MCCLAINS RV, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan MCCLAIN'S RV INC PRE-TAX PREMIUM PLAN
Measure | Date | Value |
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2022: MCCLAIN'S RV INC PRE-TAX PREMIUM PLAN 2022 401k membership |
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Total participants, beginning-of-year | 2022-01-01 | 318 |
Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 305 |
Number of retired or separated participants receiving benefits | 2022-01-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2022-01-01 | 0 |
Total of all active and inactive participants | 2022-01-01 | 305 |
2021: MCCLAIN'S RV INC PRE-TAX PREMIUM PLAN 2021 401k membership |
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Total participants, beginning-of-year | 2021-01-01 | 250 |
Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 318 |
Total of all active and inactive participants | 2021-01-01 | 318 |
2020: MCCLAIN'S RV INC PRE-TAX PREMIUM PLAN 2020 401k membership |
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Total participants, beginning-of-year | 2020-01-01 | 270 |
Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 250 |
Number of retired or separated participants receiving benefits | 2020-01-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2020-01-01 | 0 |
Total of all active and inactive participants | 2020-01-01 | 250 |
2019: MCCLAIN'S RV INC PRE-TAX PREMIUM PLAN 2019 401k membership |
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Total participants, beginning-of-year | 2019-01-01 | 296 |
Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 270 |
Number of retired or separated participants receiving benefits | 2019-01-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2019-01-01 | 0 |
Total of all active and inactive participants | 2019-01-01 | 270 |
2018: MCCLAIN'S RV INC PRE-TAX PREMIUM PLAN 2018 401k membership |
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Total participants, beginning-of-year | 2018-01-01 | 296 |
Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 296 |
Number of retired or separated participants receiving benefits | 2018-01-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2018-01-01 | 0 |
Total of all active and inactive participants | 2018-01-01 | 296 |
2017: MCCLAIN'S RV INC PRE-TAX PREMIUM PLAN 2017 401k membership |
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Total participants, beginning-of-year | 2017-01-01 | 256 |
Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 256 |
Number of retired or separated participants receiving benefits | 2017-01-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2017-01-01 | 0 |
Total of all active and inactive participants | 2017-01-01 | 256 |
2016: MCCLAIN'S RV INC PRE-TAX PREMIUM PLAN 2016 401k membership |
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Total participants, beginning-of-year | 2016-01-01 | 219 |
Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 251 |
Number of retired or separated participants receiving benefits | 2016-01-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2016-01-01 | 0 |
Total of all active and inactive participants | 2016-01-01 | 251 |
2015: MCCLAIN'S RV INC PRE-TAX PREMIUM PLAN 2015 401k membership |
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Total participants, beginning-of-year | 2015-01-01 | 203 |
Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 219 |
Number of retired or separated participants receiving benefits | 2015-01-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2015-01-01 | 0 |
Total of all active and inactive participants | 2015-01-01 | 219 |
2014: MCCLAIN'S RV INC PRE-TAX PREMIUM PLAN 2014 401k membership |
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Total participants, beginning-of-year | 2014-01-01 | 147 |
Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 203 |
Number of retired or separated participants receiving benefits | 2014-01-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2014-01-01 | 0 |
Total of all active and inactive participants | 2014-01-01 | 203 |
2013: MCCLAIN'S RV INC PRE-TAX PREMIUM PLAN 2013 401k membership |
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Total participants, beginning-of-year | 2013-01-01 | 135 |
Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 147 |
Total of all active and inactive participants | 2013-01-01 | 147 |
Total participants | 2013-01-01 | 0 |
2012: MCCLAIN'S RV INC PRE-TAX PREMIUM PLAN 2012 401k membership |
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Total participants, beginning-of-year | 2012-01-01 | 126 |
Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 135 |
Total of all active and inactive participants | 2012-01-01 | 135 |
Total participants | 2012-01-01 | 0 |
2011: MCCLAIN'S RV INC PRE-TAX PREMIUM PLAN 2011 401k membership |
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Total participants, beginning-of-year | 2011-01-01 | 128 |
Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 126 |
Total of all active and inactive participants | 2011-01-01 | 126 |
Total participants | 2011-01-01 | 126 |
2009: MCCLAIN'S RV INC PRE-TAX PREMIUM PLAN 2009 401k membership |
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Total participants, beginning-of-year | 2009-01-01 | 157 |
Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 120 |
Number of retired or separated participants receiving benefits | 2009-01-01 | 2 |
