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HEAVY MACHINES, INC. EMPLOYEE HEALTH & LIFE BENEFITS PLAN 401k Plan overview

Plan NameHEAVY MACHINES, INC. EMPLOYEE HEALTH & LIFE BENEFITS PLAN
Plan identification number 501

HEAVY MACHINES, INC. EMPLOYEE HEALTH & LIFE BENEFITS PLAN Benefits

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

401k Sponsoring company profile

HEAVY MACHINES, LLC has sponsored the creation of one or more 401k plans.

Company Name:HEAVY MACHINES, LLC
Employer identification number (EIN):620850651
NAIC Classification:423400

Additional information about HEAVY MACHINES, LLC

Jurisdiction of Incorporation: State of Delaware Division of Corporations
Incorporation Date:
Company Identification Number: 2065469

More information about HEAVY MACHINES, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HEAVY MACHINES, INC. EMPLOYEE HEALTH & LIFE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-06-01
5012021-06-01
5012020-06-01
5012019-06-01
5012018-06-01
5012017-06-01AUSGUSTUS WILSON AUSGUSTUS WILSON2019-03-15
5012016-06-01AUGUSTUS WILSON AUGUSTUS WILSON2018-03-14
5012015-06-01AUGUSTUS WILSON AUGUSTUS WILSON2017-03-15
5012014-06-01AUGUSTUS WILSON AUGUSTUS WILSON2016-03-10
5012013-06-01AUGUSTUS WILSON AUGUSTUS WILSON2015-06-24
5012012-06-01AUGUSTUS WILSON AUGUSTUS WILSON2013-07-12
5012011-06-01AUGUSTUS WILSON AUGUSTUS WILSON2012-12-21
5012010-06-01AUGUSTUS WILSON AUGUSTUS WILSON2011-12-30
5012009-06-01AUGUSTUS WILSON AUGUSTUS WILSON2010-08-10

Plan Statistics for HEAVY MACHINES, INC. EMPLOYEE HEALTH & LIFE BENEFITS PLAN

401k plan membership statisitcs for HEAVY MACHINES, INC. EMPLOYEE HEALTH & LIFE BENEFITS PLAN

