | 1808 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GUDS0ADD1 |
Policy instance | 5 |
Insurance contract or identification number | GUDS0ADD1 | Number of Individuals Covered | 0 | 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 $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $36 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $0 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 ) |
Policy contract number | GA6095 |
Policy instance | 6 |
Insurance contract or identification number | GA6095 | Number of Individuals Covered | 496 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $127,006 | Total amount of fees paid to insurance company | USD $3,443 | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $4,155,803 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $127,006 | Amount paid for insurance broker fees | 3443 | Additional information about fees paid to insurance broker | BONUS | Insurance broker organization code? | 3 |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 ) |
Policy contract number | 30040631 |
Policy instance | 7 |
Insurance contract or identification number | 30040631 | Number of Individuals Covered | 195 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $1,282 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $25,671 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,282 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GVTL0ADD1 |
Policy instance | 1 |
Insurance contract or identification number | GVTL0ADD1 | Number of Individuals Covered | 149 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $15,233 | Total amount of fees paid to insurance company | USD $2,603 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | VOLUNTARY LIFE | Welfare Benefit Premiums Paid to Carrier | USD $101,551 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $15,233 | Amount paid for insurance broker fees | 2603 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | 470322111 |
Policy instance | 2 |
Insurance contract or identification number | 470322111 | Number of Individuals Covered | 281 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $2,262 | Total amount of fees paid to insurance company | USD $390 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $15,080 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,262 | Amount paid for insurance broker fees | 390 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GVTL0ADD1 |
Policy instance | 1 |
Insurance contract or identification number | GVTL0ADD1 | Number of Individuals Covered | 155 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $13,835 | Total amount of fees paid to insurance company | USD $2,667 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | VOLUNTARY LIFE | Welfare Benefit Premiums Paid to Carrier | USD $92,234 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $13,835 | Amount paid for insurance broker fees | 2667 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
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BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 ) |
Policy contract number | GA6095 |
Policy instance | 2 |
Insurance contract or identification number | GA6095 | Number of Individuals Covered | 512 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $113,392 | Total amount of fees paid to insurance company | USD $5,080 | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $2,911,210 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $113,392 | Amount paid for insurance broker fees | 5080 | Additional information about fees paid to insurance broker | BONUS | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | 470322111 |
Policy instance | 3 |
Insurance contract or identification number | 470322111 | Number of Individuals Covered | 287 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $2,065 | Total amount of fees paid to insurance company | USD $408 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $13,766 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,065 | Amount paid for insurance broker fees | 408 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GUDS0ADD1 |
Policy instance | 4 |
Insurance contract or identification number | GUDS0ADD1 | Number of Individuals Covered | 0 | 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 $841 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $457 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $0 | Amount paid for insurance broker fees | 841 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 ) |
Policy contract number | 30040631 |
Policy instance | 5 |
Insurance contract or identification number | 30040631 | Number of Individuals Covered | 190 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $1,195 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $22,756 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,195 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GUPR0ADD1 |
Policy instance | 6 |
Insurance contract or identification number | GUPR0ADD1 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $12,640 | Total amount of fees paid to insurance company | USD $1,806 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $63,201 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $12,640 | Amount paid for insurance broker fees | 1806 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000ADD1 |
Policy instance | 7 |
Insurance contract or identification number | G000ADD1 | Number of Individuals Covered | 153 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $11,116 | Total amount of fees paid to insurance company | USD $2,169 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $74,108 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $11,116 | Amount paid for insurance broker fees | 2169 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | 470322111 |
