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LIFE MANAGEMENT OF NORTHWEST FLORIDA GROUP INSURANCE PLAN 401k Plan overview

Plan NameLIFE MANAGEMENT OF NORTHWEST FLORIDA GROUP INSURANCE PLAN
Plan identification number 501

LIFE MANAGEMENT OF NORTHWEST FLORIDA GROUP INSURANCE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)

401k Sponsoring company profile

LIFE MANAGEMENT CENTER OF NORTHWEST FLORIDA, INC. has sponsored the creation of one or more 401k plans.

Company Name:LIFE MANAGEMENT CENTER OF NORTHWEST FLORIDA, INC.
Employer identification number (EIN):591375195
NAIC Classification:621420
NAIC Description:Outpatient Mental Health and Substance Abuse Centers

Additional information about LIFE MANAGEMENT CENTER OF NORTHWEST FLORIDA, INC.

Jurisdiction of Incorporation: Florida Department of State Division of Corporations
Incorporation Date: 1971-09-21
Company Identification Number: 721746
Legal Registered Office Address: 525 EAST 15TH ST

PANAMA CITY

32405

More information about LIFE MANAGEMENT CENTER OF NORTHWEST FLORIDA, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LIFE MANAGEMENT OF NORTHWEST FLORIDA GROUP INSURANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012021-01-01EDWIN R. AILES2022-10-25 EDWIN R. AILES2022-10-25
5012020-01-01EDWIN R. AILES2021-10-12 EDWIN R. AILES2021-10-12
5012019-02-01EDWIN R. AILES2021-01-14 EDWIN R. AILES2021-01-14
5012018-02-01EDWIN R. AILES2019-11-14 EDWIN R. AILES2019-11-14
5012017-02-01
5012016-02-01
5012015-02-01
5012014-02-01
5012013-02-01
5012012-02-01EDWIN R. AILES EDWIN R. AILES2013-08-27
5012011-02-01EDWIN R. AILES EDWIN R. AILES2012-08-16
5012010-02-01EDWIN R. AILES EDWIN R. AILES2011-08-11
5012009-02-01WESLEY ALLEN BERRY WESLEY ALLEN BERRY2010-08-05

Plan Statistics for LIFE MANAGEMENT OF NORTHWEST FLORIDA GROUP INSURANCE PLAN

401k plan membership statisitcs for LIFE MANAGEMENT OF NORTHWEST FLORIDA GROUP INSURANCE PLAN

