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HOOVER FOODS, INC. WELFARE BENEFIT PLAN 401k Plan overview

Plan NameHOOVER FOODS, INC. WELFARE BENEFIT PLAN
Plan identification number 502

HOOVER FOODS, INC. WELFARE BENEFIT PLAN Benefits

401k Plan Type
Plan Features/Benefits

    401k Sponsoring company profile

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

    Company Name:HOOVER FOODS INC
    Employer identification number (EIN):581698517
    NAIC Classification:722300
    NAIC Description: Special Food Services

    Additional information about HOOVER FOODS INC

    Jurisdiction of Incorporation: Georgia Department of States Corporations Division
    Incorporation Date:
    Company Identification Number: 712408

    More information about HOOVER FOODS INC

    Form 5500 Filing Information

    Submission information for form 5500 for 401k plan HOOVER FOODS, INC. WELFARE BENEFIT PLAN

    Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
    5022020-08-01JULIE LANCASTER2022-01-18
    5022019-08-01JULIE LANCASTER2021-02-09
    5022018-08-01JULIE LANCASTER2020-06-23
    5022017-08-01JULIE LANCASTER2020-06-22
    5022016-08-01GLENN VARNER
    5022016-08-01JULIE LANCASTER2020-06-23
    5022015-08-01GLENN VARNER
    5022014-08-01GLENN VARNER
    5022013-08-01GLENN VARNER
    5022012-08-01GLENN VARNER
    5022011-08-01GLENN VARNER
    5022010-08-01GLENN VARNER
    5022009-08-01GLENN VARNER