Policy instance | 1 |
Insurance contract or identification number | 470322111 | Number of Individuals Covered | 259 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $1,903 | Total amount of fees paid to insurance company | USD $699 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $12,684 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,903 | Amount paid for insurance broker fees | 699 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
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BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 ) |
Policy contract number | GA6095 |
Policy instance | 2 |
Insurance contract or identification number | GA6095 | Number of Individuals Covered | 421 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $90,956 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $2,977,413 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $90,956 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 ) |
Policy contract number | 30040631 |
Policy instance | 3 |
Insurance contract or identification number | 30040631 | Number of Individuals Covered | 162 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $1,132 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $20,525 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,132 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GUDS0ADD1 |
Policy instance | 4 |
Insurance contract or identification number | GUDS0ADD1 | Number of Individuals Covered | 202 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $4,980 | Total amount of fees paid to insurance company | USD $6,599 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $166,015 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,980 | Amount paid for insurance broker fees | 6599 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GUPR0ADD1 |
Policy instance | 5 |
Insurance contract or identification number | GUPR0ADD1 | Number of Individuals Covered | 88 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $9,998 | Total amount of fees paid to insurance company | USD $2,663 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $49,988 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $9,998 | Amount paid for insurance broker fees | 2663 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GVTL0ADD1 |
Policy instance | 6 |
Insurance contract or identification number | GVTL0ADD1 | Number of Individuals Covered | 132 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $10,949 | Total amount of fees paid to insurance company | USD $3,886 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | VOLUNTARY LIFE | Welfare Benefit Premiums Paid to Carrier | USD $72,994 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $10,949 | Amount paid for insurance broker fees | 3886 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000ADD1 |
Policy instance | 7 |
Insurance contract or identification number | G000ADD1 | Number of Individuals Covered | 136 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $10,000 | Total amount of fees paid to insurance company | USD $3,700 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $66,670 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $10,000 | Amount paid for insurance broker fees | 3700 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
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BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 ) |
Policy contract number | GA6095 |
Policy instance | 1 |
Insurance contract or identification number | GA6095 | Number of Individuals Covered | 395 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $80,466 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $2,760,827 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $80,466 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000ADD1 |
Policy instance | 2 |
Insurance contract or identification number | G000ADD1 | Number of Individuals Covered | 125 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $9,382 | Total amount of fees paid to insurance company | USD $2,493 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $62,544 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $9,382 | Amount paid for insurance broker fees | 2493 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 ) |
Policy contract number | 30040631 |
Policy instance | 3 |
Insurance contract or identification number | 30040631 | Number of Individuals Covered | 143 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $1,102 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $18,635 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,102 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GVTL0ADD1 |
Policy instance | 4 |
Insurance contract or identification number | GVTL0ADD1 | Number of Individuals Covered | 107 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $9,625 | Total amount of fees paid to insurance company | USD $2,571 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | VOLUNTARY LIFE | Welfare Benefit Premiums Paid to Carrier | USD $64,167 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $9,625 | Amount paid for insurance broker fees | 2571 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | 470322111 |
Policy instance | 5 |
Insurance contract or identification number | 470322111 | Number of Individuals Covered | 230 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $1,759 | Total amount of fees paid to insurance company | USD $469 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $11,728 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,759 | Amount paid for insurance broker fees | 469 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GUPR0ADD1 |
