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AFFORDABLE RENT TO OWN, LLC GROUP BENEFITS PLAN 401k Plan overview

Plan NameAFFORDABLE RENT TO OWN, LLC GROUP BENEFITS PLAN
Plan identification number 501

AFFORDABLE RENT TO OWN, LLC GROUP BENEFITS PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

AFFORDABLE RENT TO OWN, LLC has sponsored the creation of one or more 401k plans.

Company Name:AFFORDABLE RENT TO OWN, LLC
Employer identification number (EIN):721147185
NAIC Classification:532210
NAIC Description:Consumer Electronics and Appliances Rental

Form 5500 Filing Information

Submission information for form 5500 for 401k plan AFFORDABLE RENT TO OWN, LLC GROUP BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01DAVE ANDREW2023-05-03
5012021-01-01DAVE ANDREW2022-07-28
5012020-01-01DAVE ANDREW2021-07-14
5012019-01-01DAVE ANDREW2020-05-04
5012018-01-01
5012017-01-01
5012016-01-01DAVID ANDREW
5012015-01-01CHRIS OVERTON
5012014-01-01CHRIS OVERTON
5012013-01-01CHRIS OVERTON CHRIS OVERTON2014-10-01
5012012-01-01CHRIS OVERTON
5012011-01-01SHARON HEARN
5012010-01-01SHARON HEARN
5012009-01-01SHARON HEARN
5012008-01-01SHARON HEARN
5012007-01-01SHARON HEARN
5012006-01-01SHARON HEARN
5012005-01-01SHARON HEARN
5012004-01-01SHARON HEARN
5012003-01-01SHARON HEARN
5012002-01-01SHARON HEARN
5012001-01-01SHARON HEARN
5012000-01-01SHARON HEARN

Plan Statistics for AFFORDABLE RENT TO OWN, LLC GROUP BENEFITS PLAN

401k plan membership statisitcs for AFFORDABLE RENT TO OWN, LLC GROUP BENEFITS PLAN