Measure Date Value
2022: HEAVY MACHINES, INC. EMPLOYEE HEALTH & LIFE BENEFITS PLAN 2022 401k membership
Total participants, beginning-of-year2022-06-01112
Total number of active participants reported on line 7a of the Form 55002022-06-01120
Total of all active and inactive participants2022-06-01120
2021: HEAVY MACHINES, INC. EMPLOYEE HEALTH & LIFE BENEFITS PLAN 2021 401k membership
Total participants, beginning-of-year2021-06-01112
Total number of active participants reported on line 7a of the Form 55002021-06-01120
Total of all active and inactive participants2021-06-01120
2020: HEAVY MACHINES, INC. EMPLOYEE HEALTH & LIFE BENEFITS PLAN 2020 401k membership
Total participants, beginning-of-year2020-06-01128
Total number of active participants reported on line 7a of the Form 55002020-06-01112
Total of all active and inactive participants2020-06-01112
2019: HEAVY MACHINES, INC. EMPLOYEE HEALTH & LIFE BENEFITS PLAN 2019 401k membership
Total participants, beginning-of-year2019-06-01147
Total number of active participants reported on line 7a of the Form 55002019-06-01147
Total of all active and inactive participants2019-06-01147
2018: HEAVY MACHINES, INC. EMPLOYEE HEALTH & LIFE BENEFITS PLAN 2018 401k membership
Total participants, beginning-of-year2018-06-01140
Total number of active participants reported on line 7a of the Form 55002018-06-01140
Total of all active and inactive participants2018-06-01140
2017: HEAVY MACHINES, INC. EMPLOYEE HEALTH & LIFE BENEFITS PLAN 2017 401k membership
Total participants, beginning-of-year2017-06-01134
Total number of active participants reported on line 7a of the Form 55002017-06-01140
Total of all active and inactive participants2017-06-01140
2016: HEAVY MACHINES, INC. EMPLOYEE HEALTH & LIFE BENEFITS PLAN 2016 401k membership
Total participants, beginning-of-year2016-06-01137
Total number of active participants reported on line 7a of the Form 55002016-06-01134
Total of all active and inactive participants2016-06-01134
2015: HEAVY MACHINES, INC. EMPLOYEE HEALTH & LIFE BENEFITS PLAN 2015 401k membership
Total participants, beginning-of-year2015-06-01123
Total number of active participants reported on line 7a of the Form 55002015-06-01136
Number of retired or separated participants receiving benefits2015-06-011
Number of other retired or separated participants entitled to future benefits2015-06-010
Total of all active and inactive participants2015-06-01137
2014: HEAVY MACHINES, INC. EMPLOYEE HEALTH & LIFE BENEFITS PLAN 2014 401k membership
Total participants, beginning-of-year2014-06-01117
Total number of active participants reported on line 7a of the Form 55002014-06-01120
Number of retired or separated participants receiving benefits2014-06-013
Number of other retired or separated participants entitled to future benefits2014-06-010
Total of all active and inactive participants2014-06-01123
2013: HEAVY MACHINES, INC. EMPLOYEE HEALTH & LIFE BENEFITS PLAN 2013 401k membership
Total participants, beginning-of-year2013-06-01105
Total number of active participants reported on line 7a of the Form 55002013-06-01116
Number of retired or separated participants receiving benefits2013-06-011
Number of other retired or separated participants entitled to future benefits2013-06-010
Total of all active and inactive participants2013-06-01117
2012: HEAVY MACHINES, INC. EMPLOYEE HEALTH & LIFE BENEFITS PLAN 2012 401k membership
Total participants, beginning-of-year2012-06-01146
Total number of active participants reported on line 7a of the Form 55002012-06-01104
Number of retired or separated participants receiving benefits2012-06-011
Total of all active and inactive participants2012-06-01105
2011: HEAVY MACHINES, INC. EMPLOYEE HEALTH & LIFE BENEFITS PLAN 2011 401k membership
Total participants, beginning-of-year2011-06-01145
Total number of active participants reported on line 7a of the Form 55002011-06-01144
Number of retired or separated participants receiving benefits2011-06-012
Total of all active and inactive participants2011-06-01146
2010: HEAVY MACHINES, INC. EMPLOYEE HEALTH & LIFE BENEFITS PLAN 2010 401k membership
Total participants, beginning-of-year2010-06-01143
Total number of active participants reported on line 7a of the Form 55002010-06-01148
Number of retired or separated participants receiving benefits2010-06-012
Number of other retired or separated participants entitled to future benefits2010-06-010
Total of all active and inactive participants2010-06-01150
2009: HEAVY MACHINES, INC. EMPLOYEE HEALTH & LIFE BENEFITS PLAN 2009 401k membership
Total participants, beginning-of-year2009-06-01145
Total number of active participants reported on line 7a of the Form 55002009-06-01102
Number of retired or separated participants receiving benefits2009-06-011
Total of all active and inactive participants2009-06-01103
Total participants2009-06-010

Form 5500 Responses for HEAVY MACHINES, INC. EMPLOYEE HEALTH & LIFE BENEFITS PLAN