Policy instance | 6 |
Insurance contract or identification number | GUPR0ADD1 | Number of Individuals Covered | 75 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $8,595 | Total amount of fees paid to insurance company | USD $1,505 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $42,977 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8,595 | Amount paid for insurance broker fees | 1505 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GUDS0ADD1 |
Policy instance | 7 |
Insurance contract or identification number | GUDS0ADD1 | Number of Individuals Covered | 188 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $4,847 | Total amount of fees paid to insurance company | USD $2,946 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $161,571 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,847 | Amount paid for insurance broker fees | 2946 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GUPR0ADD1 |
Policy instance | 7 |
Insurance contract or identification number | GUPR0ADD1 | Number of Individuals Covered | 68 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $6,599 | Total amount of fees paid to insurance company | USD $1,002 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $32,997 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,599 | Amount paid for insurance broker fees | 1002 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | NORTHWESTERN BENEFIT CORP OF GA |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GVTL0ADD1 |
Policy instance | 6 |
Insurance contract or identification number | GVTL0ADD1 | Number of Individuals Covered | 104 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $8,456 | Total amount of fees paid to insurance company | USD $1,777 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | VOLUNTARY LIFE | Welfare Benefit Premiums Paid to Carrier | USD $56,377 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8,456 | Amount paid for insurance broker fees | 1777 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | NORTHWESTERN BENEFIT CORP OF GA |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 ) |
Policy contract number | 30040631 |
Policy instance | 5 |
Insurance contract or identification number | 30040631 | Number of Individuals Covered | 129 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $900 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $15,882 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $900 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Insurance broker name | NORTHWESTERN BENEFIT CORP OF GA |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GLUG0ADD1 |
Policy instance | 4 |
Insurance contract or identification number | GLUG0ADD1 | Number of Individuals Covered | 212 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $1,549 | Total amount of fees paid to insurance company | USD $305 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $10,328 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,549 | Amount paid for insurance broker fees | 305 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | NORTHWESTERN BENEFIT CORP OF GA |
|
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GUDS0ADD1 |
Policy instance | 3 |
Insurance contract or identification number | GUDS0ADD1 | Number of Individuals Covered | 174 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $3,886 | Total amount of fees paid to insurance company | USD $1,061 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $129,543 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,886 | Amount paid for insurance broker fees | 1061 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | NORTHWESTERN BENEFIT CORP OF GA |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GUC0ADD1 |
Policy instance | 2 |
Insurance contract or identification number | GUC0ADD1 | Number of Individuals Covered | 118 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $8,256 | Total amount of fees paid to insurance company | USD $1,956 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $55,041 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8,256 | Amount paid for insurance broker fees | 1956 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | NORTHWESTERN BENEFIT CORP OF GA |
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BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 ) |
Policy contract number | GA6095 |
Policy instance | 1 |
Insurance contract or identification number | GA6095 | Number of Individuals Covered | 391 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $80,913 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $2,273,296 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $80,913 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Insurance broker name | NORTHWESTERN BENEFIT CORP OF GA |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 ) |
Policy contract number | 30040631 |
Policy instance | 8 |
Insurance contract or identification number | 30040631 | Number of Individuals Covered | 100 | Insurance policy start date | 2015-07-01 | Insurance policy end date | 2015-12-31 | Total amount of commissions paid to insurance broker | USD $577 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $6,546 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $577 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Insurance broker name | NORTHWESTERN BENEFIT CORP OF GA |
|
BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 ) |
Policy contract number | GA6095 |
Policy instance | 7 |
