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PARENT/CHILD, INC. TSA PLAN 401k Plan overview

Plan NamePARENT/CHILD, INC. TSA PLAN
Plan identification number 001

PARENT/CHILD, INC. TSA PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Code section 403(b)(1) arrangement - See Limited Pension Plan Reporting instructions for Code section 403(b)(1) arrangements for certain exempt organizations.
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover

401k Sponsoring company profile

PARENT/CHILD,INC TSA PLAN has sponsored the creation of one or more 401k plans.

Company Name:PARENT/CHILD,INC TSA PLAN
Employer identification number (EIN):742020902
NAIC Classification:624410
NAIC Description:Child Day Care Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PARENT/CHILD, INC. TSA PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012021-09-01
0012020-09-01
0012019-09-01
0012018-09-01
0012017-09-01
0012016-09-01DR. SHARON SMALL
0012015-09-01DR. SHARON SMALL DR. SHARON SMALL2017-06-13
0012014-09-01DR. SHARON SMALL2016-06-14
0012013-09-01
0012012-09-01GREGORY GARZA
0012011-09-01GREGORY GARZA
0012009-09-01GREGORY GARZA

Plan Statistics for PARENT/CHILD, INC. TSA PLAN

401k plan membership statisitcs for PARENT/CHILD, INC. TSA PLAN

Measure Date Value
2021: PARENT/CHILD, INC. TSA PLAN 2021 401k membership
Total participants, beginning-of-year2021-09-011,495
Total number of active participants reported on line 7a of the Form 55002021-09-011,439
Total of all active and inactive participants2021-09-011,439
Total participants2021-09-011,439
Number of participants with account balances2021-09-011,439
2020: PARENT/CHILD, INC. TSA PLAN 2020 401k membership
Total participants, beginning-of-year2020-09-011,425
Total number of active participants reported on line 7a of the Form 55002020-09-011,495
Total of all active and inactive participants2020-09-011,495
Total participants2020-09-011,495
Number of participants with account balances2020-09-011,495
2019: PARENT/CHILD, INC. TSA PLAN 2019 401k membership
Total participants, beginning-of-year2019-09-011,425
Total number of active participants reported on line 7a of the Form 55002019-09-011,425
Total of all active and inactive participants2019-09-011,425
Total participants2019-09-011,425
Number of participants with account balances2019-09-011,425
2018: PARENT/CHILD, INC. TSA PLAN 2018 401k membership
Total participants, beginning-of-year2018-09-011,449
Total number of active participants reported on line 7a of the Form 55002018-09-011,425
Total of all active and inactive participants2018-09-011,425
Total participants2018-09-011,425
2017: PARENT/CHILD, INC. TSA PLAN 2017 401k membership
Total participants, beginning-of-year2017-09-011,451
Total number of active participants reported on line 7a of the Form 55002017-09-011,449
Total of all active and inactive participants2017-09-011,449
Total participants2017-09-011,449
2016: PARENT/CHILD, INC. TSA PLAN 2016 401k membership
Total participants, beginning-of-year2016-09-011,486
Total number of active participants reported on line 7a of the Form 55002016-09-011,451
Total of all active and inactive participants2016-09-011,451
Total participants2016-09-011,451
2015: PARENT/CHILD, INC. TSA PLAN 2015 401k membership
Total participants, beginning-of-year2015-09-011,452
Total number of active participants reported on line 7a of the Form 55002015-09-011,486
Total of all active and inactive participants2015-09-011,486
Total participants2015-09-011,486
Number of participants with account balances2015-09-011,486
2012: PARENT/CHILD, INC. TSA PLAN 2012 401k membership
Total participants, beginning-of-year2012-09-012,019
Total number of active participants reported on line 7a of the Form 55002012-09-011,910
Total of all active and inactive participants2012-09-011,910
Total participants2012-09-011,910
2011: PARENT/CHILD, INC. TSA PLAN 2011 401k membership
Total participants, beginning-of-year2011-09-012,044
Total number of active participants reported on line 7a of the Form 55002011-09-012,019
Total of all active and inactive participants2011-09-012,019
Total participants2011-09-012,019
2009: PARENT/CHILD, INC. TSA PLAN 2009 401k membership
Total participants, beginning-of-year2009-09-012,690
Total number of active participants reported on line 7a of the Form 55002009-09-011,971
Total of all active and inactive participants2009-09-011,971
Total participants2009-09-011,971

Financial Data on PARENT/CHILD, INC. TSA PLAN

Measure Date Value
2022 : PARENT/CHILD, INC. TSA PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets2022-08-31$0
Total transfer of assets to this plan2022-08-31$43,234
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-08-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-08-31$0
Total income from all sources (including contributions)2022-08-31$457,616
Total loss/gain on sale of assets2022-08-31$0
Total of all expenses incurred2022-08-31$538,222
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-08-31$538,222
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-08-31$344,552
Value of total assets at end of year2022-08-31$5,588,772
Value of total assets at beginning of year2022-08-31$5,626,144
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-08-31$0
