FASTLINE MARKETING GROUP has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan FASTLINE PUBLICATIONS SECTION 125 CAFETERIA PLAN
401k plan membership statisitcs for FASTLINE PUBLICATIONS SECTION 125 CAFETERIA PLAN
| Measure | Date | Value |
|---|
| 2021: FASTLINE PUBLICATIONS SECTION 125 CAFETERIA PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-03-01 | 127 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-03-01 | 84 |
| Total of all active and inactive participants | 2021-03-01 | 84 |
| 2020: FASTLINE PUBLICATIONS SECTION 125 CAFETERIA PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-03-01 | 108 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-03-01 | 127 |
| Total of all active and inactive participants | 2020-03-01 | 127 |
| 2019: FASTLINE PUBLICATIONS SECTION 125 CAFETERIA PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-03-01 | 113 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-03-01 | 108 |
| Total of all active and inactive participants | 2019-03-01 | 108 |
| 2018: FASTLINE PUBLICATIONS SECTION 125 CAFETERIA PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-03-01 | 107 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-03-01 | 113 |
| Total of all active and inactive participants | 2018-03-01 | 113 |
| 2017: FASTLINE PUBLICATIONS SECTION 125 CAFETERIA PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-03-01 | 114 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-03-01 | 107 |
| Total of all active and inactive participants | 2017-03-01 | 107 |
| Total participants | 2017-03-01 | 107 |
| 2016: FASTLINE PUBLICATIONS SECTION 125 CAFETERIA PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-03-01 | 116 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-03-01 | 114 |
| Total of all active and inactive participants | 2016-03-01 | 114 |
| Total participants | 2016-03-01 | 114 |
| 2015: FASTLINE PUBLICATIONS SECTION 125 CAFETERIA PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-03-01 | 123 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-03-01 | 116 |
| Total of all active and inactive participants | 2015-03-01 | 116 |
| 2014: FASTLINE PUBLICATIONS SECTION 125 CAFETERIA PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-03-01 | 131 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-03-01 | 123 |
| Total of all active and inactive participants | 2014-03-01 | 123 |
| 2013: FASTLINE PUBLICATIONS SECTION 125 CAFETERIA PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-03-01 | 117 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-03-01 | 131 |
| Total of all active and inactive participants | 2013-03-01 | 131 |
| 2012: FASTLINE PUBLICATIONS SECTION 125 CAFETERIA PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-03-01 | 127 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-03-01 | 117 |
| Total of all active and inactive participants | 2012-03-01 | 117 |
| 2011: FASTLINE PUBLICATIONS SECTION 125 CAFETERIA PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-03-01 | 119 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-03-01 | 127 |
| Total of all active and inactive participants | 2011-03-01 | 127 |
| 2010: FASTLINE PUBLICATIONS SECTION 125 CAFETERIA PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-03-01 | 122 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-03-01 | 119 |
| Number of retired or separated participants receiving benefits | 2010-03-01 | 0 |
| Total of all active and inactive participants | 2010-03-01 | 119 |
| Total participants, beginning-of-year | 2010-01-01 | 122 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-01-01 | 119 |
| Number of retired or separated participants receiving benefits | 2010-01-01 | 0 |
| Total of all active and inactive participants | 2010-01-01 | 119 |
| 2009: FASTLINE PUBLICATIONS SECTION 125 CAFETERIA PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-01-01 | 201 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 143 |
| Number of retired or separated participants receiving benefits | 2009-01-01 | 24 |
| Total of all active and inactive participants | 2009-01-01 | 167 |
| Measure | Date | Value |
|---|
| 2017 : FASTLINE PUBLICATIONS SECTION 125 CAFETERIA PLAN 2017 401k financial data |
|---|
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2017-02-28 | No |
| Was this plan covered by a fidelity bond | 2017-02-28 | No |
| If this is an individual account plan, was there a blackout period | 2017-02-28 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2017-02-28 | No |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2017-02-28 | No |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2017-02-28 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2017-02-28 | No |
| Were any leases to which the plan was party in default or uncollectible | 2017-02-28 | No |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2017-02-28 | No |
| Was there a failure to transmit to the plan any participant contributions | 2017-02-28 | No |
| Has the plan failed to provide any benefit when due under the plan | 2017-02-28 | No |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2017-02-28 | No |
| Did the plan have assets held for investment | 2017-02-28 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2017-02-28 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2017-02-28 | No |