Measure Date Value
2021: LIFE MANAGEMENT OF NORTHWEST FLORIDA GROUP INSURANCE PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01220
Total number of active participants reported on line 7a of the Form 55002021-01-01186
Total of all active and inactive participants2021-01-01186
2020: LIFE MANAGEMENT OF NORTHWEST FLORIDA GROUP INSURANCE PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01226
Total number of active participants reported on line 7a of the Form 55002020-01-01220
Total of all active and inactive participants2020-01-01220
2019: LIFE MANAGEMENT OF NORTHWEST FLORIDA GROUP INSURANCE PLAN 2019 401k membership
Total participants, beginning-of-year2019-02-01226
Total number of active participants reported on line 7a of the Form 55002019-02-01246
Total of all active and inactive participants2019-02-01246
2018: LIFE MANAGEMENT OF NORTHWEST FLORIDA GROUP INSURANCE PLAN 2018 401k membership
Total participants, beginning-of-year2018-02-01225
Total number of active participants reported on line 7a of the Form 55002018-02-01226
Total of all active and inactive participants2018-02-01226
2017: LIFE MANAGEMENT OF NORTHWEST FLORIDA GROUP INSURANCE PLAN 2017 401k membership
Total participants, beginning-of-year2017-02-01236
Total number of active participants reported on line 7a of the Form 55002017-02-01225
Total of all active and inactive participants2017-02-01225
2016: LIFE MANAGEMENT OF NORTHWEST FLORIDA GROUP INSURANCE PLAN 2016 401k membership
Total participants, beginning-of-year2016-02-01222
Total number of active participants reported on line 7a of the Form 55002016-02-01236
Number of retired or separated participants receiving benefits2016-02-010
Number of other retired or separated participants entitled to future benefits2016-02-010
Total of all active and inactive participants2016-02-01236
2015: LIFE MANAGEMENT OF NORTHWEST FLORIDA GROUP INSURANCE PLAN 2015 401k membership
Total participants, beginning-of-year2015-02-01227
Total number of active participants reported on line 7a of the Form 55002015-02-01222
Number of other retired or separated participants entitled to future benefits2015-02-010
Total of all active and inactive participants2015-02-01222
2014: LIFE MANAGEMENT OF NORTHWEST FLORIDA GROUP INSURANCE PLAN 2014 401k membership
Total participants, beginning-of-year2014-02-01227
Total number of active participants reported on line 7a of the Form 55002014-02-01227
Number of retired or separated participants receiving benefits2014-02-010
Number of other retired or separated participants entitled to future benefits2014-02-010
Total of all active and inactive participants2014-02-01227
2013: LIFE MANAGEMENT OF NORTHWEST FLORIDA GROUP INSURANCE PLAN 2013 401k membership
Total participants, beginning-of-year2013-02-01203
Total number of active participants reported on line 7a of the Form 55002013-02-01211
Total of all active and inactive participants2013-02-01211
2012: LIFE MANAGEMENT OF NORTHWEST FLORIDA GROUP INSURANCE PLAN 2012 401k membership
Total participants, beginning-of-year2012-02-01140
Total number of active participants reported on line 7a of the Form 55002012-02-01203
Total of all active and inactive participants2012-02-01203
2011: LIFE MANAGEMENT OF NORTHWEST FLORIDA GROUP INSURANCE PLAN 2011 401k membership
Total participants, beginning-of-year2011-02-01130
Total number of active participants reported on line 7a of the Form 55002011-02-01140
Total of all active and inactive participants2011-02-01140
2010: LIFE MANAGEMENT OF NORTHWEST FLORIDA GROUP INSURANCE PLAN 2010 401k membership
Total participants, beginning-of-year2010-02-01127
Total number of active participants reported on line 7a of the Form 55002010-02-01130
Total of all active and inactive participants2010-02-01130
2009: LIFE MANAGEMENT OF NORTHWEST FLORIDA GROUP INSURANCE PLAN 2009 401k membership
Total participants, beginning-of-year2009-02-01132
Total number of active participants reported on line 7a of the Form 55002009-02-01127
Total of all active and inactive participants2009-02-01127
Total participants2009-02-010

Form 5500 Responses for LIFE MANAGEMENT OF NORTHWEST FLORIDA GROUP INSURANCE PLAN