Total interest from all sources2022-08-31$113,064
Total dividends received (eg from common stock, registered investment company shares)2022-08-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-08-31No
Was this plan covered by a fidelity bond2022-08-31No
If this is an individual account plan, was there a blackout period2022-08-31No
Were there any nonexempt tranactions with any party-in-interest2022-08-31No
Contributions received from participants2022-08-31$177,602
Participant contributions at end of year2022-08-31$63,860
Participant contributions at beginning of year2022-08-31$84,285
Participant contributions at end of year2022-08-31$16,472
Participant contributions at beginning of year2022-08-31$16,179
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2022-08-31$20,425
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-08-31No
Value of net income/loss2022-08-31$-80,606
Value of net assets at end of year (total assets less liabilities)2022-08-31$5,588,772
Value of net assets at beginning of year (total assets less liabilities)2022-08-31$5,626,144
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-08-31No
Were any loans by the plan or fixed income obligations due to the plan in default2022-08-31No
Were any leases to which the plan was party in default or uncollectible2022-08-31No
Interest earned on other investments2022-08-31$-35,132
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2022-08-31$5,493,947
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2022-08-31$5,508,367
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2022-08-31$5,508,367
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2022-08-31$148,196
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-08-31No
Was there a failure to transmit to the plan any participant contributions2022-08-31No
Has the plan failed to provide any benefit when due under the plan2022-08-31No
Contributions received in cash from employer2022-08-31$166,950
Employer contributions (assets) at end of year2022-08-31$14,493
Employer contributions (assets) at beginning of year2022-08-31$17,313
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-08-31$517,797
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32022-08-31No
Did the plan have assets held for investment2022-08-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-08-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-08-31No
2021 : PARENT/CHILD, INC. TSA PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets2021-08-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-08-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-08-31$0
Total income from all sources (including contributions)2021-08-31$460,061
Total loss/gain on sale of assets2021-08-31$0
Total of all expenses incurred2021-08-31$529,690
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-08-31$529,690
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-08-31$373,156
Value of total assets at end of year2021-08-31$5,626,144
Value of total assets at beginning of year2021-08-31$5,695,773
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-08-31$0
Total interest from all sources2021-08-31$86,905
Total dividends received (eg from common stock, registered investment company shares)2021-08-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-08-31No
Was this plan covered by a fidelity bond2021-08-31No
If this is an individual account plan, was there a blackout period2021-08-31No
Were there any nonexempt tranactions with any party-in-interest2021-08-31No
Contributions received from participants2021-08-31$194,081
Participant contributions at end of year2021-08-31$84,285
Participant contributions at beginning of year2021-08-31$87,597
Participant contributions at end of year2021-08-31$16,179
Participant contributions at beginning of year2021-08-31$18,765
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2021-08-31$3,312
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-08-31No
Value of net income/loss2021-08-31$-69,629
Value of net assets at end of year (total assets less liabilities)2021-08-31$5,626,144
Value of net assets at beginning of year (total assets less liabilities)2021-08-31$5,695,773
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-08-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-08-31No
Were any leases to which the plan was party in default or uncollectible2021-08-31No
Interest on participant loans2021-08-31$0
Interest earned on other investments2021-08-31$-54,943
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2021-08-31$5,508,367
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2021-08-31$5,571,816
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2021-08-31$5,571,816
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2021-08-31$141,848
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-08-31No
Was there a failure to transmit to the plan any participant contributions2021-08-31No
Has the plan failed to provide any benefit when due under the plan2021-08-31No
Contributions received in cash from employer2021-08-31$179,075
Employer contributions (assets) at end of year2021-08-31$17,313
Employer contributions (assets) at beginning of year2021-08-31$17,595
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-08-31$526,378