| 2016 : FASTLINE PUBLICATIONS SECTION 125 CAFETERIA PLAN 2016 401k financial data |
|---|
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2016-02-29 | No |
| Was this plan covered by a fidelity bond | 2016-02-29 | No |
| If this is an individual account plan, was there a blackout period | 2016-02-29 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2016-02-29 | No |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-02-29 | No |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2016-02-29 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2016-02-29 | No |
| Were any leases to which the plan was party in default or uncollectible | 2016-02-29 | No |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2016-02-29 | No |
| Was there a failure to transmit to the plan any participant contributions | 2016-02-29 | No |
| Has the plan failed to provide any benefit when due under the plan | 2016-02-29 | No |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2016-02-29 | No |
| Did the plan have assets held for investment | 2016-02-29 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-02-29 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2016-02-29 | No |
| 2015 : FASTLINE PUBLICATIONS SECTION 125 CAFETERIA PLAN 2015 401k financial data |
|---|
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2015-02-28 | No |
| Was this plan covered by a fidelity bond | 2015-02-28 | No |
| If this is an individual account plan, was there a blackout period | 2015-02-28 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2015-02-28 | No |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-02-28 | No |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2015-02-28 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2015-02-28 | No |
| Were any leases to which the plan was party in default or uncollectible | 2015-02-28 | No |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2015-02-28 | No |
| Was there a failure to transmit to the plan any participant contributions | 2015-02-28 | No |
| Has the plan failed to provide any benefit when due under the plan | 2015-02-28 | No |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2015-02-28 | No |
| Did the plan have assets held for investment | 2015-02-28 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-02-28 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2015-02-28 | No |
| 2014 : FASTLINE PUBLICATIONS SECTION 125 CAFETERIA PLAN 2014 401k financial data |
|---|
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2014-02-28 | No |
| Was this plan covered by a fidelity bond | 2014-02-28 | No |
| If this is an individual account plan, was there a blackout period | 2014-02-28 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2014-02-28 | No |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-02-28 | No |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2014-02-28 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2014-02-28 | No |
| Were any leases to which the plan was party in default or uncollectible | 2014-02-28 | No |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2014-02-28 | No |
| Was there a failure to transmit to the plan any participant contributions | 2014-02-28 | No |
| Has the plan failed to provide any benefit when due under the plan | 2014-02-28 | No |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2014-02-28 | No |
| Did the plan have assets held for investment | 2014-02-28 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-02-28 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2014-02-28 | No |
| 2013 : FASTLINE PUBLICATIONS SECTION 125 CAFETERIA PLAN 2013 401k financial data |
|---|
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2013-02-28 | No |
| Was this plan covered by a fidelity bond | 2013-02-28 | No |
| If this is an individual account plan, was there a blackout period | 2013-02-28 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2013-02-28 | No |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-02-28 | No |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2013-02-28 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2013-02-28 | No |
| Were any leases to which the plan was party in default or uncollectible | 2013-02-28 | No |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2013-02-28 | No |
| Was there a failure to transmit to the plan any participant contributions | 2013-02-28 | No |
| Has the plan failed to provide any benefit when due under the plan | 2013-02-28 | No |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2013-02-28 | No |
| Did the plan have assets held for investment | 2013-02-28 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-02-28 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2013-02-28 | No |
| 2012 : FASTLINE PUBLICATIONS SECTION 125 CAFETERIA PLAN 2012 401k financial data |
|---|
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2012-02-29 | No |
| Was this plan covered by a fidelity bond | 2012-02-29 | No |
| If this is an individual account plan, was there a blackout period | 2012-02-29 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2012-02-29 | No |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-02-29 | No |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2012-02-29 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2012-02-29 | No |