Measure Date Value
2022: AFFORDABLE RENT TO OWN, LLC GROUP BENEFITS PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01259
Total number of active participants reported on line 7a of the Form 55002022-01-01280
Number of retired or separated participants receiving benefits2022-01-011
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-01281
Number of employers contributing to the scheme2022-01-010
2021: AFFORDABLE RENT TO OWN, LLC GROUP BENEFITS PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01288
Total number of active participants reported on line 7a of the Form 55002021-01-01259
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-01259
Number of employers contributing to the scheme2021-01-010
2020: AFFORDABLE RENT TO OWN, LLC GROUP BENEFITS PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01319
Total number of active participants reported on line 7a of the Form 55002020-01-01299
Number of retired or separated participants receiving benefits2020-01-011
Number of other retired or separated participants entitled to future benefits2020-01-011
Total of all active and inactive participants2020-01-01301
Number of employers contributing to the scheme2020-01-010
2019: AFFORDABLE RENT TO OWN, LLC GROUP BENEFITS PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01336
Total number of active participants reported on line 7a of the Form 55002019-01-01329
Number of retired or separated participants receiving benefits2019-01-012
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-01331
Number of employers contributing to the scheme2019-01-010
2018: AFFORDABLE RENT TO OWN, LLC GROUP BENEFITS PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01242
Total number of active participants reported on line 7a of the Form 55002018-01-01273
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-013
Total of all active and inactive participants2018-01-01276
Number of employers contributing to the scheme2018-01-010
2017: AFFORDABLE RENT TO OWN, LLC GROUP BENEFITS PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01266
Total number of active participants reported on line 7a of the Form 55002017-01-01241
Number of retired or separated participants receiving benefits2017-01-011
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-01242
2016: AFFORDABLE RENT TO OWN, LLC GROUP BENEFITS PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01290
Total number of active participants reported on line 7a of the Form 55002016-01-01266
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-01266
2015: AFFORDABLE RENT TO OWN, LLC GROUP BENEFITS PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01253
Total number of active participants reported on line 7a of the Form 55002015-01-01290
Total of all active and inactive participants2015-01-01290
Total participants2015-01-01290
2014: AFFORDABLE RENT TO OWN, LLC GROUP BENEFITS PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01253
Total number of active participants reported on line 7a of the Form 55002014-01-01253
Total of all active and inactive participants2014-01-01253
Total participants2014-01-01253
2013: AFFORDABLE RENT TO OWN, LLC GROUP BENEFITS PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01251
Total number of active participants reported on line 7a of the Form 55002013-01-01251
Total of all active and inactive participants2013-01-01251
Total participants2013-01-01251
2012: AFFORDABLE RENT TO OWN, LLC GROUP BENEFITS PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01227
Total number of active participants reported on line 7a of the Form 55002012-01-01251
Total of all active and inactive participants2012-01-01251
Total participants2012-01-01251
2011: AFFORDABLE RENT TO OWN, LLC GROUP BENEFITS PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01256
Total number of active participants reported on line 7a of the Form 55002011-01-01277
Total of all active and inactive participants2011-01-01277
Total participants2011-01-01277
2010: AFFORDABLE RENT TO OWN, LLC GROUP BENEFITS PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-01263
Total number of active participants reported on line 7a of the Form 55002010-01-01256
Total of all active and inactive participants2010-01-01256
Total participants2010-01-01256
2009: AFFORDABLE RENT TO OWN, LLC GROUP BENEFITS PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01257
Total number of active participants reported on line 7a of the Form 55002009-01-01263
Total of all active and inactive participants2009-01-01263
Total participants2009-01-01263
2008: AFFORDABLE RENT TO OWN, LLC GROUP BENEFITS PLAN 2008 401k membership
Total participants, beginning-of-year2008-01-01243
Total number of active participants reported on line 7a of the Form 55002008-01-01257
Total of all active and inactive participants2008-01-01257
Total participants2008-01-01257
2007: AFFORDABLE RENT TO OWN, LLC GROUP BENEFITS PLAN 2007 401k membership
Total participants, beginning-of-year2007-01-01208
Total number of active participants reported on line 7a of the Form 55002007-01-01243
Total of all active and inactive participants2007-01-01243
Total participants2007-01-01243
2006: AFFORDABLE RENT TO OWN, LLC GROUP BENEFITS PLAN 2006 401k membership
Total participants, beginning-of-year2006-01-01205
Total number of active participants reported on line 7a of the Form 55002006-01-01208
Total of all active and inactive participants2006-01-01208
Total participants2006-01-01208
2005: AFFORDABLE RENT TO OWN, LLC GROUP BENEFITS PLAN 2005 401k membership
Total participants, beginning-of-year2005-01-01180
Total number of active participants reported on line 7a of the Form 55002005-01-01205
Total of all active and inactive participants2005-01-01205
Total participants2005-01-01205
2004: AFFORDABLE RENT TO OWN, LLC GROUP BENEFITS PLAN 2004 401k membership
Total participants, beginning-of-year2004-01-01184
Total number of active participants reported on line 7a of the Form 55002004-01-01180
Total of all active and inactive participants2004-01-01180
Total participants2004-01-01180
2003: AFFORDABLE RENT TO OWN, LLC GROUP BENEFITS PLAN 2003 401k membership
Total participants, beginning-of-year2003-01-01180
Total number of active participants reported on line 7a of the Form 55002003-01-01184
Total of all active and inactive participants2003-01-01184
Total participants2003-01-01184
2002: AFFORDABLE RENT TO OWN, LLC GROUP BENEFITS PLAN 2002 401k membership
Total participants, beginning-of-year2002-01-01147
Total number of active participants reported on line 7a of the Form 55002002-01-01180
Total of all active and inactive participants2002-01-01180
Total participants2002-01-01180
2001: AFFORDABLE RENT TO OWN, LLC GROUP BENEFITS PLAN 2001 401k membership
Total participants, beginning-of-year2001-01-01132
Total number of active participants reported on line 7a of the Form 55002001-01-01147
Total of all active and inactive participants2001-01-01147
Total participants2001-01-01147
2000: AFFORDABLE RENT TO OWN, LLC GROUP BENEFITS PLAN 2000 401k membership
Total participants, beginning-of-year2000-01-01108
Total number of active participants reported on line 7a of the Form 55002000-01-01132
Total of all active and inactive participants2000-01-01132
Total participants2000-01-01132