    Plan Statistics for HOOVER FOODS, INC. WELFARE BENEFIT PLAN

    401k plan membership statisitcs for HOOVER FOODS, INC. WELFARE BENEFIT PLAN

    Measure Date Value
    2020: HOOVER FOODS, INC. WELFARE BENEFIT PLAN 2020 401k membership
    Total participants, beginning-of-year2020-08-01106
    Total number of active participants reported on line 7a of the Form 55002020-08-0198
    Number of retired or separated participants receiving benefits2020-08-010
    Number of other retired or separated participants entitled to future benefits2020-08-010
    Total of all active and inactive participants2020-08-0198
    Number of employers contributing to the scheme2020-08-010
    2019: HOOVER FOODS, INC. WELFARE BENEFIT PLAN 2019 401k membership
    Total participants, beginning-of-year2019-08-01173
    Total number of active participants reported on line 7a of the Form 55002019-08-01106
    Number of retired or separated participants receiving benefits2019-08-010
    Number of other retired or separated participants entitled to future benefits2019-08-010
    Total of all active and inactive participants2019-08-01106
    Number of employers contributing to the scheme2019-08-010
    2018: HOOVER FOODS, INC. WELFARE BENEFIT PLAN 2018 401k membership
    Total participants, beginning-of-year2018-08-01200
    Total number of active participants reported on line 7a of the Form 55002018-08-01171
    Number of retired or separated participants receiving benefits2018-08-012
    Number of other retired or separated participants entitled to future benefits2018-08-010
    Total of all active and inactive participants2018-08-01173
    Number of employers contributing to the scheme2018-08-010
    2017: HOOVER FOODS, INC. WELFARE BENEFIT PLAN 2017 401k membership
    Total participants, beginning-of-year2017-08-01205
    Total number of active participants reported on line 7a of the Form 55002017-08-01175
    Number of retired or separated participants receiving benefits2017-08-011
    Number of other retired or separated participants entitled to future benefits2017-08-010
    Total of all active and inactive participants2017-08-01176
    Number of employers contributing to the scheme2017-08-010
    2016: HOOVER FOODS, INC. WELFARE BENEFIT PLAN 2016 401k membership
    Total participants, beginning-of-year2016-08-01229
    Total number of active participants reported on line 7a of the Form 55002016-08-01213
    Number of retired or separated participants receiving benefits2016-08-010
    Number of other retired or separated participants entitled to future benefits2016-08-010
    Total of all active and inactive participants2016-08-01213
    Number of employers contributing to the scheme2016-08-010
    2015: HOOVER FOODS, INC. WELFARE BENEFIT PLAN 2015 401k membership
    Total participants, beginning-of-year2015-08-01218
    Total number of active participants reported on line 7a of the Form 55002015-08-01229
    Number of retired or separated participants receiving benefits2015-08-010
    Number of other retired or separated participants entitled to future benefits2015-08-010
    Total of all active and inactive participants2015-08-01229
    2014: HOOVER FOODS, INC. WELFARE BENEFIT PLAN 2014 401k membership
    Total participants, beginning-of-year2014-08-01203
    Total number of active participants reported on line 7a of the Form 55002014-08-01218
    Number of retired or separated participants receiving benefits2014-08-010
    Number of other retired or separated participants entitled to future benefits2014-08-010
    Total of all active and inactive participants2014-08-01218
    2013: HOOVER FOODS, INC. WELFARE BENEFIT PLAN 2013 401k membership
    Total participants, beginning-of-year2013-08-01179
    Total number of active participants reported on line 7a of the Form 55002013-08-01203
    Number of retired or separated participants receiving benefits2013-08-010
    Number of other retired or separated participants entitled to future benefits2013-08-010
    Total of all active and inactive participants2013-08-01203
    2012: HOOVER FOODS, INC. WELFARE BENEFIT PLAN 2012 401k membership
    Total participants, beginning-of-year2012-08-01181
    Total number of active participants reported on line 7a of the Form 55002012-08-01179
    Number of retired or separated participants receiving benefits2012-08-010
    Number of other retired or separated participants entitled to future benefits2012-08-010
    Total of all active and inactive participants2012-08-01179
    2011: HOOVER FOODS, INC. WELFARE BENEFIT PLAN 2011 401k membership
    Total participants, beginning-of-year2011-08-01163
    Total number of active participants reported on line 7a of the Form 55002011-08-01181
    Number of retired or separated participants receiving benefits2011-08-010
    Number of other retired or separated participants entitled to future benefits2011-08-010
    Total of all active and inactive participants2011-08-01181
    2010: HOOVER FOODS, INC. WELFARE BENEFIT PLAN 2010 401k membership
    Total participants, beginning-of-year2010-08-01172
    Total number of active participants reported on line 7a of the Form 55002010-08-01163
    Number of retired or separated participants receiving benefits2010-08-010
    Number of other retired or separated participants entitled to future benefits2010-08-010
    Total of all active and inactive participants2010-08-01163
    2009: HOOVER FOODS, INC. WELFARE BENEFIT PLAN 2009 401k membership
    Total participants, beginning-of-year2009-08-01168
    Total number of active participants reported on line 7a of the Form 55002009-08-01172
    Number of retired or separated participants receiving benefits2009-08-010
    Number of other retired or separated participants entitled to future benefits2009-08-010
    Total of all active and inactive participants2009-08-01172
    Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-08-010