| Were any leases to which the plan was party in default or uncollectible | 2012-02-29 | No |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2012-02-29 | No |
| Was there a failure to transmit to the plan any participant contributions | 2012-02-29 | No |
| Has the plan failed to provide any benefit when due under the plan | 2012-02-29 | No |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2012-02-29 | No |
| Did the plan have assets held for investment | 2012-02-29 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-02-29 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2012-02-29 | No |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2012-02-28 | No |
| Was this plan covered by a fidelity bond | 2012-02-28 | No |
| If this is an individual account plan, was there a blackout period | 2012-02-28 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2012-02-28 | No |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-02-28 | No |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2012-02-28 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2012-02-28 | No |
| Were any leases to which the plan was party in default or uncollectible | 2012-02-28 | No |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2012-02-28 | No |
| Was there a failure to transmit to the plan any participant contributions | 2012-02-28 | No |
| Has the plan failed to provide any benefit when due under the plan | 2012-02-28 | No |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2012-02-28 | No |
| Did the plan have assets held for investment | 2012-02-28 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-02-28 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2012-02-28 | No |
| 2011 : FASTLINE PUBLICATIONS SECTION 125 CAFETERIA PLAN 2011 401k financial data |
|---|
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2011-02-28 | No |
| Was this plan covered by a fidelity bond | 2011-02-28 | No |
| If this is an individual account plan, was there a blackout period | 2011-02-28 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2011-02-28 | No |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-02-28 | No |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2011-02-28 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2011-02-28 | No |
| Were any leases to which the plan was party in default or uncollectible | 2011-02-28 | No |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2011-02-28 | No |
| Was there a failure to transmit to the plan any participant contributions | 2011-02-28 | No |
| Has the plan failed to provide any benefit when due under the plan | 2011-02-28 | No |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2011-02-28 | No |
| Did the plan have assets held for investment | 2011-02-28 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-02-28 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2011-02-28 | No |
| 2010 : FASTLINE PUBLICATIONS SECTION 125 CAFETERIA PLAN 2010 401k financial data |
|---|
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2010-02-28 | No |
| Was this plan covered by a fidelity bond | 2010-02-28 | No |
| If this is an individual account plan, was there a blackout period | 2010-02-28 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2010-02-28 | No |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2010-02-28 | No |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2010-02-28 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2010-02-28 | No |
| Were any leases to which the plan was party in default or uncollectible | 2010-02-28 | No |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2010-02-28 | No |
| Was there a failure to transmit to the plan any participant contributions | 2010-02-28 | No |
| Has the plan failed to provide any benefit when due under the plan | 2010-02-28 | No |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2010-02-28 | No |
| Did the plan have assets held for investment | 2010-02-28 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2010-02-28 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2010-02-28 | No |
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | HCL36370 |
| Policy instance | 7 |
| Insurance contract or identification number | HCL36370 | | Number of Individuals Covered | 73 | | Insurance policy start date | 2021-10-01 | | Insurance policy end date | 2022-02-28 | | Welfare Benefit Premiums Paid to Carrier | USD $79,857 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 ) |
| Policy contract number | W28076 |
| Policy instance | 1 |
| Insurance contract or identification number | W28076 | | Number of Individuals Covered | 112 | | Insurance policy start date | 2021-03-01 | | Insurance policy end date | 2021-09-30 | | Other welfare benefits provided | HEALTH INDEMNITY | | Welfare Benefit Premiums Paid to Carrier | USD $9,568 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG0AAA2 |
| Policy instance | 2 |
| Insurance contract or identification number | GLUG0AAA2 | | Number of Individuals Covered | 84 | | Insurance policy start date | 2021-03-01 | | Insurance policy end date | 2022-02-28 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $11,053 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUG0AAA2 |
| Policy instance | 3 |