Total of all active and inactive participants | 2009-01-01 | 122 |
Total participants | 2009-01-01 | 122 |
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000361H |
Policy instance | 5 |
Insurance contract or identification number | G000361H | Number of Individuals Covered | 44 | Insurance policy start date | 2022-04-01 | Insurance policy end date | 2023-03-31 | Total amount of commissions paid to insurance broker | USD $3,445 | Other welfare benefits provided | LIFE & AD&D VOLUNTARY | Welfare Benefit Premiums Paid to Carrier | USD $22,966 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,445 | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000361H |
Policy instance | 4 |
Insurance contract or identification number | G000361H | Number of Individuals Covered | 23 | Insurance policy start date | 2022-04-01 | Insurance policy end date | 2023-03-31 | Total amount of commissions paid to insurance broker | USD $3,344 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $22,296 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,344 | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000361H |
Policy instance | 3 |
Insurance contract or identification number | G000361H | Number of Individuals Covered | 55 | Insurance policy start date | 2022-04-01 | Insurance policy end date | 2023-03-31 | Total amount of commissions paid to insurance broker | USD $2,440 | Other welfare benefits provided | SHORT TERM DISABILITY VOLUNTARY | Welfare Benefit Premiums Paid to Carrier | USD $16,264 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,440 | Additional information about fees paid to insurance broker | AGNE OR BROKER OF RECORD | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000361H |
Policy instance | 2 |
Insurance contract or identification number | G000361H | Number of Individuals Covered | 181 | Insurance policy start date | 2022-04-01 | Insurance policy end date | 2023-03-31 | Other welfare benefits provided | LIFE & AD&D | Welfare Benefit Premiums Paid to Carrier | USD $27,152 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 713135 |
Policy instance | 1 |
Insurance contract or identification number | 713135 | Number of Individuals Covered | 305 | Insurance policy start date | 2022-04-01 | Insurance policy end date | 2023-03-31 | Total amount of commissions paid to insurance broker | USD $8,218 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $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 Broker | USD $8,218 | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000361H |
Policy instance | 2 |
Insurance contract or identification number | G000361H | Number of Individuals Covered | 189 | Insurance policy start date | 2021-04-01 | Insurance policy end date | 2022-03-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | LIFE & AD&D | Welfare Benefit Premiums Paid to Carrier | USD $13,309 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000361H |
Policy instance | 3 |
Insurance contract or identification number | G000361H | Number of Individuals Covered | 56 | Insurance policy start date | 2021-04-01 | Insurance policy end date | 2022-03-31 | Total amount of commissions paid to insurance broker | USD $1,786 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | SHORT TERM DISABILITY VOLUNTARY | Welfare Benefit Premiums Paid to Carrier | USD $11,905 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,786 | Additional information about fees paid to insurance broker | BROKER | Insurance broker organization code? | 3 |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 713135 |
Policy instance | 1 |
Insurance contract or identification number | 713135 | Number of Individuals Covered | 318 | Insurance policy start date | 2021-04-01 | Insurance policy end date | 2022-03-31 | Total amount of commissions paid to insurance broker | USD $7,475 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $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 Broker | USD $7,475 | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000361H |
Policy instance | 4 |
Insurance contract or identification number | G000361H | Number of Individuals Covered | 31 | Insurance policy start date | 2021-04-01 | Insurance policy end date | 2022-03-31 | Total amount of commissions paid to insurance broker | USD $2,713 | Total amount of fees paid to insurance company | USD $0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $18,089 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,713 | Additional information about fees paid to insurance broker | BROKER | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000361H |
Policy instance | 5 |
Insurance contract or identification number | G000361H | Number of Individuals Covered | 49 | Insurance policy start date | 2021-04-01 | Insurance policy end date | 2022-03-31 | Total amount of commissions paid to insurance broker | USD $3,884 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | LIFE & AD&D VOLUNTARY | Welfare Benefit Premiums Paid to Carrier | USD $25,895 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,884 | Additional information about fees paid to insurance broker | BROKER | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000361H |
Policy instance | 4 |
