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MCCLAIN'S RV INC PRE-TAX PREMIUM PLAN 401k Plan overview

Plan NameMCCLAIN'S RV INC PRE-TAX PREMIUM PLAN
Plan identification number 501

MCCLAIN'S RV INC PRE-TAX PREMIUM 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
  • Other welfare benefit cover

401k Sponsoring company profile

MCCLAINS RV, INC. has sponsored the creation of one or more 401k plans.

Company Name:MCCLAINS RV, INC.
Employer identification number (EIN):730804037
NAIC Classification:441210
NAIC Description:Recreational Vehicle Dealers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MCCLAIN'S RV INC PRE-TAX PREMIUM PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01 SANDRA DURAN2023-10-04
5012021-01-01
5012020-01-01
5012019-01-01
5012018-01-01
5012017-01-01TERESA ROBERSON
5012016-01-01TERESA ROBERSON
5012015-01-01TERESA ROBERSON
5012014-01-01TERESA ROBERSON
5012013-01-01TERESA ROBERSON
5012012-01-01TERESA ROBERSON
5012011-01-01TERESA ROBERSON
5012009-01-01TERESA ROBERSON

Plan Statistics for MCCLAIN'S RV INC PRE-TAX PREMIUM PLAN

401k plan membership statisitcs for MCCLAIN'S RV INC PRE-TAX PREMIUM PLAN

Measure Date Value
2022: MCCLAIN'S RV INC PRE-TAX PREMIUM PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01318
Total number of active participants reported on line 7a of the Form 55002022-01-01305
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-01305
2021: MCCLAIN'S RV INC PRE-TAX PREMIUM PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01250
Total number of active participants reported on line 7a of the Form 55002021-01-01318
Total of all active and inactive participants2021-01-01318
2020: MCCLAIN'S RV INC PRE-TAX PREMIUM PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01270
Total number of active participants reported on line 7a of the Form 55002020-01-01250
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-01250
2019: MCCLAIN'S RV INC PRE-TAX PREMIUM PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01296
Total number of active participants reported on line 7a of the Form 55002019-01-01270
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-01270
2018: MCCLAIN'S RV INC PRE-TAX PREMIUM PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01296
Total number of active participants reported on line 7a of the Form 55002018-01-01296
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-01296
2017: MCCLAIN'S RV INC PRE-TAX PREMIUM PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01256
Total number of active participants reported on line 7a of the Form 55002017-01-01256
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-01256
2016: MCCLAIN'S RV INC PRE-TAX PREMIUM PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01219
Total number of active participants reported on line 7a of the Form 55002016-01-01251
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 participants2016-01-01251
2015: MCCLAIN'S RV INC PRE-TAX PREMIUM PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01203
Total number of active participants reported on line 7a of the Form 55002015-01-01219
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-010
Total of all active and inactive participants2015-01-01219
2014: MCCLAIN'S RV INC PRE-TAX PREMIUM PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01147
Total number of active participants reported on line 7a of the Form 55002014-01-01203
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-010
Total of all active and inactive participants2014-01-01203
2013: MCCLAIN'S RV INC PRE-TAX PREMIUM PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01135
Total number of active participants reported on line 7a of the Form 55002013-01-01147
Total of all active and inactive participants2013-01-01147
Total participants2013-01-010
2012: MCCLAIN'S RV INC PRE-TAX PREMIUM PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01126
Total number of active participants reported on line 7a of the Form 55002012-01-01135
Total of all active and inactive participants2012-01-01135
Total participants2012-01-010
2011: MCCLAIN'S RV INC PRE-TAX PREMIUM PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01128
Total number of active participants reported on line 7a of the Form 55002011-01-01126
Total of all active and inactive participants2011-01-01126
Total participants2011-01-01126
2009: MCCLAIN'S RV INC PRE-TAX PREMIUM PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01157
Total number of active participants reported on line 7a of the Form 55002009-01-01120
Number of retired or separated participants receiving benefits2009-01-012
Total of all active and inactive participants2009-01-01122
Total participants2009-01-01122