| Insurance contract or identification number | GUG0AAA2 | | Number of Individuals Covered | 84 | | Insurance policy start date | 2021-03-01 | | Insurance policy end date | 2022-02-28 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $18,088 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GVTL0AAA2 |
| Policy instance | 4 |
| Insurance contract or identification number | GVTL0AAA2 | | Number of Individuals Covered | 39 | | Insurance policy start date | 2021-03-01 | | Insurance policy end date | 2022-02-28 | | Other welfare benefits provided | VOLUNTARY LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $16,504 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLTD0AAA2 |
| Policy instance | 5 |
| Insurance contract or identification number | GLTD0AAA2 | | Number of Individuals Covered | 84 | | Insurance policy start date | 2021-03-01 | | Insurance policy end date | 2022-02-28 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $17,507 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 ) |
| Policy contract number | W28130 |
| Policy instance | 6 |
| Insurance contract or identification number | W28130 | | Number of Individuals Covered | 152 | | Insurance policy start date | 2021-03-01 | | Insurance policy end date | 2022-02-28 | | Total amount of commissions paid to insurance broker | USD $978 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $9,649 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $581 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG0AAA2 |
| Policy instance | 2 |
| Insurance contract or identification number | GLUG0AAA2 | | Number of Individuals Covered | 93 | | Insurance policy start date | 2020-03-01 | | Insurance policy end date | 2021-02-28 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $11,860 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUG0AAA2 |
| Policy instance | 3 |
| Insurance contract or identification number | GUG0AAA2 | | Number of Individuals Covered | 93 | | Insurance policy start date | 2020-03-01 | | Insurance policy end date | 2021-02-28 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $19,201 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GVTL0AAA2 |
| Policy instance | 4 |
| Insurance contract or identification number | GVTL0AAA2 | | Number of Individuals Covered | 41 | | Insurance policy start date | 2020-03-01 | | Insurance policy end date | 2021-02-28 | | Other welfare benefits provided | VOLUNTARY LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $16,501 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 ) |
| Policy contract number | W28076 |
| Policy instance | 1 |
| Insurance contract or identification number | W28076 | | Number of Individuals Covered | 296 | | Insurance policy start date | 2020-03-01 | | Insurance policy end date | 2021-02-28 | | Total amount of fees paid to insurance company | USD $379 | | Other welfare benefits provided | HEALTH INDEMNITY | | Welfare Benefit Premiums Paid to Carrier | USD $178,666 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 379 | | Additional information about fees paid to insurance broker | FEES | | Insurance broker organization code? | 3 |
|
| ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 ) |
| Policy contract number | W28130 |
| Policy instance | 6 |
| Insurance contract or identification number | W28130 | | Number of Individuals Covered | 158 | | Insurance policy start date | 2020-03-01 | | Insurance policy end date | 2021-02-28 | | Total amount of commissions paid to insurance broker | USD $1,059 | | Total amount of fees paid to insurance company | USD $126 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,621 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $770 | | Amount paid for insurance broker fees | 126 | | Additional information about fees paid to insurance broker | FEES | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLTD0AAA2 |
| Policy instance | 5 |
| Insurance contract or identification number | GLTD0AAA2 | | Number of Individuals Covered | 93 | | Insurance policy start date | 2020-03-01 | | Insurance policy end date | 2021-02-28 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $18,789 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG0AAA2 |
| Policy instance | 2 |
| Insurance contract or identification number | GLUG0AAA2 | | Number of Individuals Covered | 108 | | Insurance policy start date | 2019-03-01 | | Insurance policy end date | 2020-02-29 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $11,773 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 ) |
| Policy contract number | W28130 |
| Policy instance | 6 |
| Insurance contract or identification number | W28130 | | Number of Individuals Covered | 175 | | Insurance policy start date | 2019-03-01 | | Insurance policy end date | 2020-02-29 | | Total amount of commissions paid to insurance broker | USD $1,007 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,914 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,007 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLTD0AAA2 |
| Policy instance | 5 |
| Insurance contract or identification number | GLTD0AAA2 | | Number of Individuals Covered | 108 | | Insurance policy start date | 2019-03-01 | | Insurance policy end date | 2020-02-29 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $18,521 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GVTL0AAA2 |
| Policy instance | 4 |