Insurance contract or identification number | G000361H | Number of Individuals Covered | 24 | Insurance policy start date | 2020-04-01 | Insurance policy end date | 2021-03-31 | Total amount of commissions paid to insurance broker | USD $1,955 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $13,031 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,955 | Additional information about fees paid to insurance broker | BROKER | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000361H |
Policy instance | 2 |
Insurance contract or identification number | G000361H | Number of Individuals Covered | 180 | Insurance policy start date | 2020-04-01 | Insurance policy end date | 2021-03-31 | Other welfare benefits provided | LIFE & AD&D | Welfare Benefit Premiums Paid to Carrier | USD $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 |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 713135 |
Policy instance | 1 |
Insurance contract or identification number | 713135 | Number of Individuals Covered | 250 | Insurance policy start date | 2020-04-01 | Insurance policy end date | 2021-03-31 | Total amount of commissions paid to insurance broker | USD $1,221 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $16,443 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,221 | Insurance broker organization code? | 3 |
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THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00548916 |
Policy instance | 6 |
Insurance contract or identification number | 00548916 | Number of Individuals Covered | 138 | Insurance policy start date | 2020-04-01 | Insurance policy end date | 2021-03-31 | Total amount of commissions paid to insurance broker | USD $11,586 | Total amount of fees paid to insurance company | USD $4,659 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $77,238 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $11,586 | Amount paid for insurance broker fees | 4659 | Insurance broker organization code? | 3 |
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TEXAS HEALTH AND AETNA HEALTH (National Association of Insurance Commissioners NAIC id number: 16121 ) |
Policy contract number | 0149063TH |
Policy instance | 7 |
Insurance contract or identification number | 0149063TH | Number of Individuals Covered | 172 | Insurance policy start date | 2020-04-01 | Insurance policy end date | 2021-03-31 | Total amount of fees paid to insurance company | USD $8,250 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $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 fees | 8250 | Additional information about fees paid to insurance broker | 2020 Q2 TEXAS HEALTH JOINT VENTURE | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000361H |
Policy instance | 3 |
Insurance contract or identification number | G000361H | Number of Individuals Covered | 40 | Insurance policy start date | 2020-04-01 | Insurance policy end date | 2021-03-31 | Total amount of commissions paid to insurance broker | USD $1,176 | Other welfare benefits provided | SHORT TERM DISABILITY VOLUNTARY | Welfare Benefit Premiums Paid to Carrier | USD $7,839 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,176 | Additional information about fees paid to insurance broker | BROKER | Insurance broker organization code? | 3 |
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AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 0149063 |
Policy instance | 8 |
Insurance contract or identification number | 0149063 | Number of Individuals Covered | 102 | Insurance policy start date | 2020-04-01 | Insurance policy end date | 2021-03-31 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $575,604 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000361H |
Policy instance | 5 |
Insurance contract or identification number | G000361H | Number of Individuals Covered | 53 | Insurance policy start date | 2020-04-01 | Insurance policy end date | 2021-03-31 | Total amount of commissions paid to insurance broker | USD $4,385 | Other welfare benefits provided | LIFE & AD&D VOLUNTARY | Welfare Benefit Premiums Paid to Carrier | USD $29,236 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,385 | Additional information about fees paid to insurance broker | BROKER | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000361H |
Policy instance | 5 |
Insurance contract or identification number | G000361H | Number of Individuals Covered | 50 | Insurance policy start date | 2019-04-01 | Insurance policy end date | 2020-03-31 | Total amount of commissions paid to insurance broker | USD $4,505 | Total amount of fees paid to insurance company | USD $1,358 | Other welfare benefits provided | LIFE & AD&D VOLUNTARY | Welfare Benefit Premiums Paid to Carrier | USD $30,033 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,505 | Amount paid for insurance broker fees | 1358 | Additional information about fees paid to insurance broker | BROKER OTHER COMPENSATION | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000361H |
Policy instance | 4 |
Insurance contract or identification number | G000361H | Number of Individuals Covered | 19 | Insurance policy start date | 2019-04-01 | Insurance policy end date | 2020-03-31 | Total amount of commissions paid to insurance broker | USD $1,746 | Total amount of fees paid to insurance company | USD $554 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $11,641 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,746 | Amount paid for insurance broker fees | 554 | Additional information about fees paid to insurance broker | BROKER OTHER COMPENSATION | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000361H |