Form 5500 Responses for AFFORDABLE RENT TO OWN, LLC GROUP BENEFITS PLAN

2022: AFFORDABLE RENT TO OWN, LLC GROUP BENEFITS PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: AFFORDABLE RENT TO OWN, LLC GROUP BENEFITS PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: AFFORDABLE RENT TO OWN, LLC GROUP BENEFITS PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: AFFORDABLE RENT TO OWN, LLC GROUP BENEFITS PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – General assets of the sponsorYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – General assets of the sponsorYes
2018: AFFORDABLE RENT TO OWN, LLC GROUP BENEFITS PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: AFFORDABLE RENT TO OWN, LLC GROUP BENEFITS PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: AFFORDABLE RENT TO OWN, LLC GROUP BENEFITS PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – General assets of the sponsorYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – General assets of the sponsorYes
2015: AFFORDABLE RENT TO OWN, LLC GROUP BENEFITS PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – General assets of the sponsorYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – General assets of the sponsorYes
2014: AFFORDABLE RENT TO OWN, LLC GROUP BENEFITS PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – General assets of the sponsorYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – General assets of the sponsorYes
2013: AFFORDABLE RENT TO OWN, LLC GROUP BENEFITS PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – General assets of the sponsorYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – General assets of the sponsorYes
2012: AFFORDABLE RENT TO OWN, LLC GROUP BENEFITS PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – General assets of the sponsorYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – General assets of the sponsorYes
2011: AFFORDABLE RENT TO OWN, LLC GROUP BENEFITS PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – General assets of the sponsorYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – General assets of the sponsorYes
2010: AFFORDABLE RENT TO OWN, LLC GROUP BENEFITS PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedNo
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan funding arrangement – General assets of the sponsorYes
2010-01-01Plan benefit arrangement – InsuranceYes
2010-01-01Plan benefit arrangement – General assets of the sponsorYes
2009: AFFORDABLE RENT TO OWN, LLC GROUP BENEFITS PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – General assets of the sponsorYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – General assets of the sponsorYes
2008: AFFORDABLE RENT TO OWN, LLC GROUP BENEFITS PLAN 2008 form 5500 responses
2008-01-01Type of plan entitySingle employer plan
2008-01-01Submission has been amendedNo
2008-01-01This submission is the final filingNo
2008-01-01This return/report is a short plan year return/report (less than 12 months)No
2008-01-01Plan is a collectively bargained planNo
2008-01-01Plan funding arrangement – InsuranceYes
2008-01-01Plan funding arrangement – General assets of the sponsorYes
2008-01-01Plan benefit arrangement – InsuranceYes
2008-01-01Plan benefit arrangement – General assets of the sponsorYes
2007: AFFORDABLE RENT TO OWN, LLC GROUP BENEFITS PLAN 2007 form 5500 responses
2007-01-01Type of plan entitySingle employer plan
2007-01-01Submission has been amendedNo
2007-01-01This submission is the final filingNo
2007-01-01This return/report is a short plan year return/report (less than 12 months)No