2021: LIFE MANAGEMENT OF NORTHWEST FLORIDA GROUP INSURANCE PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – InsuranceYes
2020: LIFE MANAGEMENT OF NORTHWEST FLORIDA GROUP INSURANCE PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – InsuranceYes
2019: LIFE MANAGEMENT OF NORTHWEST FLORIDA GROUP INSURANCE PLAN 2019 form 5500 responses
2019-02-01Type of plan entitySingle employer plan
2019-02-01Submission has been amendedNo
2019-02-01This submission is the final filingNo
2019-02-01This return/report is a short plan year return/report (less than 12 months)Yes
2019-02-01Plan is a collectively bargained planNo
2019-02-01Plan funding arrangement – InsuranceYes
2019-02-01Plan benefit arrangement – InsuranceYes
2018: LIFE MANAGEMENT OF NORTHWEST FLORIDA GROUP INSURANCE PLAN 2018 form 5500 responses
2018-02-01Type of plan entitySingle employer plan
2018-02-01Submission has been amendedNo
2018-02-01This submission is the final filingNo
2018-02-01This return/report is a short plan year return/report (less than 12 months)No
2018-02-01Plan is a collectively bargained planNo
2018-02-01Plan funding arrangement – InsuranceYes
2018-02-01Plan benefit arrangement – InsuranceYes
2017: LIFE MANAGEMENT OF NORTHWEST FLORIDA GROUP INSURANCE PLAN 2017 form 5500 responses
2017-02-01Type of plan entitySingle employer plan
2017-02-01Submission has been amendedNo
2017-02-01This submission is the final filingNo
2017-02-01This return/report is a short plan year return/report (less than 12 months)No
2017-02-01Plan is a collectively bargained planNo
2017-02-01Plan funding arrangement – InsuranceYes
2017-02-01Plan benefit arrangement – InsuranceYes
2016: LIFE MANAGEMENT OF NORTHWEST FLORIDA GROUP INSURANCE PLAN 2016 form 5500 responses
2016-02-01Type of plan entitySingle employer plan
2016-02-01Submission has been amendedNo
2016-02-01This submission is the final filingNo
2016-02-01This return/report is a short plan year return/report (less than 12 months)No
2016-02-01Plan is a collectively bargained planNo
2016-02-01Plan funding arrangement – InsuranceYes
2016-02-01Plan benefit arrangement – InsuranceYes
2015: LIFE MANAGEMENT OF NORTHWEST FLORIDA GROUP INSURANCE PLAN 2015 form 5500 responses
2015-02-01Type of plan entitySingle employer plan
2015-02-01Submission has been amendedNo
2015-02-01This submission is the final filingNo
2015-02-01This return/report is a short plan year return/report (less than 12 months)No
2015-02-01Plan is a collectively bargained planNo
2015-02-01Plan funding arrangement – InsuranceYes
2015-02-01Plan benefit arrangement – InsuranceYes
2014: LIFE MANAGEMENT OF NORTHWEST FLORIDA GROUP INSURANCE PLAN 2014 form 5500 responses
2014-02-01Type of plan entitySingle employer plan
2014-02-01Submission has been amendedNo
2014-02-01This submission is the final filingNo
2014-02-01This return/report is a short plan year return/report (less than 12 months)No
2014-02-01Plan is a collectively bargained planNo
2014-02-01Plan funding arrangement – InsuranceYes
2014-02-01Plan benefit arrangement – InsuranceYes
2013: LIFE MANAGEMENT OF NORTHWEST FLORIDA GROUP INSURANCE PLAN 2013 form 5500 responses
2013-02-01Type of plan entitySingle employer plan
2013-02-01Submission has been amendedNo
2013-02-01This submission is the final filingNo
2013-02-01This return/report is a short plan year return/report (less than 12 months)No
2013-02-01Plan is a collectively bargained planNo
2013-02-01Plan funding arrangement – InsuranceYes
2013-02-01Plan benefit arrangement – InsuranceYes
2012: LIFE MANAGEMENT OF NORTHWEST FLORIDA GROUP INSURANCE PLAN 2012 form 5500 responses
2012-02-01Type of plan entitySingle employer plan
2012-02-01Submission has been amendedNo
2012-02-01This submission is the final filingNo
2012-02-01This return/report is a short plan year return/report (less than 12 months)No
2012-02-01Plan is a collectively bargained planNo
2012-02-01Plan funding arrangement – InsuranceYes
2012-02-01Plan benefit arrangement – InsuranceYes
2011: LIFE MANAGEMENT OF NORTHWEST FLORIDA GROUP INSURANCE PLAN 2011 form 5500 responses
2011-02-01Type of plan entitySingle employer plan
2011-02-01Submission has been amendedNo
2011-02-01This submission is the final filingNo
2011-02-01This return/report is a short plan year return/report (less than 12 months)No
2011-02-01Plan is a collectively bargained planNo
2011-02-01Plan funding arrangement – InsuranceYes
2011-02-01Plan benefit arrangement – InsuranceYes
2010: LIFE MANAGEMENT OF NORTHWEST FLORIDA GROUP INSURANCE PLAN 2010 form 5500 responses
2010-02-01Type of plan entitySingle employer plan
2010-02-01Submission has been amendedNo
2010-02-01This submission is the final filingNo
2010-02-01This return/report is a short plan year return/report (less than 12 months)No
2010-02-01Plan is a collectively bargained planNo
2010-02-01Plan funding arrangement – InsuranceYes
2010-02-01Plan benefit arrangement – InsuranceYes
2009: LIFE MANAGEMENT OF NORTHWEST FLORIDA GROUP INSURANCE PLAN 2009 form 5500 responses
2009-02-01Type of plan entitySingle employer plan
2009-02-01Submission has been amendedNo
2009-02-01This submission is the final filingNo
2009-02-01This return/report is a short plan year return/report (less than 12 months)No
2009-02-01Plan is a collectively bargained planNo
2009-02-01Plan funding arrangement – InsuranceYes
2009-02-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
Policy contract number577299
Policy instance 4
Insurance contract or identification number577299
Number of Individuals Covered109
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $1,630
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $16,338
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,630
Additional information about fees paid to insurance brokerCOMMISSIONS
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number926765
Policy instance 3
Insurance contract or identification number926765
Number of Individuals Covered143
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $53,689
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees53689
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00523910
Policy instance 2
Insurance contract or identification number00523910
Number of Individuals Covered117
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $2,764
Total amount of fees paid to insurance companyUSD $2,343