Policy instance | 3 |
Insurance contract or identification number | G000361H | Number of Individuals Covered | 33 | Insurance policy start date | 2019-04-01 | Insurance policy end date | 2020-03-31 | Total amount of commissions paid to insurance broker | USD $1,015 | Total amount of fees paid to insurance company | USD $318 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $6,764 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,015 | Amount paid for insurance broker fees | 318 | Additional information about fees paid to insurance broker | BROKER OTHER COMPENSATION | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000361H |
Policy instance | 2 |
Insurance contract or identification number | G000361H | Number of Individuals Covered | 157 | Insurance policy start date | 2019-04-01 | Insurance policy end date | 2020-03-31 | Total amount of fees paid to insurance company | USD $567 | Other welfare benefits provided | LIFE & AD&D | Welfare Benefit Premiums Paid to Carrier | USD $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 fees | 567 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 713135 |
Policy instance | 1 |
Insurance contract or identification number | 713135 | Number of Individuals Covered | 270 | Insurance policy start date | 2019-04-01 | Insurance policy end date | 2020-03-31 | Total amount of commissions paid to insurance broker | USD $1,011 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $970,124 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,011 | Insurance broker organization code? | 3 |
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THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00548916 |
Policy instance | 6 |
Insurance contract or identification number | 00548916 | Number of Individuals Covered | 121 | Insurance policy start date | 2019-04-01 | Insurance policy end date | 2020-03-31 | Total amount of commissions paid to insurance broker | USD $9,419 | Total amount of fees paid to insurance company | USD $4,213 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $62,795 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $9,419 | Amount paid for insurance broker fees | 4213 |
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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 Covered | 124 | Insurance policy start date | 2018-04-01 | Insurance policy end date | 2019-03-31 | Total amount of commissions paid to insurance broker | USD $9,427 | Total amount of fees paid to insurance company | USD $3,286 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $62,850 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $9,427 | Amount paid for insurance broker fees | 3286 | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000361H |
Policy instance | 5 |
Insurance contract or identification number | G000361H | Number of Individuals Covered | 46 | Insurance policy start date | 2018-04-01 | Insurance policy end date | 2019-03-31 | Total amount of commissions paid to insurance broker | USD $4,134 | Total amount of fees paid to insurance company | USD $1,231 | Other welfare benefits provided | LIFE & AD&D VOLUNTARY | Welfare Benefit Premiums Paid to Carrier | USD $27,561 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,134 | Amount paid for insurance broker fees | 1231 | Additional information about fees paid to insurance broker | BROKER OTHER COMPENSATION | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000361H |
Policy instance | 4 |
Insurance contract or identification number | G000361H | Number of Individuals Covered | 22 | Insurance policy start date | 2018-04-01 | Insurance policy end date | 2019-03-31 | Total amount of commissions paid to insurance broker | USD $1,968 | Total amount of fees paid to insurance company | USD $583 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $13,121 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,968 | Amount paid for insurance broker fees | 583 | Additional information about fees paid to insurance broker | BROKER OTHER COMPENSATION | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000361H |
Policy instance | 3 |
Insurance contract or identification number | G000361H | Number of Individuals Covered | 38 | Insurance policy start date | 2018-04-01 | Insurance policy end date | 2019-03-31 | Total amount of commissions paid to insurance broker | USD $1,125 | Total amount of fees paid to insurance company | USD $319 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $7,499 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,125 | Amount paid for insurance broker fees | 319 | Additional information about fees paid to insurance broker | BROKER OTHER COMPENSATION | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000361H |
Policy instance | 2 |
Insurance contract or identification number | G000361H | Number of Individuals Covered | 162 | Insurance policy start date | 2018-04-01 | Insurance policy end date | 2019-03-31 | Total amount of fees paid to insurance company | USD $591 | Other welfare benefits provided | LIFE & AD&D | Welfare Benefit Premiums Paid to Carrier | USD $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 fees | 591 | Additional information about fees paid to insurance broker | AGENT OTHER COMPENSATION | Insurance broker organization code? | 3 |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 713135 |