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32021-08-31No
Did the plan have assets held for investment2021-08-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-08-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-08-31No
2020 : PARENT/CHILD, INC. TSA PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets2020-08-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-08-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-08-31$0
Total income from all sources (including contributions)2020-08-31$410,673
Total loss/gain on sale of assets2020-08-31$0
Total of all expenses incurred2020-08-31$285,287
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-08-31$285,287
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-08-31$288,797
Value of total assets at end of year2020-08-31$5,695,773
Value of total assets at beginning of year2020-08-31$5,570,387
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-08-31$0
Total interest from all sources2020-08-31$121,876
Total dividends received (eg from common stock, registered investment company shares)2020-08-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-08-31No
Was this plan covered by a fidelity bond2020-08-31No
If this is an individual account plan, was there a blackout period2020-08-31No
Were there any nonexempt tranactions with any party-in-interest2020-08-31No
Contributions received from participants2020-08-31$150,032
Participant contributions at end of year2020-08-31$87,597
Participant contributions at beginning of year2020-08-31$114,742
Participant contributions at end of year2020-08-31$18,765
Participant contributions at beginning of year2020-08-31$17,305
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2020-08-31$27,145
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-08-31No
Value of net income/loss2020-08-31$125,386
Value of net assets at end of year (total assets less liabilities)2020-08-31$5,695,773
Value of net assets at beginning of year (total assets less liabilities)2020-08-31$5,570,387
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-08-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-08-31No
Were any leases to which the plan was party in default or uncollectible2020-08-31No
Interest earned on other investments2020-08-31$-49,291
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2020-08-31$5,571,816
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2020-08-31$5,422,367
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2020-08-31$5,422,367
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2020-08-31$171,167
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-08-31No
Was there a failure to transmit to the plan any participant contributions2020-08-31No
Has the plan failed to provide any benefit when due under the plan2020-08-31No
Contributions received in cash from employer2020-08-31$138,765
Employer contributions (assets) at end of year2020-08-31$17,595
Employer contributions (assets) at beginning of year2020-08-31$15,973
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-08-31$258,142
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32020-08-31No
Did the plan have assets held for investment2020-08-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-08-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-08-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2020-08-31No
Opinion of an independent qualified public accountant for this plan2020-08-31Disclaimer
Accountancy firm name2020-08-31GARZA/GONZALEZ & ASSOCIATES CPAS
Accountancy firm EIN2020-08-31741867466
2019 : PARENT/CHILD, INC. TSA PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets2019-08-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-08-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-08-31$0
Total income from all sources (including contributions)2019-08-31$336,443
Total loss/gain on sale of assets2019-08-31$0
Total of all expenses incurred2019-08-31$546,922
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-08-31$546,922
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-08-31$277,013
Value of total assets at end of year2019-08-31$5,570,387
Value of total assets at beginning of year2019-08-31$5,780,866
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-08-31$0
Total interest from all sources2019-08-31$59,430
Total dividends received (eg from common stock, registered investment company shares)2019-08-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-08-31No
Was this plan covered by a fidelity bond2019-08-31No
If this is an individual account plan, was there a blackout period2019-08-31No
Were there any nonexempt tranactions with any party-in-interest2019-08-31No
Contributions received from participants2019-08-31$144,047
Participant contributions at end of year2019-08-31$114,742
Participant contributions at beginning of year2019-08-31$114,473
Participant contributions at end of year2019-08-31$17,305
Participant contributions at beginning of year2019-08-31$13,888
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2019-08-31$-269
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-08-31No
Value of net income/loss2019-08-31$-210,479
Value of net assets at end of year (total assets less liabilities)2019-08-31$5,570,387
Value of net assets at beginning of year (total assets less liabilities)2019-08-31$5,780,866