2022: HEAVY MACHINES, INC. EMPLOYEE HEALTH & LIFE BENEFITS PLAN 2022 form 5500 responses
2022-06-01Type of plan entitySingle employer plan
2022-06-01Submission has been amendedNo
2022-06-01This submission is the final filingNo
2022-06-01This return/report is a short plan year return/report (less than 12 months)Yes
2022-06-01Plan is a collectively bargained planNo
2022-06-01Plan funding arrangement – InsuranceYes
2022-06-01Plan benefit arrangement – InsuranceYes
2021: HEAVY MACHINES, INC. EMPLOYEE HEALTH & LIFE BENEFITS PLAN 2021 form 5500 responses
2021-06-01Type of plan entitySingle employer plan
2021-06-01Submission has been amendedNo
2021-06-01This submission is the final filingNo
2021-06-01This return/report is a short plan year return/report (less than 12 months)No
2021-06-01Plan is a collectively bargained planNo
2021-06-01Plan funding arrangement – InsuranceYes
2021-06-01Plan benefit arrangement – InsuranceYes
2020: HEAVY MACHINES, INC. EMPLOYEE HEALTH & LIFE BENEFITS PLAN 2020 form 5500 responses
2020-06-01Type of plan entitySingle employer plan
2020-06-01Submission has been amendedNo
2020-06-01This submission is the final filingNo
2020-06-01This return/report is a short plan year return/report (less than 12 months)No
2020-06-01Plan is a collectively bargained planNo
2020-06-01Plan funding arrangement – InsuranceYes
2020-06-01Plan benefit arrangement – InsuranceYes
2019: HEAVY MACHINES, INC. EMPLOYEE HEALTH & LIFE BENEFITS PLAN 2019 form 5500 responses
2019-06-01Type of plan entitySingle employer plan
2019-06-01Submission has been amendedNo
2019-06-01This submission is the final filingNo
2019-06-01This return/report is a short plan year return/report (less than 12 months)No
2019-06-01Plan is a collectively bargained planNo
2019-06-01Plan funding arrangement – InsuranceYes
2019-06-01Plan benefit arrangement – InsuranceYes
2018: HEAVY MACHINES, INC. EMPLOYEE HEALTH & LIFE BENEFITS PLAN 2018 form 5500 responses
2018-06-01Type of plan entitySingle employer plan
2018-06-01Submission has been amendedNo
2018-06-01This submission is the final filingNo
2018-06-01This return/report is a short plan year return/report (less than 12 months)No
2018-06-01Plan is a collectively bargained planNo
2018-06-01Plan funding arrangement – InsuranceYes
2018-06-01Plan benefit arrangement – InsuranceYes
2017: HEAVY MACHINES, INC. EMPLOYEE HEALTH & LIFE BENEFITS PLAN 2017 form 5500 responses
2017-06-01Type of plan entitySingle employer plan
2017-06-01Submission has been amendedNo
2017-06-01This submission is the final filingNo
2017-06-01This return/report is a short plan year return/report (less than 12 months)No
2017-06-01Plan is a collectively bargained planNo
2017-06-01Plan funding arrangement – InsuranceYes
2017-06-01Plan benefit arrangement – InsuranceYes
2016: HEAVY MACHINES, INC. EMPLOYEE HEALTH & LIFE BENEFITS PLAN 2016 form 5500 responses
2016-06-01Type of plan entitySingle employer plan
2016-06-01Submission has been amendedNo
2016-06-01This submission is the final filingNo
2016-06-01This return/report is a short plan year return/report (less than 12 months)No
2016-06-01Plan is a collectively bargained planNo
2016-06-01Plan funding arrangement – InsuranceYes
2016-06-01Plan benefit arrangement – InsuranceYes
2015: HEAVY MACHINES, INC. EMPLOYEE HEALTH & LIFE BENEFITS PLAN 2015 form 5500 responses
2015-06-01Type of plan entitySingle employer plan
2015-06-01Submission has been amendedNo
2015-06-01This submission is the final filingNo
2015-06-01This return/report is a short plan year return/report (less than 12 months)No
2015-06-01Plan is a collectively bargained planNo
2015-06-01Plan funding arrangement – InsuranceYes
2015-06-01Plan benefit arrangement – InsuranceYes
2014: HEAVY MACHINES, INC. EMPLOYEE HEALTH & LIFE BENEFITS PLAN 2014 form 5500 responses
2014-06-01Type of plan entitySingle employer plan
2014-06-01Submission has been amendedNo
2014-06-01This submission is the final filingNo
2014-06-01This return/report is a short plan year return/report (less than 12 months)No
2014-06-01Plan is a collectively bargained planNo
2014-06-01Plan funding arrangement – InsuranceYes
2014-06-01Plan benefit arrangement – InsuranceYes
2013: HEAVY MACHINES, INC. EMPLOYEE HEALTH & LIFE BENEFITS PLAN 2013 form 5500 responses
2013-06-01Type of plan entitySingle employer plan
2013-06-01Submission has been amendedNo
2013-06-01This submission is the final filingNo
2013-06-01This return/report is a short plan year return/report (less than 12 months)No
2013-06-01Plan is a collectively bargained planNo
2013-06-01Plan funding arrangement – InsuranceYes
2013-06-01Plan benefit arrangement – InsuranceYes
2012: HEAVY MACHINES, INC. EMPLOYEE HEALTH & LIFE BENEFITS PLAN 2012 form 5500 responses
2012-06-01Type of plan entitySingle employer plan
2012-06-01Submission has been amendedNo
2012-06-01This submission is the final filingNo
2012-06-01This return/report is a short plan year return/report (less than 12 months)No
2012-06-01Plan is a collectively bargained planNo
2012-06-01Plan funding arrangement – InsuranceYes
2012-06-01Plan benefit arrangement – InsuranceYes
2011: HEAVY MACHINES, INC. EMPLOYEE HEALTH & LIFE BENEFITS PLAN 2011 form 5500 responses
2011-06-01Type of plan entitySingle employer plan
2011-06-01Submission has been amendedNo
2011-06-01This submission is the final filingNo