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $59,976
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,764
Amount paid for insurance broker fees2343
Additional information about fees paid to insurance brokerCOMMISSIONS AND FEES
Insurance broker organization code?3
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50042837
Policy instance 1
Insurance contract or identification number50042837
Number of Individuals Covered167
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $1,851
Total amount of fees paid to insurance companyUSD $163
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $15,334
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,851
Additional information about fees paid to insurance brokerCOMMISSIONS
Insurance broker organization code?3
Amount paid for insurance broker fees163
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50042837
Policy instance 1
Insurance contract or identification number50042837
Number of Individuals Covered186
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $2,860
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $17,783
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,980
Additional information about fees paid to insurance brokerCOMMISSSIONS
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00523910
Policy instance 2
Insurance contract or identification number00523910
Number of Individuals Covered127
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $2,851
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $56,771
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,851
Additional information about fees paid to insurance brokerCOMMISSIONS
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 )
Policy contract number90581
Policy instance 3
Insurance contract or identification number90581
Number of Individuals Covered97
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $30,658
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $30,658
Additional information about fees paid to insurance brokerCOMMISSIONS
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 95089 )
Policy contract number90581
Policy instance 4
Insurance contract or identification number90581
Number of Individuals Covered40
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $12,759
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,759
Additional information about fees paid to insurance brokerCOMMISSIONS
Insurance broker organization code?3
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
Policy contract number577299
Policy instance 5
Insurance contract or identification number577299
Number of Individuals Covered124
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $1,745
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $17,605
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,745
Additional information about fees paid to insurance brokerCOMMISSIONS
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000B48C
Policy instance 1
Insurance contract or identification numberG000B48C
Number of Individuals Covered220
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $2,255
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $22,552
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,255
Additional information about fees paid to insurance brokerCOMMISSIONS
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00523910
Policy instance 2
Insurance contract or identification number00523910
Number of Individuals Covered135
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $3,182
Total amount of fees paid to insurance companyUSD $4,089
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $70,555
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,182
Amount paid for insurance broker fees4089
Additional information about fees paid to insurance brokerCOMMISSIONS AND FEES
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 )
Policy contract number90581
Policy instance 3
Insurance contract or identification number90581
Number of Individuals Covered98
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $30,404
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $30,404
Additional information about fees paid to insurance brokerCOMMISSIONS
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 95089 )
Policy contract number90581
Policy instance 4
Insurance contract or identification number90581
Number of Individuals Covered54
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $15,637
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,637
Additional information about fees paid to insurance brokerCOMMISSIONS
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00523910
Policy instance 4
Insurance contract or identification number00523910
Number of Individuals Covered161
Insurance policy start date2019-02-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $3,896
Total amount of fees paid to insurance companyUSD $4,171
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $72,922
Commission paid to Insurance BrokerUSD $3,896
Amount paid for insurance broker fees4171
Additional information about fees paid to insurance brokerCOMMISSIONS AND FEES
Insurance broker organization code?3
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
Policy contract number577299
Policy instance 3
Insurance contract or identification number577299
Number of Individuals Covered157
Insurance policy start date2019-02-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $2,071
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $20,836
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,071
Additional information about fees paid to insurance brokerCOMMISSIONS
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000B48C
Policy instance 2
Insurance contract or identification numberG000B48C
Number of Individuals Covered246
Insurance policy start date2019-02-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $2,050
Total amount of fees paid to insurance companyUSD $858
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $20,502
Commission paid to Insurance BrokerUSD $2,050
Amount paid for insurance broker fees858
Additional information about fees paid to insurance brokerCOMMISIONS AND FEES
Insurance broker organization code?3
QBE A&H (National Association of Insurance Commissioners NAIC id number: 39217 )
Policy contract numberLGS02169-19
Policy instance 1