| Insurance contract or identification number | GVTL0AAA2 | | Number of Individuals Covered | 46 | | Insurance policy start date | 2019-03-01 | | Insurance policy end date | 2020-02-29 | | Other welfare benefits provided | VOLUNTARY LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $15,141 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUG0AAA2 |
| Policy instance | 3 |
| Insurance contract or identification number | GUG0AAA2 | | Number of Individuals Covered | 108 | | Insurance policy start date | 2019-03-01 | | Insurance policy end date | 2020-02-29 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $19,448 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 ) |
| Policy contract number | W28076 |
| Policy instance | 1 |
| Insurance contract or identification number | W28076 | | Number of Individuals Covered | 201 | | Insurance policy start date | 2019-03-01 | | Insurance policy end date | 2020-02-29 | | Other welfare benefits provided | HEALTH INDEMNITY | | Welfare Benefit Premiums Paid to Carrier | USD $192,136 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUG0AAA2 |
| Policy instance | 4 |
| Insurance contract or identification number | GUG0AAA2 | | Number of Individuals Covered | 113 | | Insurance policy start date | 2018-03-01 | | Insurance policy end date | 2019-02-28 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $18,842 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG0AAA2 |
| Policy instance | 3 |
| Insurance contract or identification number | GLUG0AAA2 | | Number of Individuals Covered | 113 | | Insurance policy start date | 2018-03-01 | | Insurance policy end date | 2019-02-28 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $11,236 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GVTL0AAA2 |
| Policy instance | 5 |
| Insurance contract or identification number | GVTL0AAA2 | | Number of Individuals Covered | 46 | | Insurance policy start date | 2018-03-01 | | Insurance policy end date | 2019-02-28 | | Other welfare benefits provided | VOLUNTARY LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $15,950 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 ) |
| Policy contract number | 000009587 |
| Policy instance | 1 |
| Insurance contract or identification number | 000009587 | | Number of Individuals Covered | 196 | | Insurance policy start date | 2018-03-01 | | Insurance policy end date | 2019-02-28 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $178,807 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E3088101 |
| Policy instance | 2 |
| Insurance contract or identification number | E3088101 | | Number of Individuals Covered | 50 | | Insurance policy start date | 2018-03-01 | | Insurance policy end date | 2019-02-28 | | Total amount of commissions paid to insurance broker | USD $5,417 | | Total amount of fees paid to insurance company | USD $682 | | Other welfare benefits provided | CANCER, CRITICAL ILLNESS, ACCIDENT | | Welfare Benefit Premiums Paid to Carrier | USD $30,326 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,208 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 209 |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E3088101 |
| Policy instance | 2 |
| Insurance contract or identification number | E3088101 | | Number of Individuals Covered | 56 | | Insurance policy start date | 2017-03-01 | | Insurance policy end date | 2018-02-28 | | Total amount of commissions paid to insurance broker | USD $6,708 | | Total amount of fees paid to insurance company | USD $1,088 | | Other welfare benefits provided | CANCER, CRITICAL ILLNESS, ACCIDENT | | Welfare Benefit Premiums Paid to Carrier | USD $32,247 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,660 | | Amount paid for insurance broker fees | 183 | | Insurance broker organization code? | 3 | | Insurance broker name | THE WORKSIGHT GROUP, LLC |
|
| ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 ) |
| Policy contract number | 000009587 |
| Policy instance | 1 |
| Insurance contract or identification number | 000009587 | | Number of Individuals Covered | 196 | | Insurance policy start date | 2017-03-01 | | Insurance policy end date | 2018-02-28 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $182,002 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E3088101 |
| Policy instance | 2 |
| Insurance contract or identification number | E3088101 | | Number of Individuals Covered | 64 | | Insurance policy start date | 2015-03-01 | | Insurance policy end date | 2016-02-29 | | Total amount of commissions paid to insurance broker | USD $18,482 | | Total amount of fees paid to insurance company | USD $6,706 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,347 | | Amount paid for insurance broker fees | 3353 | | Insurance broker organization code? | 3 | | Insurance broker name | TED BENNETT |
|
| ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 ) |
| Policy contract number | 000009587 |
| Policy instance | 1 |
| Insurance contract or identification number | 000009587 | | Number of Individuals Covered | 235 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $47,725 | | Total amount of fees paid to insurance company | USD $110 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $47,725 | | Amount paid for insurance broker fees | 110 | | Insurance broker organization code? | 3 | | Insurance broker name | EPIC INSURANCE SOLUTIONS LLC |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E3088101 |
