LOPEZ FOOD, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan DORADA NON UNION WELFARE BENEFIT PLAN
| Measure | Date | Value |
|---|
| 2022: DORADA NON UNION WELFARE BENEFIT PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 228 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 256 |
| Total of all active and inactive participants | 2022-01-01 | 256 |
| 2021: DORADA NON UNION WELFARE BENEFIT PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 233 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 228 |
| Total of all active and inactive participants | 2021-01-01 | 228 |
| 2020: DORADA NON UNION WELFARE BENEFIT PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 211 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 233 |
| Total of all active and inactive participants | 2020-01-01 | 233 |
| 2019: DORADA NON UNION WELFARE BENEFIT PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 206 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 211 |
| Total of all active and inactive participants | 2019-01-01 | 211 |
| Total participants | 2019-01-01 | 211 |
| 2018: DORADA NON UNION WELFARE BENEFIT PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 187 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 206 |
| Total of all active and inactive participants | 2018-01-01 | 206 |
| Total participants | 2018-01-01 | 206 |
| 2017: DORADA NON UNION WELFARE BENEFIT PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 176 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 187 |
| Total of all active and inactive participants | 2017-01-01 | 187 |
| Total participants | 2017-01-01 | 187 |
| 2016: DORADA NON UNION WELFARE BENEFIT PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 152 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 176 |
| Total of all active and inactive participants | 2016-01-01 | 176 |
| Total participants | 2016-01-01 | 176 |
| 2015: DORADA NON UNION WELFARE BENEFIT PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 94 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 152 |
| Total of all active and inactive participants | 2015-01-01 | 152 |
| Total participants | 2015-01-01 | 152 |
| 2014: DORADA NON UNION WELFARE BENEFIT PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 78 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 94 |
| Total of all active and inactive participants | 2014-01-01 | 94 |
| Total participants | 2014-01-01 | 94 |
| 2013: DORADA NON UNION WELFARE BENEFIT PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 0 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 78 |
| Total of all active and inactive participants | 2013-01-01 | 78 |
| Total participants | 2013-01-01 | 78 |
| 2022: DORADA NON UNION WELFARE BENEFIT PLAN 2022 form 5500 responses |
|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: DORADA NON UNION WELFARE BENEFIT PLAN 2021 form 5500 responses |
|---|
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: DORADA NON UNION WELFARE BENEFIT PLAN 2020 form 5500 responses |
|---|
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: DORADA NON UNION WELFARE BENEFIT PLAN 2019 form 5500 responses |
|---|
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: DORADA NON UNION WELFARE BENEFIT PLAN 2018 form 5500 responses |
|---|
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: DORADA NON UNION WELFARE BENEFIT PLAN 2017 form 5500 responses |
|---|
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: DORADA NON UNION WELFARE BENEFIT PLAN 2016 form 5500 responses |
|---|
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: DORADA NON UNION WELFARE BENEFIT PLAN 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: DORADA NON UNION WELFARE BENEFIT PLAN 2014 form 5500 responses |
|---|
| 2014-01-01 | Type of plan entity | Single employer plan |
| 2014-01-01 | Plan funding arrangement – Insurance | Yes |
| 2014-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: DORADA NON UNION WELFARE BENEFIT PLAN 2013 form 5500 responses |
|---|
| 2013-01-01 | Type of plan entity | Single employer plan |
| 2013-01-01 | First time form 5500 has been submitted | Yes |
| 2013-01-01 | Plan funding arrangement – Insurance | Yes |
| 2013-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 000107 |
| Policy instance | 2 |
| Insurance contract or identification number | 000107 | | Number of Individuals Covered | 518 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $41,228 | | Total amount of fees paid to insurance company | USD $6,057 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $211,974 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $41,228 | | Amount paid for insurance broker fees | 6057 | | Additional information about fees paid to insurance broker | SPECIAL PROGRAMS | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AIIXS |
| Policy instance | 1 |
| Insurance contract or identification number | G000AIIXS | | Number of Individuals Covered | 270 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2023-01-01 | | Total amount of commissions paid to insurance broker | USD $9,788 | | Total amount of fees paid to insurance company | USD $4,640 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | SHORT TERM DISABILITY & AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $105,840 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,788 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 4640 | | Additional information about fees paid to insurance broker | ADMINISTRATION |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 000107 |
| Policy instance | 2 |