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-08-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-08-31No
Were any leases to which the plan was party in default or uncollectible2019-08-31No
Interest earned on other investments2019-08-31$-67,553
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2019-08-31$5,422,367
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2019-08-31$5,639,686
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2019-08-31$5,639,686
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2019-08-31$126,983
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-08-31No
Was there a failure to transmit to the plan any participant contributions2019-08-31No
Has the plan failed to provide any benefit when due under the plan2019-08-31No
Contributions received in cash from employer2019-08-31$132,966
Employer contributions (assets) at end of year2019-08-31$15,973
Employer contributions (assets) at beginning of year2019-08-31$12,819
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-08-31$547,191
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32019-08-31No
Did the plan have assets held for investment2019-08-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-08-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-08-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-08-31No
Opinion of an independent qualified public accountant for this plan2019-08-31Disclaimer
Accountancy firm name2019-08-31GARZA.GONZALEZ & ASSOCIATES CPAS
Accountancy firm EIN2019-08-31741867466
2018 : PARENT/CHILD, INC. TSA PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets2018-08-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-08-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-08-31$0
Total income from all sources (including contributions)2018-08-31$397,557
Total loss/gain on sale of assets2018-08-31$0
Total of all expenses incurred2018-08-31$313,981
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-08-31$313,981
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-08-31$257,440
Value of total assets at end of year2018-08-31$5,780,866
Value of total assets at beginning of year2018-08-31$5,697,290
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-08-31$0
Total interest from all sources2018-08-31$140,117
Total dividends received (eg from common stock, registered investment company shares)2018-08-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-08-31No
Was this plan covered by a fidelity bond2018-08-31No
If this is an individual account plan, was there a blackout period2018-08-31No
Were there any nonexempt tranactions with any party-in-interest2018-08-31No
Contributions received from participants2018-08-31$133,821
Participant contributions at end of year2018-08-31$114,473
Participant contributions at beginning of year2018-08-31$109,151
Participant contributions at end of year2018-08-31$13,888
Participant contributions at beginning of year2018-08-31$12,256
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-08-31No
Value of net income/loss2018-08-31$83,576
Value of net assets at end of year (total assets less liabilities)2018-08-31$5,780,866
Value of net assets at beginning of year (total assets less liabilities)2018-08-31$5,697,290
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-08-31No
Were any loans by the plan or fixed income obligations due to the plan in default2018-08-31No
Were any leases to which the plan was party in default or uncollectible2018-08-31No
Interest earned on other investments2018-08-31$-3,965
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2018-08-31$5,639,686
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2018-08-31$5,564,663
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2018-08-31$5,564,663
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2018-08-31$144,082
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-08-31No
Was there a failure to transmit to the plan any participant contributions2018-08-31No
Has the plan failed to provide any benefit when due under the plan2018-08-31No
Contributions received in cash from employer2018-08-31$123,619
Employer contributions (assets) at end of year2018-08-31$12,819
Employer contributions (assets) at beginning of year2018-08-31$11,220
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-08-31$313,981
Did the plan have assets held for investment2018-08-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-08-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-08-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-08-31No
Opinion of an independent qualified public accountant for this plan2018-08-31Disclaimer
Accountancy firm name2018-08-31GARZA/GONZALEZ & ASSOCIATES CPAS
Accountancy firm EIN2018-08-31741867466
2017 : PARENT/CHILD, INC. TSA PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets2017-08-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-08-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-08-31$0
Total income from all sources (including contributions)2017-08-31$343,419
Total loss/gain on sale of assets2017-08-31$0
Total of all expenses incurred2017-08-31$237,329
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-08-31$237,329
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-08-31$261,779