Insurance contract or identification numberLGS02169-19
Number of Individuals Covered176
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $28,232
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $417,063
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $28,232
Additional information about fees paid to insurance brokerSERVICE FEES
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00523910
Policy instance 4
Insurance contract or identification number00523910
Number of Individuals Covered130
Insurance policy start date2018-02-01
Insurance policy end date2019-01-31
Total amount of commissions paid to insurance brokerUSD $3,318
Total amount of fees paid to insurance companyUSD $4,194
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $61,864
Commission paid to Insurance BrokerUSD $3,318
Amount paid for insurance broker fees4194
Additional information about fees paid to insurance brokerCOMMISSIONS AND FEES
Insurance broker organization code?3
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
Policy contract number577299
Policy instance 3
Insurance contract or identification number577299
Number of Individuals Covered131
Insurance policy start date2018-02-01
Insurance policy end date2019-01-31
Total amount of commissions paid to insurance brokerUSD $1,738
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $17,402
Commission paid to Insurance BrokerUSD $1,738
Additional information about fees paid to insurance brokerCOMMISSIONS
Insurance broker organization code?3
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract numberHCL34002
Policy instance 1
Insurance contract or identification numberHCL34002
Number of Individuals Covered155
Insurance policy start date2018-02-01
Insurance policy end date2019-01-01
Total amount of commissions paid to insurance brokerUSD $12,087
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $300,509
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19
Additional information about fees paid to insurance brokerCOMMISSIONS
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000B48C
Policy instance 2
Insurance contract or identification numberG000B48C
Number of Individuals Covered226
Insurance policy start date2018-02-01
Insurance policy end date2019-01-31
Total amount of commissions paid to insurance brokerUSD $2,084
Total amount of fees paid to insurance companyUSD $824
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $20,841
Commission paid to Insurance BrokerUSD $2,084
Amount paid for insurance broker fees824
Additional information about fees paid to insurance brokerCOMMISSIONS AND FEES
Insurance broker organization code?3
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
Policy contract number577299
Policy instance 3
Insurance contract or identification number577299
Number of Individuals Covered129
Insurance policy start date2017-02-01
Insurance policy end date2018-01-31
Total amount of commissions paid to insurance brokerUSD $1,759
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $19,502
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,759
Additional information about fees paid to insurance brokerCOMMISSIONS
Insurance broker organization code?3
Insurance broker nameFALATKO & ASSOCIATES INC
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00523910
Policy instance 4
Insurance contract or identification number00523910
Number of Individuals Covered119
Insurance policy start date2017-02-01
Insurance policy end date2018-01-31
Total amount of commissions paid to insurance brokerUSD $2,966
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,932
Additional information about fees paid to insurance brokerCOMMISSIONS
Insurance broker organization code?3
Insurance broker nameUNITED BENEFIT ADVISORS OF FLORIDA
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000B48C
Policy instance 2
Insurance contract or identification numberG000B48C
Number of Individuals Covered225
Insurance policy start date2017-02-01
Insurance policy end date2018-01-31
Total amount of commissions paid to insurance brokerUSD $2,156
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $21,559
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,156
Additional information about fees paid to insurance brokerCOMMISSIONS
Insurance broker organization code?3
Insurance broker nameTHE CLEMONS COMPANY
BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 )
Policy contract number90581
Policy instance 1
Insurance contract or identification number90581
Number of Individuals Covered153
Insurance policy start date2017-02-01
Insurance policy end date2018-01-01
Total amount of commissions paid to insurance brokerUSD $30,784
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $30,784
Additional information about fees paid to insurance brokerCOMMISSIONS
Insurance broker organization code?3
Insurance broker nameTHE CLEMONS COMPANY
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number157158
Policy instance 2
Insurance contract or identification number157158
Number of Individuals Covered222
Insurance policy start date2015-02-01
Insurance policy end date2016-01-31
Total amount of commissions paid to insurance brokerUSD $2,181
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Commission paid to Insurance BrokerUSD $2,181
Additional information about fees paid to insurance brokerCOMMISSIONS
Insurance broker organization code?3
Insurance broker nameTHE CLEMONS COMPANY
BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 )
Policy contract number90581
Policy instance 1
Insurance contract or identification number90581
Insurance policy start date2015-02-01
Insurance policy end date2016-01-01
Total amount of commissions paid to insurance brokerUSD $35,783
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $35,783
Additional information about fees paid to insurance brokerFEES AND COMMISSIONS
Insurance broker organization code?3
Insurance broker nameTHE CLEMONS COMPANY
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
Policy contract number577299
Policy instance 3
Insurance contract or identification number577299
Number of Individuals Covered98
Insurance policy start date2015-02-01
Insurance policy end date2016-01-31
Total amount of commissions paid to insurance brokerUSD $1,449
Vision Insurance Welfare BenefitYes
Commission paid to Insurance BrokerUSD $1,449
Additional information about fees paid to insurance brokerCOMMISSIONS