| Policy instance | 5 |
| Insurance contract or identification number | E3088101 | | Number of Individuals Covered | 16 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $1,046 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $753 | | Insurance broker name | TED BENNETT |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AAA2 |
| Policy instance | 4 |
| Insurance contract or identification number | G000AAA2 | | Number of Individuals Covered | 138 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $749 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $749 | | Insurance broker name | BB&T INSURANCE SERVCIES |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AAA2 |
| Policy instance | 3 |
| Insurance contract or identification number | G000AAA2 | | Number of Individuals Covered | 138 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $491 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $491 | | Insurance broker name | BB&T INSURANCE SERVCIES |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AAA2 |
| Policy instance | 2 |
| Insurance contract or identification number | G000AAA2 | | Number of Individuals Covered | 138 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $562 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $562 | | Insurance broker name | BB&T INSURANCE SERVCIES |
|
| ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 ) |
| Policy contract number | 000009587 |
| Policy instance | 1 |
| Insurance contract or identification number | 000009587 | | Number of Individuals Covered | 272 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $30,000 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $30,000 | | Insurance broker name | BB&T INSURANCE SERVCIES |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E3088101 |
| Policy instance | 3 |
| Insurance contract or identification number | E3088101 | | Number of Individuals Covered | 17 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $1,326 | | Total amount of fees paid to insurance company | USD $25 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $840 | | Amount paid for insurance broker fees | 22 | | Insurance broker organization code? | 3 | | Insurance broker name | MICHAEL BOONE |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AAA2 |
| Policy instance | 2 |
| Insurance contract or identification number | G000AAA2 | | Number of Individuals Covered | 132 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $491 | | Total amount of fees paid to insurance company | USD $1,620 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $0 | | Amount paid for insurance broker fees | 749 | | Insurance broker organization code? | 3 | | Insurance broker name | BB&T INSURANCE |
|
| ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 ) |
| Policy contract number | 000009587 |
| Policy instance | 1 |
| Insurance contract or identification number | 000009587 | | Number of Individuals Covered | 120 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $145,925 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $115,925 | | Insurance broker name | BB&T INSURANCE |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AAA2 |
| Policy instance | 2 |
| Insurance contract or identification number | G000AAA2 | | Number of Individuals Covered | 117 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $367 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $367 | | Insurance broker name | BB&T INSURANCE |
|
| ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 ) |
| Policy contract number | 000009587 |
| Policy instance | 1 |
| Insurance contract or identification number | 000009587 | | Number of Individuals Covered | 273 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $105,498 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $105,498 | | Insurance broker name | USI MIDWEST |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E3088101 |
| Policy instance | 6 |
| Insurance contract or identification number | E3088101 | | Number of Individuals Covered | 17 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $1,104 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $782 | | Insurance broker name | TED BENNETT |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AAA2 |
| Policy instance | 5 |
| Insurance contract or identification number | G000AAA2 | | Number of Individuals Covered | 117 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $548 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $548 | | Insurance broker name | BB&T INSURANCE |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AAA2 |
| Policy instance | 4 |
| Insurance contract or identification number | G000AAA2 | | Number of Individuals Covered | 117 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $590 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $590 | | Insurance broker name | NATIONAL CITY INSURANCE GROUP INC |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AAA2 |
| Policy instance | 3 |
| Insurance contract or identification number | G000AAA2 | | Number of Individuals Covered | 117 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $666 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $666 | | Insurance broker name | BB&T INSURANCE |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AAA2 |
| Policy instance | 3 |