Insurance contract or identification number | GA6095 | Number of Individuals Covered | 347 | Insurance policy start date | 2015-07-01 | Insurance policy end date | 2015-12-31 | Total amount of commissions paid to insurance broker | USD $29,723 | Total amount of fees paid to insurance company | USD $972 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $861,788 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $23,705 | Amount paid for insurance broker fees | 972 | Insurance broker organization code? | 3 | Insurance broker name | LOCKTON COMPANIES LLC |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GLUG0ADD1 |
Policy instance | 6 |
Insurance contract or identification number | GLUG0ADD1 | Number of Individuals Covered | 147 | Insurance policy start date | 2014-07-01 | Insurance policy end date | 2015-06-30 | Total amount of commissions paid to insurance broker | USD $1,140 | Total amount of fees paid to insurance company | USD $300 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $7,601 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,140 | Amount paid for insurance broker fees | 300 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | NORTHWESTERN BENEFIT CORP OF GA |
|
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GUC0ADD1 |
Policy instance | 4 |
Insurance contract or identification number | GUC0ADD1 | Number of Individuals Covered | 104 | Insurance policy start date | 2014-07-01 | Insurance policy end date | 2015-06-30 | Total amount of commissions paid to insurance broker | USD $7,531 | Total amount of fees paid to insurance company | USD $1,998 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $50,209 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,531 | Amount paid for insurance broker fees | 1998 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | NORTHWESTERN BENEFIT CORP OF GA |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GVTL0ADD1 |
Policy instance | 3 |
Insurance contract or identification number | GVTL0ADD1 | Number of Individuals Covered | 83 | Insurance policy start date | 2015-07-01 | Insurance policy end date | 2015-12-31 | Total amount of commissions paid to insurance broker | USD $3,167 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | VOLUNTARY LIFE | Welfare Benefit Premiums Paid to Carrier | USD $21,113 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,167 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Insurance broker name | NORTHWESTERN BENEFIT CORP OF GA |
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BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 ) |
Policy contract number | GA6095 |
Policy instance | 2 |
Insurance contract or identification number | GA6095 | Number of Individuals Covered | 352 | Insurance policy start date | 2014-07-01 | Insurance policy end date | 2015-06-30 | Total amount of commissions paid to insurance broker | USD $76,192 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,999,857 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $76,192 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Insurance broker name | NORTHWESTERN BENEFIT CORP OF GA |
|
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GUDS0ADD1 |
Policy instance | 1 |
Insurance contract or identification number | GUDS0ADD1 | Number of Individuals Covered | 147 | Insurance policy start date | 2015-07-01 | Insurance policy end date | 2015-12-31 | Total amount of commissions paid to insurance broker | USD $1,625 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $54,155 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,625 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Insurance broker name | NORTHWESTERN BENEFIT CORP OF GA |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GVTL0ADD1 |
Policy instance | 9 |
Insurance contract or identification number | GVTL0ADD1 | Number of Individuals Covered | 81 | Insurance policy start date | 2014-07-01 | Insurance policy end date | 2015-06-30 | Total amount of commissions paid to insurance broker | USD $6,164 | Total amount of fees paid to insurance company | USD $1,680 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | VOLUNTARY LIFE | Welfare Benefit Premiums Paid to Carrier | USD $41,091 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,164 | Amount paid for insurance broker fees | 1680 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | NORTHWESTERN BENEFIT CORP OF GA |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GLUG0ADD1 |
Policy instance | 10 |
Insurance contract or identification number | GLUG0ADD1 | Number of Individuals Covered | 146 | Insurance policy start date | 2015-07-01 | Insurance policy end date | 2015-12-31 | Total amount of commissions paid to insurance broker | USD $573 | 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 $3,819 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $573 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Insurance broker name | NORTHWESTERN BENEFIT CORP OF GA |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GUPR0ADD1 |
Policy instance | 11 |
Insurance contract or identification number | GUPR0ADD1 | Number of Individuals Covered | 45 | Insurance policy start date | 2015-07-01 | Insurance policy end date | 2015-12-31 | Total amount of commissions paid to insurance broker | USD $2,315 | Total amount of fees paid to insurance company | USD $0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $11,573 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,315 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Insurance broker name | NORTHWESTERN BENEFIT CORP OF GA |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 ) |
Policy contract number | 30040631 |
Policy instance | 5 |