2007-01-01Plan is a collectively bargained planNo
2007-01-01Plan funding arrangement – InsuranceYes
2007-01-01Plan funding arrangement – General assets of the sponsorYes
2007-01-01Plan benefit arrangement – InsuranceYes
2007-01-01Plan benefit arrangement – General assets of the sponsorYes
2006: AFFORDABLE RENT TO OWN, LLC GROUP BENEFITS PLAN 2006 form 5500 responses
2006-01-01Type of plan entitySingle employer plan
2006-01-01Submission has been amendedNo
2006-01-01This submission is the final filingNo
2006-01-01This return/report is a short plan year return/report (less than 12 months)No
2006-01-01Plan is a collectively bargained planNo
2006-01-01Plan funding arrangement – General assets of the sponsorYes
2006-01-01Plan benefit arrangement – General assets of the sponsorYes
2005: AFFORDABLE RENT TO OWN, LLC GROUP BENEFITS PLAN 2005 form 5500 responses
2005-01-01Type of plan entitySingle employer plan
2005-01-01Submission has been amendedNo
2005-01-01This submission is the final filingNo
2005-01-01This return/report is a short plan year return/report (less than 12 months)No
2005-01-01Plan is a collectively bargained planNo
2005-01-01Plan funding arrangement – General assets of the sponsorYes
2005-01-01Plan benefit arrangement – General assets of the sponsorYes
2004: AFFORDABLE RENT TO OWN, LLC GROUP BENEFITS PLAN 2004 form 5500 responses
2004-01-01Type of plan entitySingle employer plan
2004-01-01Submission has been amendedNo
2004-01-01This submission is the final filingNo
2004-01-01This return/report is a short plan year return/report (less than 12 months)No
2004-01-01Plan is a collectively bargained planNo
2004-01-01Plan funding arrangement – InsuranceYes
2004-01-01Plan benefit arrangement – InsuranceYes
2003: AFFORDABLE RENT TO OWN, LLC GROUP BENEFITS PLAN 2003 form 5500 responses
2003-01-01Type of plan entitySingle employer plan
2003-01-01Submission has been amendedNo
2003-01-01This submission is the final filingNo
2003-01-01This return/report is a short plan year return/report (less than 12 months)No
2003-01-01Plan is a collectively bargained planNo
2003-01-01Plan funding arrangement – InsuranceYes
2003-01-01Plan benefit arrangement – InsuranceYes
2002: AFFORDABLE RENT TO OWN, LLC GROUP BENEFITS PLAN 2002 form 5500 responses
2002-01-01Type of plan entitySingle employer plan
2002-01-01Submission has been amendedNo
2002-01-01This submission is the final filingNo
2002-01-01This return/report is a short plan year return/report (less than 12 months)No
2002-01-01Plan is a collectively bargained planNo
2002-01-01Plan funding arrangement – InsuranceYes
2002-01-01Plan benefit arrangement – InsuranceYes
2001: AFFORDABLE RENT TO OWN, LLC GROUP BENEFITS PLAN 2001 form 5500 responses
2001-01-01Type of plan entitySingle employer plan
2001-01-01Submission has been amendedNo
2001-01-01This submission is the final filingNo
2001-01-01This return/report is a short plan year return/report (less than 12 months)No
2001-01-01Plan is a collectively bargained planNo
2001-01-01Plan funding arrangement – InsuranceYes
2001-01-01Plan benefit arrangement – InsuranceYes
2000: AFFORDABLE RENT TO OWN, LLC GROUP BENEFITS PLAN 2000 form 5500 responses
2000-01-01Type of plan entitySingle employer plan
2000-01-01First time form 5500 has been submittedYes
2000-01-01Submission has been amendedNo
2000-01-01This submission is the final filingNo
2000-01-01This return/report is a short plan year return/report (less than 12 months)No
2000-01-01Plan is a collectively bargained planNo
2000-01-01Plan funding arrangement – InsuranceYes
2000-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