    Form 5500 Responses for HOOVER FOODS, INC. WELFARE BENEFIT PLAN

    2020: HOOVER FOODS, INC. WELFARE BENEFIT PLAN 2020 form 5500 responses
    2020-08-01Type of plan entitySingle employer plan
    2020-08-01Plan funding arrangement – InsuranceYes
    2020-08-01Plan funding arrangement – General assets of the sponsorYes
    2020-08-01Plan benefit arrangement – InsuranceYes
    2020-08-01Plan benefit arrangement – General assets of the sponsorYes
    2019: HOOVER FOODS, INC. WELFARE BENEFIT PLAN 2019 form 5500 responses
    2019-08-01Type of plan entitySingle employer plan
    2019-08-01Plan funding arrangement – InsuranceYes
    2019-08-01Plan funding arrangement – General assets of the sponsorYes
    2019-08-01Plan benefit arrangement – InsuranceYes
    2019-08-01Plan benefit arrangement – General assets of the sponsorYes
    2018: HOOVER FOODS, INC. WELFARE BENEFIT PLAN 2018 form 5500 responses
    2018-08-01Type of plan entitySingle employer plan
    2018-08-01Plan funding arrangement – InsuranceYes
    2018-08-01Plan funding arrangement – General assets of the sponsorYes
    2018-08-01Plan benefit arrangement – InsuranceYes
    2018-08-01Plan benefit arrangement – General assets of the sponsorYes
    2017: HOOVER FOODS, INC. WELFARE BENEFIT PLAN 2017 form 5500 responses
    2017-08-01Type of plan entitySingle employer plan
    2017-08-01Plan funding arrangement – InsuranceYes
    2017-08-01Plan funding arrangement – General assets of the sponsorYes
    2017-08-01Plan benefit arrangement – InsuranceYes
    2017-08-01Plan benefit arrangement – General assets of the sponsorYes
    2016: HOOVER FOODS, INC. WELFARE BENEFIT PLAN 2016 form 5500 responses
    2016-08-01Type of plan entitySingle employer plan
    2016-08-01Submission has been amendedNo
    2016-08-01This submission is the final filingNo
    2016-08-01This return/report is a short plan year return/report (less than 12 months)No
    2016-08-01Plan is a collectively bargained planNo
    2016-08-01Plan funding arrangement – InsuranceYes
    2016-08-01Plan benefit arrangement – InsuranceYes
    2015: HOOVER FOODS, INC. WELFARE BENEFIT PLAN 2015 form 5500 responses
    2015-08-01Type of plan entitySingle employer plan
    2015-08-01Submission has been amendedNo
    2015-08-01This submission is the final filingNo
    2015-08-01This return/report is a short plan year return/report (less than 12 months)No
    2015-08-01Plan is a collectively bargained planNo
    2015-08-01Plan funding arrangement – InsuranceYes
    2015-08-01Plan benefit arrangement – InsuranceYes
    2014: HOOVER FOODS, INC. WELFARE BENEFIT PLAN 2014 form 5500 responses
    2014-08-01Type of plan entitySingle employer plan
    2014-08-01Submission has been amendedNo
    2014-08-01This submission is the final filingNo
    2014-08-01This return/report is a short plan year return/report (less than 12 months)No
    2014-08-01Plan is a collectively bargained planNo
    2014-08-01Plan funding arrangement – InsuranceYes
    2014-08-01Plan benefit arrangement – InsuranceYes
    2013: HOOVER FOODS, INC. WELFARE BENEFIT PLAN 2013 form 5500 responses
    2013-08-01Type of plan entitySingle employer plan
    2013-08-01Submission has been amendedNo
    2013-08-01This submission is the final filingNo
    2013-08-01This return/report is a short plan year return/report (less than 12 months)No
    2013-08-01Plan is a collectively bargained planNo
    2013-08-01Plan funding arrangement – InsuranceYes
    2013-08-01Plan benefit arrangement – InsuranceYes
    2012: HOOVER FOODS, INC. WELFARE BENEFIT PLAN 2012 form 5500 responses
    2012-08-01Type of plan entitySingle employer plan
    2012-08-01Submission has been amendedNo
    2012-08-01This submission is the final filingNo
    2012-08-01This return/report is a short plan year return/report (less than 12 months)No
    2012-08-01Plan is a collectively bargained planNo
    2012-08-01Plan funding arrangement – InsuranceYes
    2012-08-01Plan benefit arrangement – InsuranceYes
    2011: HOOVER FOODS, INC. WELFARE BENEFIT PLAN 2011 form 5500 responses
    2011-08-01Type of plan entitySingle employer plan
    2011-08-01Submission has been amendedNo
    2011-08-01This submission is the final filingNo
    2011-08-01This return/report is a short plan year return/report (less than 12 months)No
    2011-08-01Plan is a collectively bargained planNo
    2011-08-01Plan funding arrangement – InsuranceYes
    2011-08-01Plan benefit arrangement – InsuranceYes
    2010: HOOVER FOODS, INC. WELFARE BENEFIT PLAN 2010 form 5500 responses
    2010-08-01Type of plan entitySingle employer plan
    2010-08-01Submission has been amendedNo
    2010-08-01This submission is the final filingNo
    2010-08-01This return/report is a short plan year return/report (less than 12 months)No
    2010-08-01Plan is a collectively bargained planNo
    2010-08-01Plan funding arrangement – InsuranceYes
    2010-08-01Plan benefit arrangement – InsuranceYes
    2009: HOOVER FOODS, INC. WELFARE BENEFIT PLAN 2009 form 5500 responses
    2009-08-01Type of plan entitySingle employer plan
    2009-08-01Submission has been amendedYes
    2009-08-01This submission is the final filingNo
    2009-08-01This return/report is a short plan year return/report (less than 12 months)No
    2009-08-01Plan is a collectively bargained planNo
    2009-08-01Plan funding arrangement – InsuranceYes
    2009-08-01Plan benefit arrangement – InsuranceYes