Insurance contract or identification number | 30040631 | Number of Individuals Covered | 103 | Insurance policy start date | 2014-07-01 | Insurance policy end date | 2015-06-30 | Total amount of commissions paid to insurance broker | USD $873 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $13,442 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $873 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Insurance broker name | NORTHWESTERN BENEFIT CORP OF GA |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GUC 0ADD1 |
Policy instance | 12 |
Insurance contract or identification number | GUC 0ADD1 | Number of Individuals Covered | 100 | Insurance policy start date | 2015-07-01 | Insurance policy end date | 2015-12-31 | Total amount of commissions paid to insurance broker | USD $3,616 | Total amount of fees paid to insurance company | USD $0 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $24,106 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,616 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Insurance broker name | NORTHWESTERN BENEFIT CORP OF GA |
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AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | AV779 |
Policy instance | 5 |
Insurance contract or identification number | AV779 | Number of Individuals Covered | 38 | Insurance policy start date | 2013-07-01 | Insurance policy end date | 2014-06-30 | Total amount of commissions paid to insurance broker | USD $10,175 | Total amount of fees paid to insurance company | USD $0 | Commission paid to Insurance Broker | USD $3,068 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Insurance broker name | RAYMOND L MELVIN |
|
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GVTL0ADD1 |
Policy instance | 1 |
Insurance contract or identification number | GVTL0ADD1 | Number of Individuals Covered | 81 | Insurance policy start date | 2013-07-01 | Insurance policy end date | 2014-06-30 | Total amount of commissions paid to insurance broker | USD $6,329 | Total amount of fees paid to insurance company | USD $1,113 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | VOLUNTARY LIFE | Welfare Benefit Premiums Paid to Carrier | USD $42,194 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,329 | Amount paid for insurance broker fees | 1113 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | NORTHWESTERN BENEFIT CORP OF GA |
|
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GUC 0ADD1 |
Policy instance | 2 |
Insurance contract or identification number | GUC 0ADD1 | Number of Individuals Covered | 103 | Insurance policy start date | 2013-07-01 | Insurance policy end date | 2014-06-30 | Total amount of commissions paid to insurance broker | USD $7,446 | Total amount of fees paid to insurance company | USD $1,304 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $49,639 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,446 | Amount paid for insurance broker fees | 1304 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | NORTHWESTERN BENEFIT CORP OF GA |
|
BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 ) |
Policy contract number | GA6095 |
Policy instance | 3 |
Insurance contract or identification number | GA6095 | Number of Individuals Covered | 349 | Insurance policy start date | 2013-07-01 | Insurance policy end date | 2014-06-30 | Total amount of commissions paid to insurance broker | USD $74,781 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,625,389 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $74,781 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Insurance broker name | NORTHWESTERN BENEFIT CORP OF GA |
|
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GLUG0ADD1 |
Policy instance | 4 |
Insurance contract or identification number | GLUG0ADD1 | Number of Individuals Covered | 142 | Insurance policy start date | 2013-07-01 | Insurance policy end date | 2014-06-30 | Total amount of commissions paid to insurance broker | USD $1,094 | Total amount of fees paid to insurance company | USD $189 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $7,295 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,094 | Amount paid for insurance broker fees | 189 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | NORTHWESTERN BENEFIT CORP OF GA |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 ) |
Policy contract number | 30040631 |
Policy instance | 6 |
Insurance contract or identification number | 30040631 | Number of Individuals Covered | 105 | Insurance policy start date | 2013-07-01 | Insurance policy end date | 2014-06-30 | Total amount of commissions paid to insurance broker | USD $873 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $13,460 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $873 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Insurance broker name | NORTHWESTERN BENEFIT CORP OF GA |
|
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | AV779 |
Policy instance | 3 |
Insurance contract or identification number | AV779 | Number of Individuals Covered | 45 | Insurance policy start date | 2012-07-01 | Insurance policy end date | 2013-06-30 | Total amount of commissions paid to insurance broker | USD $7,682 | Other welfare benefits provided | VOLUNTARY SPECIFIED | Welfare Benefit Premiums Paid to Carrier | USD $53,589 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,535 | Insurance broker organization code? | 3 | Insurance broker name | MARK S LEE |
|
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000ADD1 |
Policy instance | 1 |