Form 5500 Responses for MCCLAIN'S RV INC PRE-TAX PREMIUM PLAN

2022: MCCLAIN'S RV INC PRE-TAX PREMIUM PLAN 2022 form 5500 responses
2022-01-01Type of plan entityMulitple employer plan
2022-01-01Plan is a collectively bargained planYes
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – InsuranceYes
2021: MCCLAIN'S RV INC PRE-TAX PREMIUM PLAN 2021 form 5500 responses
2021-01-01Type of plan entityMulitple employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – InsuranceYes
2020: MCCLAIN'S RV INC PRE-TAX PREMIUM PLAN 2020 form 5500 responses
2020-01-01Type of plan entityMulitple employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – InsuranceYes
2019: MCCLAIN'S RV INC PRE-TAX PREMIUM PLAN 2019 form 5500 responses
2019-01-01Type of plan entityMulitple employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – InsuranceYes
2018: MCCLAIN'S RV INC PRE-TAX PREMIUM PLAN 2018 form 5500 responses
2018-01-01Type of plan entityMulitple employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – InsuranceYes
2017: MCCLAIN'S RV INC PRE-TAX PREMIUM PLAN 2017 form 5500 responses
2017-01-01Type of plan entityMulitple employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – InsuranceYes
2016: MCCLAIN'S RV INC PRE-TAX PREMIUM PLAN 2016 form 5500 responses
2016-01-01Type of plan entityMulitple employer plan
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – InsuranceYes
2015: MCCLAIN'S RV INC PRE-TAX PREMIUM PLAN 2015 form 5500 responses
2015-01-01Type of plan entityMulitple employer plan
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: MCCLAIN'S RV INC PRE-TAX PREMIUM PLAN 2014 form 5500 responses
2014-01-01Type of plan entityMulitple employer plan
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: MCCLAIN'S RV INC PRE-TAX PREMIUM PLAN 2013 form 5500 responses
2013-01-01Type of plan entityMulitple employer plan
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: MCCLAIN'S RV INC PRE-TAX PREMIUM PLAN 2012 form 5500 responses
2012-01-01Type of plan entityMulitple employer plan
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: MCCLAIN'S RV INC PRE-TAX PREMIUM PLAN 2011 form 5500 responses
2011-01-01Type of plan entityMulitple employer plan
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – InsuranceYes
2009: MCCLAIN'S RV INC PRE-TAX PREMIUM PLAN 2009 form 5500 responses
2009-01-01Type of plan entityMulti-employer plan
2009-01-01Plan is a collectively bargained planYes
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000361H
Policy instance 5
Insurance contract or identification numberG000361H
Number of Individuals Covered44
Insurance policy start date2022-04-01
Insurance policy end date2023-03-31
Total amount of commissions paid to insurance brokerUSD $3,445
Other welfare benefits providedLIFE & AD&D VOLUNTARY
Welfare Benefit Premiums Paid to CarrierUSD $22,966
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,445
Additional information about fees paid to insurance brokerAGENT OR BROKER OF RECORD
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000361H
Policy instance 4
Insurance contract or identification numberG000361H
Number of Individuals Covered23
Insurance policy start date2022-04-01
Insurance policy end date2023-03-31
Total amount of commissions paid to insurance brokerUSD $3,344
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $22,296
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,344
Additional information about fees paid to insurance brokerAGENT OR BROKER OF RECORD
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000361H
Policy instance 3
Insurance contract or identification numberG000361H
Number of Individuals Covered55
Insurance policy start date2022-04-01
Insurance policy end date2023-03-31
Total amount of commissions paid to insurance brokerUSD $2,440
Other welfare benefits providedSHORT TERM DISABILITY VOLUNTARY
Welfare Benefit Premiums Paid to CarrierUSD $16,264
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,440
Additional information about fees paid to insurance brokerAGNE OR BROKER OF RECORD
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000361H
Policy instance 2
Insurance contract or identification numberG000361H
Number of Individuals Covered181
Insurance policy start date2022-04-01
Insurance policy end date2023-03-31
Other welfare benefits providedLIFE & AD&D
Welfare Benefit Premiums Paid to CarrierUSD $27,152
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number713135
Policy instance 1
Insurance contract or identification number713135
Number of Individuals Covered305
Insurance policy start date2022-04-01
Insurance policy end date2023-03-31
Total amount of commissions paid to insurance brokerUSD $8,218
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,931,646
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,218
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000361H
Policy instance 2
Insurance contract or identification numberG000361H
Number of Individuals Covered189
Insurance policy start date2021-04-01
Insurance policy end date2022-03-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedLIFE & AD&D
Welfare Benefit Premiums Paid to CarrierUSD $13,309
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 numberG000361H
Policy instance 3
Insurance contract or identification numberG000361H
Number of Individuals Covered56
Insurance policy start date2021-04-01
Insurance policy end date2022-03-31
Total amount of commissions paid to insurance brokerUSD $1,786