    Insurance Providers Used on plan

    MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
    Policy contract numberGUDS0ALE5
    Policy instance 1
    Insurance contract or identification numberGUDS0ALE5
    Number of Individuals Covered98
    Insurance policy start date2020-08-01
    Insurance policy end date2021-07-31
    Total amount of commissions paid to insurance brokerUSD $8,512
    Total amount of fees paid to insurance companyUSD $2,965
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitYes
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
    Welfare Benefit Premiums Paid to CarrierUSD $85,491
    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 numberGUDSOALE5
    Policy instance 2
    Insurance contract or identification numberGUDSOALE5
    Number of Individuals Covered106
    Insurance policy start date2019-08-01
    Insurance policy end date2020-07-31
    Total amount of commissions paid to insurance brokerUSD $7,560
    Total amount of fees paid to insurance companyUSD $3,287
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
    Welfare Benefit Premiums Paid to CarrierUSD $91,121
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $7,560
    Amount paid for insurance broker fees3287
    Additional information about fees paid to insurance brokerOTHER COMPENSATION
    Insurance broker organization code?3
    HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
    Policy contract number544110
    Policy instance 1
    Insurance contract or identification number544110
    Number of Individuals Covered59
    Insurance policy start date2019-08-01
    Insurance policy end date2020-07-31
    Total amount of commissions paid to insurance brokerUSD $1,107
    Total amount of fees paid to insurance companyUSD $0
    Vision Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $11,304
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,107
    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 numberGLUGALE5
    Policy instance 2
    Insurance contract or identification numberGLUGALE5
    Number of Individuals Covered160
    Insurance policy start date2018-08-01
    Insurance policy end date2019-07-31
    Total amount of commissions paid to insurance brokerUSD $9,771
    Total amount of fees paid to insurance companyUSD $6,419
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
    Welfare Benefit Premiums Paid to CarrierUSD $122,679
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $9,771
    Amount paid for insurance broker fees6419
    Additional information about fees paid to insurance brokerOTHER COMPENSATION
    Insurance broker organization code?3
    HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
    Policy contract number544110
    Policy instance 1
    Insurance contract or identification number544110
    Number of Individuals Covered106
    Insurance policy start date2018-08-01
    Insurance policy end date2019-07-31
    Total amount of commissions paid to insurance brokerUSD $1,569
    Total amount of fees paid to insurance companyUSD $0
    Vision Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $11,674
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,569
    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 numberGLUG0ALE5
    Policy instance 2
    Insurance contract or identification numberGLUG0ALE5
    Number of Individuals Covered183
    Insurance policy start date2017-08-01
    Insurance policy end date2018-07-31
    Total amount of commissions paid to insurance brokerUSD $10,164
    Total amount of fees paid to insurance companyUSD $4,453
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
    Welfare Benefit Premiums Paid to CarrierUSD $133,486
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
    Policy contract number544110
    Policy instance 1
    Insurance contract or identification number544110
    Number of Individuals Covered120
    Insurance policy start date2017-08-01
    Insurance policy end date2018-07-31
    Total amount of commissions paid to insurance brokerUSD $1,640
    Total amount of fees paid to insurance companyUSD $0
    Vision Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $16,399
    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 numberGUPR0ALE5
    Policy instance 4
    Insurance contract or identification numberGUPR0ALE5
    Number of Individuals Covered76
    Insurance policy start date2015-08-01
    Insurance policy end date2016-07-31
    Total amount of commissions paid to insurance brokerUSD $1,360
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $13,602
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,360
    Insurance broker organization code?3
    Insurance broker nameJOHNSON AND BRYAN
    MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
    Policy contract numberGUDS0ALE5
    Policy instance 3
    Insurance contract or identification numberGUDS0ALE5
    Number of Individuals Covered191
    Insurance policy start date2015-08-01
    Insurance policy end date2016-07-31
    Total amount of commissions paid to insurance brokerUSD $3,348
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $3,348
    Insurance broker organization code?3
    Insurance broker nameJOHNSON AND BRYAN
    MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
    Policy contract numberGLUG0ALE5
    Policy instance 2
    Insurance contract or identification numberGLUG0ALE5
    Number of Individuals Covered229
    Insurance policy start date2015-08-01