Value of total assets at end of year2017-08-31$5,669,193
Value of total assets at beginning of year2017-08-31$5,563,103
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-08-31$0
Total interest from all sources2017-08-31$81,640
Total dividends received (eg from common stock, registered investment company shares)2017-08-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-08-31No
Was this plan covered by a fidelity bond2017-08-31No
If this is an individual account plan, was there a blackout period2017-08-31No
Were there any nonexempt tranactions with any party-in-interest2017-08-31No
Contributions received from participants2017-08-31$136,125
Participant contributions at end of year2017-08-31$12,256
Participant contributions at beginning of year2017-08-31$5,682
Value of other receiveables (less allowance for doubtful accounts) at end of year2017-08-31$109,151
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2017-08-31$115,568
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-08-31No
Value of net income/loss2017-08-31$106,090
Value of net assets at end of year (total assets less liabilities)2017-08-31$5,669,193
Value of net assets at beginning of year (total assets less liabilities)2017-08-31$5,563,103
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-08-31No
Were any loans by the plan or fixed income obligations due to the plan in default2017-08-31No
Were any leases to which the plan was party in default or uncollectible2017-08-31No
Interest earned on other investments2017-08-31$-62,164
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2017-08-31$5,536,566
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2017-08-31$5,436,608
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2017-08-31$5,436,608
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2017-08-31$143,804
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-08-31No
Was there a failure to transmit to the plan any participant contributions2017-08-31No
Has the plan failed to provide any benefit when due under the plan2017-08-31No
Contributions received in cash from employer2017-08-31$125,654
Employer contributions (assets) at end of year2017-08-31$11,220
Employer contributions (assets) at beginning of year2017-08-31$5,245
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-08-31$237,329
Did the plan have assets held for investment2017-08-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-08-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-08-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-08-31Yes
Opinion of an independent qualified public accountant for this plan2017-08-31Disclaimer
Accountancy firm name2017-08-31GARZA/GONZALEZ & ASSOCIATES CPAS
Accountancy firm EIN2017-08-31741867466
2016 : PARENT/CHILD, INC. TSA PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets2016-08-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-08-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-08-31$0
Total income from all sources (including contributions)2016-08-31$292,638
Total loss/gain on sale of assets2016-08-31$0
Total of all expenses incurred2016-08-31$194,486
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-08-31$194,486
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-08-31$235,283
Value of total assets at end of year2016-08-31$5,563,103
Value of total assets at beginning of year2016-08-31$5,464,951
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-08-31$0
Total interest from all sources2016-08-31$57,355
Total dividends received (eg from common stock, registered investment company shares)2016-08-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-08-31No
Was this plan covered by a fidelity bond2016-08-31No
If this is an individual account plan, was there a blackout period2016-08-31No
Were there any nonexempt tranactions with any party-in-interest2016-08-31No
Contributions received from participants2016-08-31$122,490
Participant contributions at end of year2016-08-31$5,682
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2016-08-31$998
Value of other receiveables (less allowance for doubtful accounts) at end of year2016-08-31$115,568
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2016-08-31$158,292
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-08-31No
Value of net income/loss2016-08-31$98,152
Value of net assets at end of year (total assets less liabilities)2016-08-31$5,563,103
Value of net assets at beginning of year (total assets less liabilities)2016-08-31$5,464,951
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-08-31No
Were any loans by the plan or fixed income obligations due to the plan in default2016-08-31No
Were any leases to which the plan was party in default or uncollectible2016-08-31No
Income. Interest from loans (other than to participants)2016-08-31$-42,723
Interest earned on other investments2016-08-31$-77,304
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2016-08-31$5,436,608
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2016-08-31$5,306,659
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2016-08-31$5,306,659
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2016-08-31$177,382
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-08-31No