MERITAIN HEALTH (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract numberD4191
Policy instance 1
Insurance contract or identification numberD4191
Number of Individuals Covered177
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $7,142
Total amount of fees paid to insurance companyUSD $8,570
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Welfare Benefit Premiums Paid to CarrierUSD $71,420
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,142
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerADMIN FEES
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLLV0BMRJ
Policy instance 2
Insurance contract or identification numberGLLV0BMRJ
Number of Individuals Covered256
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $19,123
Total amount of fees paid to insurance companyUSD $12,860
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $134,217
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,123
Amount paid for insurance broker fees3421
Additional information about fees paid to insurance brokerADMINISTRATION
Insurance broker organization code?3
MERITAIN HEALTH (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract numberD4191
Policy instance 1
Insurance contract or identification numberD4191
Number of Individuals Covered212
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $7,586
Total amount of fees paid to insurance companyUSD $9,103
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Welfare Benefit Premiums Paid to CarrierUSD $75,859
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,586
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerADMINISTRATION FEES
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLLV0BMRJ
Policy instance 2
Insurance contract or identification numberGLLV0BMRJ
Number of Individuals Covered268
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $19,155
Total amount of fees paid to insurance companyUSD $14,601
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $134,821
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,155
Amount paid for insurance broker fees14601
Additional information about fees paid to insurance brokerOTHER COMPENSATION, ADMINISTRATION
Insurance broker organization code?3
MERITAIN HEALTH (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract numberD4191
Policy instance 1
Insurance contract or identification numberD4191
Number of Individuals Covered222
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $7,859
Total amount of fees paid to insurance companyUSD $9,430
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Welfare Benefit Premiums Paid to CarrierUSD $78,586
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,859
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerADMINISTRATION FEES
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLLV0BMRJ
Policy instance 2
Insurance contract or identification numberGLLV0BMRJ
Number of Individuals Covered279
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $18,812
Total amount of fees paid to insurance companyUSD $1,639
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $133,200
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $18,812
Amount paid for insurance broker fees1639
Additional information about fees paid to insurance brokerADMINISTRATION
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number5941489
Policy instance 1
Insurance contract or identification number5941489
Number of Individuals Covered375
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $19,557
Total amount of fees paid to insurance companyUSD $54
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $131,203
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,948
Amount paid for insurance broker fees54
Additional information about fees paid to insurance brokerNON-MONETARY COMPENSATION
Insurance broker organization code?3
MERITAIN HEALTH (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract numberD4191
Policy instance 2
Insurance contract or identification numberD4191
Number of Individuals Covered376
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $7,709
Total amount of fees paid to insurance companyUSD $9,251
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Welfare Benefit Premiums Paid to CarrierUSD $77,090
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,709
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerADMINISTRATIVE FEES
MERITAIN HEALTH (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract numberD4191
Policy instance 2
Insurance contract or identification numberD4191
Number of Individuals Covered256
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $7,034
Total amount of fees paid to insurance companyUSD $8,441
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $70,339
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,034
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerADMIN FEES
STARMOUNT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68985 )
Policy contract numberAFFR317
Policy instance 3
Insurance contract or identification numberAFFR317
Number of Individuals Covered214
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $2,399
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $21,936
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,399
Amount paid for insurance broker fees0
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number5941489
Policy instance 1
Insurance contract or identification number5941489
Number of Individuals Covered273
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $11,144
Total amount of fees paid to insurance companyUSD $1,169
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $81,315
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $11,144
Amount paid for insurance broker fees1169
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number5941489
Policy instance 1
Insurance contract or identification number5941489
Number of Individuals Covered225
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $11,333
Total amount of fees paid to insurance companyUSD $1,232
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $61,509
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,333
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker nameHUB INTERNATIONAL INS SVCES INC
MERITAIN HEALTH (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract numberD4191
Policy instance 2
Insurance contract or identification numberD4191
Number of Individuals Covered285
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $7,314
Total amount of fees paid to insurance companyUSD $8,777
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $73,141
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,314
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerADMIN FEES
Insurance broker nameCRESCENT DENTAL PLAN
STARMOUNT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68985 )
Policy contract numberAFFR317
Policy instance 3
Insurance contract or identification numberAFFR317
Number of Individuals Covered174
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $1,951
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $17,993
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,951
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameHUB INTERNATIONAL INS. SVCES., INC.
AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )
Policy contract numberG-00606194
Policy instance 1
Insurance contract or identification numberG-00606194
Number of Individuals Covered185