Insurance broker organization code?3
Insurance broker nameFALATKO & ASSOCIATES INC
UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 )
Policy contract number900418-000
Policy instance 4
Insurance contract or identification number900418-000
Number of Individuals Covered186
Insurance policy start date2015-02-01
Insurance policy end date2016-01-31
Total amount of commissions paid to insurance brokerUSD $6,426
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Commission paid to Insurance BrokerUSD $6,426
Additional information about fees paid to insurance brokerCOMMISSIONS
Insurance broker organization code?3
Insurance broker nameTHE CLEMONS COMPANY
UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 )
Policy contract number900418-000
Policy instance 3
Insurance contract or identification number900418-000
Number of Individuals Covered167
Insurance policy start date2014-02-01
Insurance policy end date2015-01-31
Total amount of commissions paid to insurance brokerUSD $6,121
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Commission paid to Insurance BrokerUSD $6,121
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerCOMMISSIONS
Insurance broker organization code?3
Insurance broker nameTHE CLEMONS COMPANY
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number157158
Policy instance 2
Insurance contract or identification number157158
Number of Individuals Covered227
Insurance policy start date2014-02-01
Insurance policy end date2015-01-31
Total amount of commissions paid to insurance brokerUSD $2,785
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Commission paid to Insurance BrokerUSD $2,785
Additional information about fees paid to insurance brokerCOMMISSIONS
Insurance broker organization code?3
Insurance broker nameTHE CLEMONS COMPANY
BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 )
Policy contract number90581
Policy instance 1
Insurance contract or identification number90581
Number of Individuals Covered151
Insurance policy start date2014-02-01
Insurance policy end date2015-01-01
Total amount of commissions paid to insurance brokerUSD $32,220
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Commission paid to Insurance BrokerUSD $32,220
Additional information about fees paid to insurance brokerFEES AND COMMISSIONS
Insurance broker organization code?3
Insurance broker nameTHE CLEMONS COMPANY
BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 )
Policy contract number90581
Policy instance 1
Insurance contract or identification number90581
Number of Individuals Covered147
Insurance policy start date2013-02-01
Insurance policy end date2014-01-01
Total amount of commissions paid to insurance brokerUSD $32,498
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Commission paid to Insurance BrokerUSD $32,498
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
Insurance broker nameTHE CLEMONS COMPANY
FLORIDA COMBINED LIFE INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 76031 )
Policy contract number90581
Policy instance 2
Insurance contract or identification number90581
Number of Individuals Covered211
Insurance policy start date2013-02-01
Insurance policy end date2014-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $3,823
Life Insurance Welfare BenefitYes
Amount paid for insurance broker fees3823
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
Insurance broker nameTHE CLEMONS COMPANY
UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 )
Policy contract number900418-000
Policy instance 3
Insurance contract or identification number900418-000
Number of Individuals Covered149
Insurance policy start date2013-02-01
Insurance policy end date2014-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $5,255
Dental Insurance Welfare BenefitYes
Amount paid for insurance broker fees5255
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
Insurance broker nameTHE CLEMONS COMPANY
FLORIDA COMBINED LIFE INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 76031 )
Policy contract number25Y0186
Policy instance 3
Insurance contract or identification number25Y0186
Number of Individuals Covered96
Insurance policy start date2012-02-01
Insurance policy end date2013-01-31
Total amount of fees paid to insurance companyUSD $3,001
Dental Insurance Welfare BenefitYes
Amount paid for insurance broker fees3001
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
Insurance broker nameTHE CLEMONS COMPANY
FLORIDA COMBINED LIFE INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 76031 )
Policy contract number90581
Policy instance 2
Insurance contract or identification number90581
Number of Individuals Covered203
Insurance policy start date2012-02-01
Insurance policy end date2013-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $3,783
Life Insurance Welfare BenefitYes
Amount paid for insurance broker fees3783
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
Insurance broker nameTHE CLEMONS COMPANY
BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 )
Policy contract number90581
Policy instance 1
Insurance contract or identification number90581
Number of Individuals Covered144
Insurance policy start date2012-02-01
Insurance policy end date2013-01-01
Total amount of commissions paid to insurance brokerUSD $31,891
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Commission paid to Insurance BrokerUSD $31,891
Insurance broker organization code?3
Insurance broker nameTHE CLEMONS COMPANY
BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 )
Policy contract number90581
Policy instance 1
Insurance contract or identification number90581
Number of Individuals Covered140
Insurance policy start date2011-02-01
Insurance policy end date2012-01-31
Total amount of commissions paid to insurance brokerUSD $29,915
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 )
Policy contract number90581
Policy instance 1
Insurance contract or identification number90581
Number of Individuals Covered130
Insurance policy start date2010-02-01
Insurance policy end date2011-01-31
Total amount of commissions paid to insurance brokerUSD $24,945
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Commission paid to Insurance BrokerUSD $24,945
Insurance broker organization code?3
Insurance broker nameTHE CLEMONS COMPANY

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