Was there a failure to transmit to the plan any participant contributions2016-08-31Yes
Has the plan failed to provide any benefit when due under the plan2016-08-31No
Contributions received in cash from employer2016-08-31$112,793
Employer contributions (assets) at end of year2016-08-31$5,245
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-08-31$193,488
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32016-08-31No
Did the plan have assets held for investment2016-08-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-08-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-08-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-08-31Yes
Opinion of an independent qualified public accountant for this plan2016-08-31Disclaimer
Accountancy firm name2016-08-31GARZA/GONZALEZ & ASSOCIATES CPAS
Accountancy firm EIN2016-08-31741867466
2013 : PARENT/CHILD, INC. TSA PLAN 2013 401k financial data
Total unrealized appreciation/depreciation of assets2013-08-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-08-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-08-31$0
Total income from all sources (including contributions)2013-08-31$0
Total loss/gain on sale of assets2013-08-31$0
Total of all expenses incurred2013-08-31$0
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-08-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-08-31$0
Value of total assets at end of year2013-08-31$0
Value of total assets at beginning of year2013-08-31$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-08-31$0
Total interest from all sources2013-08-31$0
Total dividends received (eg from common stock, registered investment company shares)2013-08-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-08-31No
Was this plan covered by a fidelity bond2013-08-31No
If this is an individual account plan, was there a blackout period2013-08-31No
Were there any nonexempt tranactions with any party-in-interest2013-08-31No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-08-31No
Value of net income/loss2013-08-31$0
Value of net assets at end of year (total assets less liabilities)2013-08-31$0
Value of net assets at beginning of year (total assets less liabilities)2013-08-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-08-31No
Were any loans by the plan or fixed income obligations due to the plan in default2013-08-31No
Were any leases to which the plan was party in default or uncollectible2013-08-31No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-08-31No
Was there a failure to transmit to the plan any participant contributions2013-08-31No
Has the plan failed to provide any benefit when due under the plan2013-08-31No
Did the plan have assets held for investment2013-08-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-08-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-08-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-08-31Yes
Opinion of an independent qualified public accountant for this plan2013-08-31Disclaimer
Accountancy firm name2013-08-31GARZA/GONZALEZ & ASSOCIATES CPAS
Accountancy firm EIN2013-08-31741867466
2012 : PARENT/CHILD, INC. TSA PLAN 2012 401k financial data
Total unrealized appreciation/depreciation of assets2012-08-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-08-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-08-31$0
Total income from all sources (including contributions)2012-08-31$0
Total loss/gain on sale of assets2012-08-31$0
Total of all expenses incurred2012-08-31$0
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-08-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-08-31$0
Value of total assets at end of year2012-08-31$0
Value of total assets at beginning of year2012-08-31$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-08-31$0
Total interest from all sources2012-08-31$0
Total dividends received (eg from common stock, registered investment company shares)2012-08-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-08-31No
Was this plan covered by a fidelity bond2012-08-31No
If this is an individual account plan, was there a blackout period2012-08-31No
Were there any nonexempt tranactions with any party-in-interest2012-08-31No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-08-31No
Value of net income/loss2012-08-31$0
Value of net assets at end of year (total assets less liabilities)2012-08-31$0
Value of net assets at beginning of year (total assets less liabilities)2012-08-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-08-31No
Were any loans by the plan or fixed income obligations due to the plan in default2012-08-31No
Were any leases to which the plan was party in default or uncollectible2012-08-31No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-08-31No
Was there a failure to transmit to the plan any participant contributions2012-08-31No
Has the plan failed to provide any benefit when due under the plan2012-08-31No
Did the plan have assets held for investment2012-08-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-08-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-08-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-08-31Yes
Opinion of an independent qualified public accountant for this plan2012-08-31Disclaimer
Accountancy firm name2012-08-31GARZA/GONZALEZ & ASSOCIATES CPAS
Accountancy firm EIN2012-08-31741867466