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedSHORT TERM DISABILITY VOLUNTARY
Welfare Benefit Premiums Paid to CarrierUSD $11,905
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,786
Additional information about fees paid to insurance brokerBROKER
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number713135
Policy instance 1
Insurance contract or identification number713135
Number of Individuals Covered318
Insurance policy start date2021-04-01
Insurance policy end date2022-03-31
Total amount of commissions paid to insurance brokerUSD $7,475
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,792,171
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,475
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000361H
Policy instance 4
Insurance contract or identification numberG000361H
Number of Individuals Covered31
Insurance policy start date2021-04-01
Insurance policy end date2022-03-31
Total amount of commissions paid to insurance brokerUSD $2,713
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $18,089
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,713
Additional information about fees paid to insurance brokerBROKER
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000361H
Policy instance 5
Insurance contract or identification numberG000361H
Number of Individuals Covered49
Insurance policy start date2021-04-01
Insurance policy end date2022-03-31
Total amount of commissions paid to insurance brokerUSD $3,884
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedLIFE & AD&D VOLUNTARY
Welfare Benefit Premiums Paid to CarrierUSD $25,895
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,884
Additional information about fees paid to insurance brokerBROKER
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000361H
Policy instance 4
Insurance contract or identification numberG000361H
Number of Individuals Covered24
Insurance policy start date2020-04-01
Insurance policy end date2021-03-31
Total amount of commissions paid to insurance brokerUSD $1,955
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $13,031
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,955
Additional information about fees paid to insurance brokerBROKER
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000361H
Policy instance 2
Insurance contract or identification numberG000361H
Number of Individuals Covered180
Insurance policy start date2020-04-01
Insurance policy end date2021-03-31
Other welfare benefits providedLIFE & AD&D
Welfare Benefit Premiums Paid to CarrierUSD $13,076
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number713135
Policy instance 1
Insurance contract or identification number713135
Number of Individuals Covered250
Insurance policy start date2020-04-01
Insurance policy end date2021-03-31
Total amount of commissions paid to insurance brokerUSD $1,221
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $16,443
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,221
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00548916
Policy instance 6
Insurance contract or identification number00548916
Number of Individuals Covered138
Insurance policy start date2020-04-01
Insurance policy end date2021-03-31
Total amount of commissions paid to insurance brokerUSD $11,586
Total amount of fees paid to insurance companyUSD $4,659
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $77,238
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,586
Amount paid for insurance broker fees4659
Insurance broker organization code?3
TEXAS HEALTH AND AETNA HEALTH (National Association of Insurance Commissioners NAIC id number: 16121 )
Policy contract number0149063TH
Policy instance 7
Insurance contract or identification number0149063TH
Number of Individuals Covered172
Insurance policy start date2020-04-01
Insurance policy end date2021-03-31
Total amount of fees paid to insurance companyUSD $8,250
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $815,382
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees8250
Additional information about fees paid to insurance broker2020 Q2 TEXAS HEALTH JOINT VENTURE
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000361H
Policy instance 3
Insurance contract or identification numberG000361H
Number of Individuals Covered40
Insurance policy start date2020-04-01
Insurance policy end date2021-03-31
Total amount of commissions paid to insurance brokerUSD $1,176
Other welfare benefits providedSHORT TERM DISABILITY VOLUNTARY
Welfare Benefit Premiums Paid to CarrierUSD $7,839
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,176
Additional information about fees paid to insurance brokerBROKER
Insurance broker organization code?3
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number0149063
Policy instance 8
Insurance contract or identification number0149063
Number of Individuals Covered102
Insurance policy start date2020-04-01
Insurance policy end date2021-03-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $575,604
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 numberG000361H
Policy instance 5
Insurance contract or identification numberG000361H
Number of Individuals Covered53
Insurance policy start date2020-04-01
Insurance policy end date2021-03-31
Total amount of commissions paid to insurance brokerUSD $4,385
Other welfare benefits providedLIFE & AD&D VOLUNTARY
Welfare Benefit Premiums Paid to CarrierUSD $29,236
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,385
Additional information about fees paid to insurance brokerBROKER