| Insurance contract or identification number | 000107 | | Number of Individuals Covered | 471 | | Insurance policy start date | 2021-01-02 | | Insurance policy end date | 2021-12-27 | | Total amount of commissions paid to insurance broker | USD $28,908 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $182,025 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $28,908 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AIIXS |
| Policy instance | 1 |
| Insurance contract or identification number | G000AIIXS | | Number of Individuals Covered | 253 | | Insurance policy start date | 2021-01-02 | | Insurance policy end date | 2021-12-27 | | Total amount of commissions paid to insurance broker | USD $6,336 | | Total amount of fees paid to insurance company | USD $2,385 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | SHORT TERM DISABILITY & AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $44,518 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,336 | | Amount paid for insurance broker fees | 2385 | | Insurance broker organization code? | 4 |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 000107 |
| Policy instance | 2 |
| Insurance contract or identification number | 000107 | | Number of Individuals Covered | 515 | | Insurance policy start date | 2020-01-02 | | Insurance policy end date | 2020-12-27 | | Total amount of commissions paid to insurance broker | USD $28,870 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $169,933 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $28,870 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AIIXS |
| Policy instance | 1 |
| Insurance contract or identification number | G000AIIXS | | Number of Individuals Covered | 217 | | Insurance policy start date | 2020-01-02 | | Insurance policy end date | 2020-12-27 | | Total amount of commissions paid to insurance broker | USD $8,049 | | Total amount of fees paid to insurance company | USD $10,561 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | SHORT TERM DISABILITY & AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $68,813 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,049 | | Amount paid for insurance broker fees | 10561 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE SERVICE OR OTHER FEE. | | Insurance broker organization code? | 3 |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 000107 |
| Policy instance | 2 |
| Insurance contract or identification number | 000107 | | Number of Individuals Covered | 442 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $19,877 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $130,515 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $19,877 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AIIXS |
| Policy instance | 1 |
| Insurance contract or identification number | G000AIIXS | | Number of Individuals Covered | 212 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2020-01-01 | | Total amount of commissions paid to insurance broker | USD $6,355 | | Total amount of fees paid to insurance company | USD $8,686 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | SHORT TERM DISABILITY & AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $60,583 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,355 | | Amount paid for insurance broker fees | 8686 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE SERVICE OR OTHER FEE | | Insurance broker organization code? | 3 |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 000107 |
| Policy instance | 2 |
| Insurance contract or identification number | 000107 | | Number of Individuals Covered | 436 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $34,509 | | Total amount of fees paid to insurance company | USD $135,295 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $103,655 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $34,509 | | Amount paid for insurance broker fees | 135295 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE SERVICE OR OTHER FEE | | Insurance broker organization code? | 3 | | Insurance broker name | THE PLEXUS GROUPE |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AIIXS |
| Policy instance | 1 |
| Insurance contract or identification number | G000AIIXS | | Number of Individuals Covered | 220 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2018-01-01 | | Total amount of commissions paid to insurance broker | USD $9,895 | | Total amount of fees paid to insurance company | USD $9,967 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADMINISTRATIVE SERVICES & AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $60,411 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,895 | | Amount paid for insurance broker fees | 9967 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE SERVICE OR OTHER FEE | | Insurance broker organization code? | 3 | | Insurance broker name | THE PLEXUS GROUPE |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 000107 |
| Policy instance | 3 |
| Insurance contract or identification number | 000107 | | Number of Individuals Covered | 634 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $27,527 | | Total amount of fees paid to insurance company | USD $97,297 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $64,006 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $27,527 | | Amount paid for insurance broker fees | 97297 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE SERVICE OR OTHER FEE | | Insurance broker organization code? | 3 | | Insurance broker name | CHER A. BUMPS & ASSOCIATES, INC. |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AIIXS |
| Policy instance | 2 |