| Insurance contract or identification number | G000AAA2 | | Number of Individuals Covered | 127 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $2,815 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E3088101 |
| Policy instance | 6 |
| Insurance contract or identification number | E3088101 | | Number of Individuals Covered | 17 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $1,478 | | Total amount of fees paid to insurance company | USD $52 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 ) |
| Policy contract number | 000009587 |
| Policy instance | 1 |
| Insurance contract or identification number | 000009587 | | Number of Individuals Covered | 276 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $115,811 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AAA2 |
| Policy instance | 2 |
| Insurance contract or identification number | G000AAA2 | | Number of Individuals Covered | 127 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $1,551 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AAA2 |
| Policy instance | 5 |
| Insurance contract or identification number | G000AAA2 | | Number of Individuals Covered | 127 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $2,491 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AAA2 |
| Policy instance | 4 |
| Insurance contract or identification number | G000AAA2 | | Number of Individuals Covered | 127 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $2,491 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 ) |
| Policy contract number | 000009587 |
| Policy instance | 1 |
| Insurance contract or identification number | 000009587 | | Number of Individuals Covered | 300 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $873 | | Total amount of fees paid to insurance company | USD $182,883 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $307 | | Amount paid for insurance broker fees | 174172 | | Insurance broker name | THOMPSON ASSOCIATES |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AAA2 |
| Policy instance | 2 |
| Insurance contract or identification number | G000AAA2 | | Number of Individuals Covered | 135 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $1,661 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,287 | | Insurance broker name | NATIONAL CITY INSURANCE GROUP INC |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AAA2 |
| Policy instance | 3 |
| Insurance contract or identification number | G000AAA2 | | Number of Individuals Covered | 135 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $3,017 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,337 | | Insurance broker name | NATIONAL CITY INSURANCE GROUP INC |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AAA2 |
| Policy instance | 4 |
| Insurance contract or identification number | G000AAA2 | | Number of Individuals Covered | 135 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $2,661 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,062 | | Insurance broker name | NATIONAL CITY INSURANCE GROUP INC |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E3088101 |
| Policy instance | 6 |
| Insurance contract or identification number | E3088101 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $1,394 | | Total amount of fees paid to insurance company | USD $8 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $883 | | Amount paid for insurance broker fees | 8 | | Insurance broker name | RICHARD SINCLAIR ABBOTT |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AAA2 |
| Policy instance | 5 |
| Insurance contract or identification number | G000AAA2 | | Number of Individuals Covered | 57 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $2,381 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,811 | | Insurance broker name | NATIONAL CITY INSURANCE GROUP INC |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AAA2 |
| Policy instance | 2 |
| Insurance contract or identification number | G000AAA2 | | Number of Individuals Covered | 135 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker name | USI MIDWEST |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E3088101 |
| Policy instance | 6 |
| Insurance contract or identification number | E3088101 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker name | RICHARD SINCLAIR ABBOTT |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AAA2 |
| Policy instance | 5 |
| Insurance contract or identification number | G000AAA2 | | Number of Individuals Covered | 57 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker name | USI MIDWEST |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AAA2 |
| Policy instance | 4 |
| Insurance contract or identification number | G000AAA2 | | Number of Individuals Covered | 135 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker name | USI MIDWEST |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AAA2 |
| Policy instance | 3 |
| Insurance contract or identification number | G000AAA2 | | Number of Individuals Covered | 135 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker name | USI MIDWEST |
|
| ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 ) |
| Policy contract number | 000009587 |
| Policy instance | 1 |
| Insurance contract or identification number | 000009587 | | Number of Individuals Covered | 300 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker name | USI MIDWEST |
|