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000361H
Policy instance 5
Insurance contract or identification numberG000361H
Number of Individuals Covered50
Insurance policy start date2019-04-01
Insurance policy end date2020-03-31
Total amount of commissions paid to insurance brokerUSD $4,505
Total amount of fees paid to insurance companyUSD $1,358
Other welfare benefits providedLIFE & AD&D VOLUNTARY
Welfare Benefit Premiums Paid to CarrierUSD $30,033
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,505
Amount paid for insurance broker fees1358
Additional information about fees paid to insurance brokerBROKER OTHER COMPENSATION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000361H
Policy instance 4
Insurance contract or identification numberG000361H
Number of Individuals Covered19
Insurance policy start date2019-04-01
Insurance policy end date2020-03-31
Total amount of commissions paid to insurance brokerUSD $1,746
Total amount of fees paid to insurance companyUSD $554
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $11,641
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,746
Amount paid for insurance broker fees554
Additional information about fees paid to insurance brokerBROKER OTHER COMPENSATION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000361H
Policy instance 3
Insurance contract or identification numberG000361H
Number of Individuals Covered33
Insurance policy start date2019-04-01
Insurance policy end date2020-03-31
Total amount of commissions paid to insurance brokerUSD $1,015
Total amount of fees paid to insurance companyUSD $318
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $6,764
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,015
Amount paid for insurance broker fees318
Additional information about fees paid to insurance brokerBROKER OTHER COMPENSATION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000361H
Policy instance 2
Insurance contract or identification numberG000361H
Number of Individuals Covered157
Insurance policy start date2019-04-01
Insurance policy end date2020-03-31
Total amount of fees paid to insurance companyUSD $567
Other welfare benefits providedLIFE & AD&D
Welfare Benefit Premiums Paid to CarrierUSD $12,282
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees567
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number713135
Policy instance 1
Insurance contract or identification number713135
Number of Individuals Covered270
Insurance policy start date2019-04-01
Insurance policy end date2020-03-31
Total amount of commissions paid to insurance brokerUSD $1,011
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $970,124
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,011
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00548916
Policy instance 6
Insurance contract or identification number00548916
Number of Individuals Covered121
Insurance policy start date2019-04-01
Insurance policy end date2020-03-31
Total amount of commissions paid to insurance brokerUSD $9,419
Total amount of fees paid to insurance companyUSD $4,213
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $62,795
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,419
Amount paid for insurance broker fees4213
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number
Policy instance 6
Number of Individuals Covered124
Insurance policy start date2018-04-01
Insurance policy end date2019-03-31
Total amount of commissions paid to insurance brokerUSD $9,427
Total amount of fees paid to insurance companyUSD $3,286
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $62,850
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,427
Amount paid for insurance broker fees3286
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000361H
Policy instance 5
Insurance contract or identification numberG000361H
Number of Individuals Covered46
Insurance policy start date2018-04-01
Insurance policy end date2019-03-31
Total amount of commissions paid to insurance brokerUSD $4,134
Total amount of fees paid to insurance companyUSD $1,231
Other welfare benefits providedLIFE & AD&D VOLUNTARY
Welfare Benefit Premiums Paid to CarrierUSD $27,561
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 fees1231
Additional information about fees paid to insurance brokerBROKER OTHER COMPENSATION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000361H
Policy instance 4
Insurance contract or identification numberG000361H
Number of Individuals Covered22
Insurance policy start date2018-04-01
Insurance policy end date2019-03-31
Total amount of commissions paid to insurance brokerUSD $1,968
Total amount of fees paid to insurance companyUSD $583
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $13,121
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,968
Amount paid for insurance broker fees583
Additional information about fees paid to insurance brokerBROKER OTHER COMPENSATION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000361H
Policy instance 3
Insurance contract or identification numberG000361H
Number of Individuals Covered38
Insurance policy start date2018-04-01
Insurance policy end date2019-03-31
Total amount of commissions paid to insurance brokerUSD $1,125
Total amount of fees paid to insurance companyUSD $319
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $7,499
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,125
Amount paid for insurance broker fees319
Additional information about fees paid to insurance brokerBROKER OTHER COMPENSATION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000361H