| Insurance contract or identification number | G000AIIXS | | Number of Individuals Covered | 361 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2016-01-01 | | Total amount of commissions paid to insurance broker | USD $7,078 | | Total amount of fees paid to insurance company | USD $6,604 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADMINISTRATIVE SERVICES & AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $37,262 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,078 | | Amount paid for insurance broker fees | 6604 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE SERVICE OR OTHER FEE | | Insurance broker organization code? | 3 | | Insurance broker name | CHER A. BUMPS & ASSOCIATES, INC. |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 094995 |
| Policy instance | 1 |
| Insurance contract or identification number | 094995 | | Number of Individuals Covered | 4 | | Insurance policy start date | 2015-04-01 | | Insurance policy end date | 2016-04-01 | | Total amount of commissions paid to insurance broker | USD $613 | | Other welfare benefits provided | GROUP LONG TERM CARE | | Welfare Benefit Premiums Paid to Carrier | USD $2,834 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $613 | | Insurance broker organization code? | 3 | | Insurance broker name | CHER A. BUMPS & ASSOCIATES INC |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 000107 |
| Policy instance | 3 |
| Insurance contract or identification number | 000107 | | Number of Individuals Covered | 436 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $18,338 | | Total amount of fees paid to insurance company | USD $60,836 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $43,628 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $18,338 | | Amount paid for insurance broker fees | 60836 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE SERVICE OR OTHER FEE | | Insurance broker organization code? | 3 | | Insurance broker name | CHER A. BUMPS & ASSOCIATES, INC. |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AIIXS |
| Policy instance | 2 |
| Insurance contract or identification number | G000AIIXS | | Number of Individuals Covered | 239 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2015-01-01 | | Total amount of commissions paid to insurance broker | USD $5,233 | | Total amount of fees paid to insurance company | USD $4,880 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADMINISTRATIVE SERVICES & AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $27,461 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,233 | | Amount paid for insurance broker fees | 4880 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE SERVICE OR OTHER FEE | | Insurance broker organization code? | 3 | | Insurance broker name | CHER A. BUMPS & ASSOCIATES, INC. |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 094995 |
| Policy instance | 1 |
| Insurance contract or identification number | 094995 | | Number of Individuals Covered | 4 | | Insurance policy start date | 2014-04-01 | | Insurance policy end date | 2015-04-01 | | Total amount of commissions paid to insurance broker | USD $481 | | Other welfare benefits provided | GROUP LONG TERM CARE | | Welfare Benefit Premiums Paid to Carrier | USD $2,583 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $481 | | Insurance broker organization code? | 3 | | Insurance broker name | CHER A. BUMPS & ASSOCIATES INC |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 000107 |
| Policy instance | 3 |
| Insurance contract or identification number | 000107 | | Number of Individuals Covered | 373 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2014-01-01 | | Total amount of commissions paid to insurance broker | USD $15,041 | | Total amount of fees paid to insurance company | USD $51,605 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $600,872 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $15,041 | | Amount paid for insurance broker fees | 51605 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE SERVICE OR OTHER FEE | | Insurance broker organization code? | 3 | | Insurance broker name | CHER A. BUMPS & ASSOCIATES, INC. |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AIIXS |
| Policy instance | 2 |
| Insurance contract or identification number | G000AIIXS | | Number of Individuals Covered | 211 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2014-01-01 | | Total amount of commissions paid to insurance broker | USD $4,292 | | Total amount of fees paid to insurance company | USD $4,030 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADMINISTRATIVE SERVICES & AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $22,477 | | Commission paid to Insurance Broker | USD $4,292 | | Amount paid for insurance broker fees | 4030 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE SERVICE OR OTHER FEE | | Insurance broker organization code? | 3 | | Insurance broker name | CHER A. BUMPS & ASSOCIATES, INC. |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 094995 |
| Policy instance | 1 |
| Insurance contract or identification number | 094995 | | Number of Individuals Covered | 3 | | Insurance policy start date | 2013-04-01 | | Insurance policy end date | 2014-04-04 | | Total amount of commissions paid to insurance broker | USD $421 | | Other welfare benefits provided | GROUP LONG TERM CARE | | Welfare Benefit Premiums Paid to Carrier | USD $1,930 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $421 | | Insurance broker organization code? | 3 | | Insurance broker name | CHER A. BUMPS & ASSOCIATES INC |
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