2011-06-01This return/report is a short plan year return/report (less than 12 months)No
2011-06-01Plan is a collectively bargained planNo
2011-06-01Plan funding arrangement – InsuranceYes
2011-06-01Plan benefit arrangement – InsuranceYes
2010: HEAVY MACHINES, INC. EMPLOYEE HEALTH & LIFE BENEFITS PLAN 2010 form 5500 responses
2010-06-01Type of plan entitySingle employer plan
2010-06-01Submission has been amendedNo
2010-06-01This submission is the final filingNo
2010-06-01This return/report is a short plan year return/report (less than 12 months)No
2010-06-01Plan is a collectively bargained planNo
2010-06-01Plan funding arrangement – InsuranceYes
2010-06-01Plan benefit arrangement – InsuranceYes
2009: HEAVY MACHINES, INC. EMPLOYEE HEALTH & LIFE BENEFITS PLAN 2009 form 5500 responses
2009-06-01Type of plan entitySingle employer plan
2009-06-01Submission has been amendedNo
2009-06-01This submission is the final filingNo
2009-06-01This return/report is a short plan year return/report (less than 12 months)No
2009-06-01Plan is a collectively bargained planNo
2009-06-01Plan funding arrangement – InsuranceYes
2009-06-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00553656
Policy instance 3
Insurance contract or identification number00553656
Number of Individuals Covered153
Insurance policy start date2022-06-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $24,707
Total amount of fees paid to insurance companyUSD $10,529
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D, OPTIONAL AD&D, OPTIONAL LIFE, VOLUNTARY CRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $197,276
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $24,707
Amount paid for insurance broker fees10529
Insurance broker organization code?3
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract numberHCCLOT40099
Policy instance 2
Insurance contract or identification numberHCCLOT40099
Number of Individuals Covered119
Insurance policy start date2022-06-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedORGAN TRANSPLANT
Welfare Benefit Premiums Paid to CarrierUSD $20,816
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract numberHCL32651
Policy instance 1
Insurance contract or identification numberHCL32651
Number of Individuals Covered119
Insurance policy start date2022-06-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $43,102
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $433,172
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $43,102
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00553656
Policy instance 3
Insurance contract or identification number00553656
Number of Individuals Covered153
Insurance policy start date2021-10-01
Insurance policy end date2022-05-31
Total amount of commissions paid to insurance brokerUSD $24,707
Total amount of fees paid to insurance companyUSD $10,529
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D, OPTIONAL AD&D, OPTIONAL LIFE, VOLUNTARY CRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $197,276
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $24,707
Amount paid for insurance broker fees10529
Insurance broker organization code?3
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract numberHCCLOT40099
Policy instance 2
Insurance contract or identification numberHCCLOT40099
Number of Individuals Covered119
Insurance policy start date2021-06-01
Insurance policy end date2022-05-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedORGAN TRANSPLANT
Welfare Benefit Premiums Paid to CarrierUSD $20,816
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract numberHCL32651
Policy instance 1
Insurance contract or identification numberHCL32651
Number of Individuals Covered119
Insurance policy start date2021-06-01
Insurance policy end date2022-05-31
Total amount of commissions paid to insurance brokerUSD $43,102
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $433,172
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $43,102
Insurance broker organization code?3
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract numberHCL32651
Policy instance 1
Insurance contract or identification numberHCL32651
Number of Individuals Covered102
Insurance policy start date2020-06-01
Insurance policy end date2021-05-31
Total amount of commissions paid to insurance brokerUSD $46,257
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $464,756
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $46,257
Insurance broker organization code?3
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract numberHCCLOT40099
Policy instance 2
Insurance contract or identification numberHCCLOT40099
Number of Individuals Covered102
Insurance policy start date2020-06-01
Insurance policy end date2021-05-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedORGAN TRANSPLANT
Welfare Benefit Premiums Paid to CarrierUSD $22,324
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00553656
Policy instance 3
Insurance contract or identification number00553656
Number of Individuals Covered134
Insurance policy start date2020-10-01
Insurance policy end date2021-05-31
Total amount of commissions paid to insurance brokerUSD $24,515
Total amount of fees paid to insurance companyUSD $54
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D, OPTIONAL AD&D, OPTIONAL LIFE, VOLUNTARY CRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $197,193