Policy instance 2
Insurance contract or identification numberG000361H
Number of Individuals Covered162
Insurance policy start date2018-04-01
Insurance policy end date2019-03-31
Total amount of fees paid to insurance companyUSD $591
Other welfare benefits providedLIFE & AD&D
Welfare Benefit Premiums Paid to CarrierUSD $13,093
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees591
Additional information about fees paid to insurance brokerAGENT OTHER COMPENSATION
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number713135
Policy instance 1
Insurance contract or identification number713135
Number of Individuals Covered296
Insurance policy start date2018-04-01
Insurance policy end date2019-03-31
Total amount of commissions paid to insurance brokerUSD $1,655
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,107,933
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,655
Insurance broker organization code?3
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number113353
Policy instance 2
Insurance contract or identification number113353
Number of Individuals Covered256
Insurance policy start date2017-04-01
Insurance policy end date2018-03-31
Total amount of fees paid to insurance companyUSD $57
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,147,780
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees57
Additional information about fees paid to insurance brokerGIFTS
Insurance broker organization code?3
Insurance broker nameBRINSON BENEFITS, INC.
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000361H
Policy instance 3
Insurance contract or identification numberG000361H
Number of Individuals Covered31
Insurance policy start date2017-04-01
Insurance policy end date2018-04-01
Total amount of commissions paid to insurance brokerUSD $884
Total amount of fees paid to insurance companyUSD $348
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,896
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $884
Amount paid for insurance broker fees348
Additional information about fees paid to insurance brokerAGENT OTHER COMPENSATION
Insurance broker organization code?3
Insurance broker nameBRINSON BENEFITS INC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000361H
Policy instance 4
Insurance contract or identification numberG000361H
Number of Individuals Covered163
Insurance policy start date2017-04-01
Insurance policy end date2018-04-01
Total amount of fees paid to insurance companyUSD $800
Other welfare benefits providedLIFE & AD&D
Welfare Benefit Premiums Paid to CarrierUSD $13,365
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees800
Additional information about fees paid to insurance brokerBROKER OTHER COMPENSATION
Insurance broker organization code?3
Insurance broker nameBRINSON BENEFITS INC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000361H
Policy instance 5
Insurance contract or identification numberG000361H
Number of Individuals Covered23
Insurance policy start date2017-04-01
Insurance policy end date2018-04-01
Total amount of commissions paid to insurance brokerUSD $2,030
Total amount of fees paid to insurance companyUSD $796
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $13,532
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,030
Amount paid for insurance broker fees796
Additional information about fees paid to insurance brokerBROKER OTHER COMPENSATION
Insurance broker organization code?3
Insurance broker nameBRINSON BENEFITS INC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000361H
Policy instance 6
Insurance contract or identification numberG000361H
Number of Individuals Covered50
Insurance policy start date2017-04-01
Insurance policy end date2018-04-01
Total amount of commissions paid to insurance brokerUSD $4,116
Total amount of fees paid to insurance companyUSD $1,616
Other welfare benefits providedLIFE & AD&D VOLUNTARY
Welfare Benefit Premiums Paid to CarrierUSD $27,439
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,116
Amount paid for insurance broker fees1616
Additional information about fees paid to insurance brokerBROKER OTHER COMPENSATION
Insurance broker organization code?3
Insurance broker nameBRINSON BENEFITS INC
UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 )
Policy contract number468919
Policy instance 7
Insurance contract or identification number468919
Number of Individuals Covered20
Insurance policy start date2017-04-01
Insurance policy end date2018-04-01
Total amount of commissions paid to insurance brokerUSD $9,477
Total amount of fees paid to insurance companyUSD $474
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $63,248
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,477
Amount paid for insurance broker fees474
Additional information about fees paid to insurance brokerCOMMISSIONS ADDITIONAL COMPENSATION PAID
Insurance broker organization code?3
Insurance broker nameBRINSON BENEFITS, INC.
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number713135
Policy instance 1
Insurance contract or identification number713135
Number of Individuals Covered105
Insurance policy start date2017-04-01
Insurance policy end date2018-03-31
Total amount of commissions paid to insurance brokerUSD $1,469
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $9,790
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,469
Insurance broker organization code?3
Insurance broker nameBRINSON BENEFITS INC

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