    Insurance policy end date2016-07-31
    Total amount of commissions paid to insurance brokerUSD $6,336
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $6,336
    Insurance broker organization code?3
    Insurance broker nameJOHNSON AND BRYAN
    CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
    Policy contract number00609382
    Policy instance 1
    Insurance contract or identification number00609382
    Number of Individuals Covered295
    Insurance policy start date2015-08-01
    Insurance policy end date2016-07-31
    Total amount of commissions paid to insurance brokerUSD $5,000
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $249,789
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $5,000
    Insurance broker organization code?3
    Insurance broker nameJOHNSON AND BRYAN INC
    MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
    Policy contract numberGUPR0ALE5
    Policy instance 4
    Insurance contract or identification numberGUPR0ALE5
    Number of Individuals Covered72
    Insurance policy start date2014-08-01
    Insurance policy end date2015-07-31
    Total amount of commissions paid to insurance brokerUSD $1,330
    Total amount of fees paid to insurance companyUSD $315
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $13,305
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,330
    Amount paid for insurance broker fees315
    Additional information about fees paid to insurance brokerOTHER COMPENSATION
    Insurance broker organization code?3
    Insurance broker nameJOHNSON AND BRYAN
    MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
    Policy contract numberGUDS0ALE5
    Policy instance 3
    Insurance contract or identification numberGUDS0ALE5
    Number of Individuals Covered200
    Insurance policy start date2014-08-01
    Insurance policy end date2015-07-31
    Total amount of commissions paid to insurance brokerUSD $3,206
    Total amount of fees paid to insurance companyUSD $557
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $89,858
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $3,206
    Amount paid for insurance broker fees557
    Additional information about fees paid to insurance brokerOTHER COMPENSATION
    Insurance broker organization code?3
    Insurance broker nameJOHNSON AND BRYAN
    CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
    Policy contract number00609382
    Policy instance 2
    Insurance contract or identification number00609382
    Number of Individuals Covered244
    Insurance policy start date2014-08-01
    Insurance policy end date2015-07-31
    Total amount of commissions paid to insurance brokerUSD $0
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $226,266
    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 numberGLUG0ALE5
    Policy instance 1
    Insurance contract or identification numberGLUG0ALE5
    Number of Individuals Covered218
    Insurance policy start date2014-08-01
    Insurance policy end date2015-07-31
    Total amount of commissions paid to insurance brokerUSD $5,814
    Total amount of fees paid to insurance companyUSD $880
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $38,762
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $5,814
    Amount paid for insurance broker fees880
    Additional information about fees paid to insurance brokerOTHER COMPENSATION
    Insurance broker organization code?3
    Insurance broker nameJOHNSON AND BRYAN
    CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
    Policy contract number00609382
    Policy instance 2
    Insurance contract or identification number00609382
    Number of Individuals Covered310
    Insurance policy start date2013-08-01
    Insurance policy end date2014-07-31
    Total amount of commissions paid to insurance brokerUSD $0
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $177,268
    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 numberGLUG0ALE5
    Policy instance 1
    Insurance contract or identification numberGLUG0ALE5
    Number of Individuals Covered217
    Insurance policy start date2013-08-01
    Insurance policy end date2014-07-31
    Total amount of commissions paid to insurance brokerUSD $4,977
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $33,177
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $4,977
    Insurance broker organization code?3
    Insurance broker nameJOHNSON AND BRYAN
    MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
    Policy contract numberGUDS0ALE5
    Policy instance 3
    Insurance contract or identification numberGUDS0ALE5
    Number of Individuals Covered203
    Insurance policy start date2013-08-01
    Insurance policy end date2014-07-31
    Total amount of commissions paid to insurance brokerUSD $3,448
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $89,485
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $3,448
    Insurance broker organization code?3
    Insurance broker nameJOHNSON AND BRYAN
    MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
    Policy contract numberGUPR0ALE5
    Policy instance 4
    Insurance contract or identification numberGUPR0ALE5
    Number of Individuals Covered81
    Insurance policy start date2013-08-01
    Insurance policy end date2014-07-31
    Total amount of commissions paid to insurance brokerUSD $1,175
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $11,750
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,175