Policy instance | 1 |
Insurance contract or identification number | 713135 | Number of Individuals Covered | 296 | Insurance policy start date | 2018-04-01 | Insurance policy end date | 2019-03-31 | Total amount of commissions paid to insurance broker | USD $1,655 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $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 Broker | USD $1,655 | Insurance broker organization code? | 3 |
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BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
Policy contract number | 113353 |
Policy instance | 2 |
Insurance contract or identification number | 113353 | Number of Individuals Covered | 256 | Insurance policy start date | 2017-04-01 | Insurance policy end date | 2018-03-31 | Total amount of fees paid to insurance company | USD $57 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $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 fees | 57 | Additional information about fees paid to insurance broker | GIFTS | Insurance broker organization code? | 3 | Insurance broker name | BRINSON BENEFITS, INC. |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000361H |
Policy instance | 3 |
Insurance contract or identification number | G000361H | Number of Individuals Covered | 31 | Insurance policy start date | 2017-04-01 | Insurance policy end date | 2018-04-01 | Total amount of commissions paid to insurance broker | USD $884 | Total amount of fees paid to insurance company | USD $348 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $5,896 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $884 | Amount paid for insurance broker fees | 348 | Additional information about fees paid to insurance broker | AGENT OTHER COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | BRINSON BENEFITS INC |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000361H |
Policy instance | 4 |
Insurance contract or identification number | G000361H | Number of Individuals Covered | 163 | Insurance policy start date | 2017-04-01 | Insurance policy end date | 2018-04-01 | Total amount of fees paid to insurance company | USD $800 | Other welfare benefits provided | LIFE & AD&D | Welfare Benefit Premiums Paid to Carrier | USD $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 fees | 800 | Additional information about fees paid to insurance broker | BROKER OTHER COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | BRINSON BENEFITS INC |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000361H |
Policy instance | 5 |
Insurance contract or identification number | G000361H | Number of Individuals Covered | 23 | Insurance policy start date | 2017-04-01 | Insurance policy end date | 2018-04-01 | Total amount of commissions paid to insurance broker | USD $2,030 | Total amount of fees paid to insurance company | USD $796 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $13,532 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,030 | Amount paid for insurance broker fees | 796 | Additional information about fees paid to insurance broker | BROKER OTHER COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | BRINSON BENEFITS INC |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000361H |
Policy instance | 6 |
Insurance contract or identification number | G000361H | Number of Individuals Covered | 50 | Insurance policy start date | 2017-04-01 | Insurance policy end date | 2018-04-01 | Total amount of commissions paid to insurance broker | USD $4,116 | Total amount of fees paid to insurance company | USD $1,616 | Other welfare benefits provided | LIFE & AD&D VOLUNTARY | Welfare Benefit Premiums Paid to Carrier | USD $27,439 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,116 | Amount paid for insurance broker fees | 1616 | Additional information about fees paid to insurance broker | BROKER OTHER COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | BRINSON BENEFITS INC |
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UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) |
Policy contract number | 468919 |
Policy instance | 7 |
Insurance contract or identification number | 468919 | Number of Individuals Covered | 20 | Insurance policy start date | 2017-04-01 | Insurance policy end date | 2018-04-01 | Total amount of commissions paid to insurance broker | USD $9,477 | Total amount of fees paid to insurance company | USD $474 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $63,248 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $9,477 | Amount paid for insurance broker fees | 474 | Additional information about fees paid to insurance broker | COMMISSIONS ADDITIONAL COMPENSATION PAID | Insurance broker organization code? | 3 | Insurance broker name | BRINSON BENEFITS, INC. |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 713135 |
Policy instance | 1 |
Insurance contract or identification number | 713135 | Number of Individuals Covered | 105 | Insurance policy start date | 2017-04-01 | Insurance policy end date | 2018-03-31 | Total amount of commissions paid to insurance broker | USD $1,469 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $9,790 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,469 | Insurance broker organization code? | 3 | Insurance broker name | BRINSON BENEFITS INC |
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