Commission paid to Insurance BrokerUSD $24,515
Amount paid for insurance broker fees54
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00553656
Policy instance 3
Insurance contract or identification number00553656
Number of Individuals Covered159
Insurance policy start date2019-10-01
Insurance policy end date2020-05-31
Total amount of commissions paid to insurance brokerUSD $25,188
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D, OPTIONAL AD&D, OPTIONAL LIFE
Welfare Benefit Premiums Paid to CarrierUSD $207,237
Commission paid to Insurance BrokerUSD $25,188
Insurance broker organization code?3
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract numberHCCLOT40099
Policy instance 2
Insurance contract or identification numberHCCLOT40099
Number of Individuals Covered132
Insurance policy start date2019-06-01
Insurance policy end date2020-05-31
Other welfare benefits providedORGAN TRANSPLANT
Welfare Benefit Premiums Paid to CarrierUSD $20,194
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )
Policy contract numberHCL32651
Policy instance 1
Insurance contract or identification numberHCL32651
Number of Individuals Covered135
Insurance policy start date2019-06-01
Insurance policy end date2020-05-31
Total amount of commissions paid to insurance brokerUSD $54,350
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $547,762
Commission paid to Insurance BrokerUSD $2,024
Insurance broker organization code?3
Amount paid for insurance broker fees0
BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )
Policy contract number129336
Policy instance 5
Insurance contract or identification number129336
Number of Individuals Covered0
Insurance policy start date2018-10-01
Insurance policy end date2018-09-30
Total amount of commissions paid to insurance brokerUSD $1,987
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $25,213
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,987
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010221464
Policy instance 4
Insurance contract or identification number000010221464
Number of Individuals Covered136
Insurance policy start date2018-10-01
Insurance policy end date2019-05-31
Total amount of commissions paid to insurance brokerUSD $1,654
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $11,028
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,654
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00553656
Policy instance 3
Insurance contract or identification number00553656
Number of Individuals Covered152
Insurance policy start date2018-10-01
Insurance policy end date2019-05-31
Total amount of commissions paid to insurance brokerUSD $16,569
Total amount of fees paid to insurance companyUSD $1,184
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D, OPTIONAL AD&D, OPTIONAL LIFE
Welfare Benefit Premiums Paid to CarrierUSD $138,102
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,569
Amount paid for insurance broker fees1184
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010221463
Policy instance 2
Insurance contract or identification number000010221463
Number of Individuals Covered273
Insurance policy start date2018-10-01
Insurance policy end date2019-05-31
Total amount of commissions paid to insurance brokerUSD $1,041
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $6,940
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,041
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000400001000
Policy instance 1
Insurance contract or identification number000400001000
Number of Individuals Covered150
Insurance policy start date2018-10-01
Insurance policy end date2019-05-31
Total amount of commissions paid to insurance brokerUSD $1,648
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedVOLUNTARY, SPOUSE, CHILD AD&D
Welfare Benefit Premiums Paid to CarrierUSD $10,986
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,648
Insurance broker organization code?3
BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )
Policy contract number129336
Policy instance 4
Insurance contract or identification number129336
Number of Individuals Covered243
Insurance policy start date2017-10-01
Insurance policy end date2018-05-31
Total amount of commissions paid to insurance brokerUSD $9,664
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $82,826
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010221464
Policy instance 3
Insurance contract or identification number000010221464
Number of Individuals Covered145
Insurance policy start date2017-10-01
Insurance policy end date2018-05-31
Total amount of commissions paid to insurance brokerUSD $4,882
Total amount of fees paid to insurance companyUSD $79
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $32,549
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010221463
Policy instance 2
Insurance contract or identification number000010221463
Number of Individuals Covered289
Insurance policy start date2017-10-01
Insurance policy end date2018-05-31
Total amount of commissions paid to insurance brokerUSD $3,052
Total amount of fees paid to insurance companyUSD $49
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $20,345
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000400001000
Policy instance 1
Insurance contract or identification number000400001000
Number of Individuals Covered153