Total amount of commissions paid to insurance brokerUSD $33,924
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $113,079
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $22,616
Amount paid for insurance broker fees11308
Insurance broker organization code?3
Insurance broker nameASSOCIATED BENEFITS PLAN, INC.
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number2AFF708
Policy instance 2
Insurance contract or identification number2AFF708
Number of Individuals Covered160
Total amount of commissions paid to insurance brokerUSD $2,141
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $19,718
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,141
Insurance broker organization code?3
Insurance broker nameASSOCIATED BENEFITS PLAN, INC
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract numberD4191
Policy instance 3
Insurance contract or identification numberD4191
Number of Individuals Covered290
Insurance policy start date2015-01-01
Insurance policy end date2016-12-31
Total amount of commissions paid to insurance brokerUSD $16,689
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $75,859
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,172
Insurance broker organization code?3
Insurance broker nameALFORD, STAPLES, LAPEYRE & ROBICHAU
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract number6112550825 000
Policy instance 4
Insurance contract or identification number6112550825 000
Number of Individuals Covered28
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $2,463
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $6,081
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $459
Insurance broker organization code?3
Insurance broker nameALFORD, STAPLES, LAPEYRE & ROBICHAU
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract number6112550825
Policy instance 1
Insurance contract or identification number6112550825
Number of Individuals Covered266
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $9,830
Total amount of fees paid to insurance companyUSD $8,880
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,809
Amount paid for insurance broker fees4809
Additional information about fees paid to insurance brokerADMINISTRATION
Insurance broker organization code?5
Insurance broker nameCRESCENT DENTAL EMPLOYEE BENEFIT
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract number6112550825
Policy instance 1
Insurance contract or identification number6112550825
Number of Individuals Covered268
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $9,365
Total amount of fees paid to insurance companyUSD $8,360
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,529
Amount paid for insurance broker fees4529
Additional information about fees paid to insurance brokerADMINISTRATION
Insurance broker organization code?5
Insurance broker nameCRESCENT DENTAL EMPLOYEE BENEFITS
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract number6112550825
Policy instance 1
Insurance contract or identification number6112550825
Number of Individuals Covered251
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $9,010
Total amount of fees paid to insurance companyUSD $8,074
Dental Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,134
Amount paid for insurance broker fees4134
Additional information about fees paid to insurance brokerGENERAL AGENT
Insurance broker organization code?3
Insurance broker nameMERITAIN HEALTH
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract number6112550825
Policy instance 1
Insurance contract or identification number6112550825
Number of Individuals Covered227
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $11,762
Total amount of fees paid to insurance companyUSD $4,049
Dental Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $67,436
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract number6112550825
Policy instance 1
Insurance contract or identification number6112550825
Number of Individuals Covered210
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $11,765
Total amount of fees paid to insurance companyUSD $4,507
Dental Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $64,181
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract number611250825
Policy instance 1
Insurance contract or identification number611250825
Number of Individuals Covered197
Insurance policy start date2008-01-01
Insurance policy end date2008-12-31
Total amount of commissions paid to insurance brokerUSD $8,976
Total amount of fees paid to insurance companyUSD $4,768
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $56,098
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract number6112550825
Policy instance 1
Insurance contract or identification number6112550825
Number of Individuals Covered169
Insurance policy start date2007-01-01
Insurance policy end date2007-12-31
Total amount of commissions paid to insurance brokerUSD $8,024
Total amount of fees paid to insurance companyUSD $4,263
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $50,153
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
WASHINGTON NATIONAL (National Association of Insurance Commissioners NAIC id number: 53742 )
Policy contract number44502
Policy instance 1
Insurance contract or identification number44502
Number of Individuals Covered180
Insurance policy start date2004-01-01
Insurance policy end date2004-12-31
Total amount of commissions paid to insurance brokerUSD $28,270
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $83,552
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
WASHINGTON NATIONAL (National Association of Insurance Commissioners NAIC id number: 53742 )
Policy contract number44502
Policy instance 1
Insurance contract or identification number44502
Number of Individuals Covered184
Insurance policy start date2003-01-01
Insurance policy end date2003-12-31
Total amount of commissions paid to insurance brokerUSD $2,724
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $15,402
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
WASHINGTON NATIONAL (National Association of Insurance Commissioners NAIC id number: 53742 )
Policy contract number44502
Policy instance 1
Insurance contract or identification number44502
Number of Individuals Covered180
Insurance policy start date2002-01-01
Insurance policy end date2002-12-31
Total amount of commissions paid to insurance brokerUSD $8,691
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $28,255
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
WASHINGTON NATIONAL (National Association of Insurance Commissioners NAIC id number: 53742 )
Policy contract number44502
Policy instance 1
Insurance contract or identification number44502
Number of Individuals Covered147
Insurance policy start date2001-01-01
Insurance policy end date2001-12-31
Total amount of commissions paid to insurance brokerUSD $11,993
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $38,208
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
WASHINGTON NATIONAL (National Association of Insurance Commissioners NAIC id number: 53742 )
Policy contract number44502
Policy instance 1
Insurance contract or identification number44502
Number of Individuals Covered132
Insurance policy start date2000-01-01
Insurance policy end date2000-12-31
Total amount of commissions paid to insurance brokerUSD $14,317
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $35,198
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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