    Insurance broker organization code?3
    Insurance broker nameJOHNSON AND BRYAN
    MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
    Policy contract numberGUDS0ALE5
    Policy instance 3
    Insurance contract or identification numberGUDS0ALE5
    Number of Individuals Covered156
    Insurance policy start date2012-08-01
    Insurance policy end date2013-07-31
    Total amount of commissions paid to insurance brokerUSD $2,955
    Total amount of fees paid to insurance companyUSD $208
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $44,354
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $2,955
    Amount paid for insurance broker fees208
    Additional information about fees paid to insurance brokerFEES PAID
    Insurance broker organization code?3
    Insurance broker nameJOHNSON AND BRYAN
    MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
    Policy contract numberGUPR0ALE5
    Policy instance 4
    Insurance contract or identification numberGUPR0ALE5
    Number of Individuals Covered65
    Insurance policy start date2012-08-01
    Insurance policy end date2013-07-31
    Total amount of commissions paid to insurance brokerUSD $994
    Total amount of fees paid to insurance companyUSD $149
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $9,940
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $994
    Amount paid for insurance broker fees149
    Additional information about fees paid to insurance brokerFEES PAID
    Insurance broker organization code?3
    Insurance broker nameJOHNSON AND BRYAN
    HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
    Policy contract number544110
    Policy instance 2
    Insurance contract or identification number544110
    Number of Individuals Covered179
    Insurance policy start date2012-08-01
    Insurance policy end date2013-07-31
    Total amount of commissions paid to insurance brokerUSD $46,459
    Total amount of fees paid to insurance companyUSD $4,759
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitYes
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $1,016,379
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $46,459
    Amount paid for insurance broker fees4759
    Additional information about fees paid to insurance brokerFEES PAID
    Insurance broker organization code?3
    Insurance broker nameJOHNSON AND BRYAN INC
    MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
    Policy contract numberGLUG0ALE5
    Policy instance 1
    Insurance contract or identification numberGLUG0ALE5
    Number of Individuals Covered173
    Insurance policy start date2012-08-01
    Insurance policy end date2013-07-31
    Total amount of commissions paid to insurance brokerUSD $4,280
    Total amount of fees paid to insurance companyUSD $415
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $28,534
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $4,280
    Amount paid for insurance broker fees415
    Additional information about fees paid to insurance brokerFEES PAID
    Insurance broker organization code?3
    Insurance broker nameJOHNSON AND BRYAN
    RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
    Policy contract numberVPL300025
    Policy instance 3
    Insurance contract or identification numberVPL300025
    Number of Individuals Covered57
    Insurance policy start date2011-08-01
    Insurance policy end date2012-07-31
    Total amount of commissions paid to insurance brokerUSD $937
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $6,831
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
    Policy contract number544110
    Policy instance 1
    Insurance contract or identification number544110
    Number of Individuals Covered181
    Insurance policy start date2011-08-01
    Insurance policy end date2012-07-31
    Total amount of commissions paid to insurance brokerUSD $63,506
    Total amount of fees paid to insurance companyUSD $7,004
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitYes
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $1,013,377
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
    Policy contract numberGL147488
    Policy instance 2
    Insurance contract or identification numberGL147488
    Number of Individuals Covered178
    Insurance policy start date2011-08-01
    Insurance policy end date2012-07-31
    Total amount of commissions paid to insurance brokerUSD $2,254
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $21,934
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
    Policy contract numberGL147488
    Policy instance 2
    Insurance contract or identification numberGL147488
    Number of Individuals Covered163
    Insurance policy start date2010-08-01
    Insurance policy end date2011-07-31
    Total amount of commissions paid to insurance brokerUSD $2,686
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $26,856
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
    Policy contract number544110
    Policy instance 1
    Insurance contract or identification number544110
    Number of Individuals Covered144
    Insurance policy start date2010-08-01
    Insurance policy end date2011-07-31
    Total amount of commissions paid to insurance brokerUSD $44,961
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitYes
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $888,089
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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