Insurance policy start date2017-10-01
Insurance policy end date2018-05-31
Total amount of commissions paid to insurance brokerUSD $5,431
Total amount of fees paid to insurance companyUSD $96
Life Insurance Welfare BenefitYes
Other welfare benefits providedVOLUNTARY, SPOUSE, CHILD AD&D
Welfare Benefit Premiums Paid to CarrierUSD $36,204
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 numberG000ARMI
Policy instance 1
Insurance contract or identification numberG000ARMI
Number of Individuals Covered338
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $12,714
Total amount of fees paid to insurance companyUSD $2,292
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $84,752
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,713
Amount paid for insurance broker fees2292
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
Insurance broker nameJAS. D. COLLIER & CO.
BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )
Policy contract number129336
Policy instance 2
Insurance contract or identification number129336
Number of Individuals Covered293
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $51,355
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $890,261
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $51,355
Insurance broker organization code?3
Insurance broker nameWENDELL DYSON
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000ARMI
Policy instance 1
Insurance contract or identification numberG000ARMI
Number of Individuals Covered387
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $13,111
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $87,407
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,111
Insurance broker organization code?3
Insurance broker nameCLAY & LAND INS INC
BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )
Policy contract number129336
Policy instance 2
Insurance contract or identification number129336
Number of Individuals Covered286
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $49,775
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $960,466
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $49,775
Insurance broker organization code?3
Insurance broker nameWENDELL DYSON
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number837852
Policy instance 1
Insurance contract or identification number837852
Number of Individuals Covered356
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $65,956
Total amount of fees paid to insurance companyUSD $1,139
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $1,060,237
Commission paid to Insurance BrokerUSD $65,956
Amount paid for insurance broker fees1139
Additional information about fees paid to insurance brokerPM CROSS-SALE
Insurance broker organization code?3
Insurance broker nameCLAY AND LAND INSURANCE INC
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number837852
Policy instance 1
Insurance contract or identification number837852
Number of Individuals Covered229
Insurance policy start date2012-02-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $51,562
Total amount of fees paid to insurance companyUSD $5,721
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $905,416
Commission paid to Insurance BrokerUSD $51,562
Amount paid for insurance broker fees5721
Additional information about fees paid to insurance brokerPM CROSS-SALE
Insurance broker organization code?3
Insurance broker nameCLAY AND LAND INSURANCE INC
BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )
Policy contract number118646
Policy instance 1
Insurance contract or identification number118646
Number of Individuals Covered242
Insurance policy start date2011-02-01
Insurance policy end date2012-01-31
Total amount of commissions paid to insurance brokerUSD $44,458
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,008,868
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number004156828
Policy instance 2
Insurance contract or identification number004156828
Number of Individuals Covered148
Insurance policy start date2010-08-01
Insurance policy end date2012-01-31
Total amount of commissions paid to insurance brokerUSD $17,043
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $177,748
BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )
Policy contract number118646
Policy instance 1
Insurance contract or identification number118646
Number of Individuals Covered245
Insurance policy start date2010-02-01
Insurance policy end date2011-01-31
Total amount of commissions paid to insurance brokerUSD $43,053
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $978,880
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number010-032068
Policy instance 3
Insurance contract or identification number010-032068
Number of Individuals Covered180
Insurance policy start date2009-08-09
Insurance policy end date2010-07-31
Total amount of commissions paid to insurance brokerUSD $2,696
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $60,064
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AAAZ
Policy instance 2
Insurance contract or identification numberG000AAAZ
Number of Individuals Covered144
Insurance policy start date2010-04-01
Insurance policy end date2011-04-01
Total amount of commissions paid to insurance brokerUSD $6,880
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $39,203

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