Insurance contract or identification number | G000ADD1 | Number of Individuals Covered | 150 | Insurance policy start date | 2012-07-01 | Insurance policy end date | 2013-07-01 | Total amount of commissions paid to insurance broker | USD $16,608 | Total amount of fees paid to insurance company | USD $2,539 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $110,723 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,066 | Amount paid for insurance broker fees | 1079 | Additional information about fees paid to insurance broker | AGENT OF RECORD | Insurance broker organization code? | 3 | Insurance broker name | NORTHWESTERN BENEFIT CORP OF GA |
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BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 ) |
Policy contract number | 1031793000 |
Policy instance | 2 |
Insurance contract or identification number | 1031793000 | Number of Individuals Covered | 358 | Insurance policy start date | 2012-07-01 | Insurance policy end date | 2013-06-30 | Total amount of commissions paid to insurance broker | USD $140,470 | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,530,432 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $80,260 | Insurance broker organization code? | 3 | Insurance broker name | NORTHWESTERN BENEFIT CORP OF GA |
|
BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 ) |
Policy contract number | 1031793000 |
Policy instance | 2 |
Insurance contract or identification number | 1031793000 | Number of Individuals Covered | 348 | Insurance policy start date | 2011-07-01 | Insurance policy end date | 2012-06-30 | Total amount of commissions paid to insurance broker | USD $78,267 | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,576,227 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $78,267 | Insurance broker organization code? | 3 | Insurance broker name | NORTHWESTERN BENEFIT |
|
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | AV779 |
Policy instance | 3 |
Insurance contract or identification number | AV779 | Number of Individuals Covered | 45 | Insurance policy start date | 2011-07-01 | Insurance policy end date | 2012-06-30 | Total amount of commissions paid to insurance broker | USD $10,804 | Total amount of fees paid to insurance company | USD $642 | Other welfare benefits provided | VOLUNTARY SPECIFIED | Welfare Benefit Premiums Paid to Carrier | USD $58,932 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,798 | Amount paid for insurance broker fees | 321 | Insurance broker organization code? | 3 | Insurance broker name | DORIS BRACKETT |
|
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000ADD1 |
Policy instance | 1 |
Insurance contract or identification number | G000ADD1 | Number of Individuals Covered | 151 | Insurance policy start date | 2011-07-01 | Insurance policy end date | 2012-07-01 | Total amount of commissions paid to insurance broker | USD $18,930 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $114,171 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $18,930 | Insurance broker organization code? | 3 | Insurance broker name | NORTHWESTERN BENEFIT |
|
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | AV779 |
Policy instance | 3 |
Insurance contract or identification number | AV779 | Number of Individuals Covered | 46 | Insurance policy start date | 2011-07-01 | Insurance policy end date | 2012-06-30 | Total amount of commissions paid to insurance broker | USD $10,804 | Total amount of fees paid to insurance company | USD $642 | Other welfare benefits provided | VOLUNTARY SPECIFIED | Welfare Benefit Premiums Paid to Carrier | USD $58,932 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 ) |
Policy contract number | 1031793000 |
Policy instance | 1 |
Insurance contract or identification number | 1031793000 | Number of Individuals Covered | 348 | Insurance policy start date | 2011-07-01 | Insurance policy end date | 2012-06-30 | Total amount of commissions paid to insurance broker | USD $78,267 | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,576,227 | 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 | G000ADD1 |
Policy instance | 2 |
Insurance contract or identification number | G000ADD1 | Number of Individuals Covered | 151 | Insurance policy start date | 2011-07-01 | Insurance policy end date | 2012-07-01 | Total amount of commissions paid to insurance broker | USD $18,930 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $114,171 | 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 | G000ADD1 |
Policy instance | 2 |
Insurance contract or identification number | G000ADD1 | Number of Individuals Covered | 153 | Insurance policy start date | 2010-07-01 | Insurance policy end date | 2011-07-01 | Total amount of commissions paid to insurance broker | USD $16,359 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $109,060 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | AV779 |
Policy instance | 3 |
Insurance contract or identification number | AV779 | Number of Individuals Covered | 49 | Insurance policy start date | 2010-07-01 | Insurance policy end date | 2011-06-30 | Total amount of commissions paid to insurance broker | USD $11,421 | Total amount of fees paid to insurance company | USD $341 | Other welfare benefits provided | VOLUNTARY SPECIFIED | Welfare Benefit Premiums Paid to Carrier | USD $52,205 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 ) |
Policy contract number | 1031793000 |
Policy instance | 1 |
Insurance contract or identification number | 1031793000 | Number of Individuals Covered | 335 | Insurance policy start date | 2010-07-01 | Insurance policy end date | 2011-06-30 | Total amount of commissions paid to insurance broker | USD $74,939 | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,503,955 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|