2011 : PARENT/CHILD, INC. TSA PLAN 2011 401k financial data
Total unrealized appreciation/depreciation of assets2011-08-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-08-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-08-31$0
Total income from all sources (including contributions)2011-08-31$0
Total loss/gain on sale of assets2011-08-31$0
Total of all expenses incurred2011-08-31$0
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-08-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-08-31$0
Value of total assets at end of year2011-08-31$0
Value of total assets at beginning of year2011-08-31$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-08-31$0
Total interest from all sources2011-08-31$0
Total dividends received (eg from common stock, registered investment company shares)2011-08-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-08-31No
Was this plan covered by a fidelity bond2011-08-31No
If this is an individual account plan, was there a blackout period2011-08-31No
Were there any nonexempt tranactions with any party-in-interest2011-08-31No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-08-31No
Value of net income/loss2011-08-31$0
Value of net assets at end of year (total assets less liabilities)2011-08-31$0
Value of net assets at beginning of year (total assets less liabilities)2011-08-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-08-31No
Were any loans by the plan or fixed income obligations due to the plan in default2011-08-31No
Were any leases to which the plan was party in default or uncollectible2011-08-31No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-08-31No
Was there a failure to transmit to the plan any participant contributions2011-08-31No
Has the plan failed to provide any benefit when due under the plan2011-08-31No
Did the plan have assets held for investment2011-08-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-08-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-08-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-08-31Yes
Opinion of an independent qualified public accountant for this plan2011-08-31Disclaimer
Accountancy firm name2011-08-31GARZA/GONZALEZ & ASSOCIATES CPAS
Accountancy firm EIN2011-08-31741867466

Form 5500 Responses for PARENT/CHILD, INC. TSA PLAN

2021: PARENT/CHILD, INC. TSA PLAN 2021 form 5500 responses
2021-09-01Type of plan entitySingle employer plan
2021-09-01Submission has been amendedNo
2021-09-01This submission is the final filingNo
2021-09-01This return/report is a short plan year return/report (less than 12 months)No
2021-09-01Plan is a collectively bargained planNo
2021-09-01Plan funding arrangement – InsuranceYes
2021-09-01Plan benefit arrangement – InsuranceYes
2020: PARENT/CHILD, INC. TSA PLAN 2020 form 5500 responses
2020-09-01Type of plan entitySingle employer plan
2020-09-01Submission has been amendedNo
2020-09-01This submission is the final filingNo
2020-09-01This return/report is a short plan year return/report (less than 12 months)No
2020-09-01Plan is a collectively bargained planNo
2020-09-01Plan funding arrangement – InsuranceYes
2020-09-01Plan benefit arrangement – InsuranceYes
2019: PARENT/CHILD, INC. TSA PLAN 2019 form 5500 responses
2019-09-01Type of plan entitySingle employer plan
2019-09-01Submission has been amendedNo
2019-09-01This submission is the final filingNo
2019-09-01This return/report is a short plan year return/report (less than 12 months)No
2019-09-01Plan is a collectively bargained planNo
2019-09-01Plan funding arrangement – InsuranceYes
2019-09-01Plan benefit arrangement – InsuranceYes
2018: PARENT/CHILD, INC. TSA PLAN 2018 form 5500 responses
2018-09-01Type of plan entitySingle employer plan
2018-09-01Submission has been amendedNo
2018-09-01This submission is the final filingNo
2018-09-01This return/report is a short plan year return/report (less than 12 months)No
2018-09-01Plan is a collectively bargained planNo
2018-09-01Plan funding arrangement – InsuranceYes
2018-09-01Plan benefit arrangement – InsuranceYes
2017: PARENT/CHILD, INC. TSA PLAN 2017 form 5500 responses
2017-09-01Type of plan entitySingle employer plan
2017-09-01Submission has been amendedNo
2017-09-01This submission is the final filingNo
2017-09-01This return/report is a short plan year return/report (less than 12 months)No
2017-09-01Plan is a collectively bargained planNo
2017-09-01Plan funding arrangement – InsuranceYes
2017-09-01Plan benefit arrangement – InsuranceYes
2016: PARENT/CHILD, INC. TSA PLAN 2016 form 5500 responses
2016-09-01Type of plan entitySingle employer plan
2016-09-01Submission has been amendedNo
2016-09-01This submission is the final filingNo
2016-09-01This return/report is a short plan year return/report (less than 12 months)No
2016-09-01Plan is a collectively bargained planNo
2016-09-01Plan funding arrangement – InsuranceYes
2016-09-01Plan benefit arrangement – InsuranceYes
2015: PARENT/CHILD, INC. TSA PLAN 2015 form 5500 responses
2015-09-01Type of plan entitySingle employer plan
2015-09-01Submission has been amendedNo
2015-09-01This submission is the final filingNo
2015-09-01This return/report is a short plan year return/report (less than 12 months)No
2015-09-01Plan is a collectively bargained planNo
2015-09-01Plan funding arrangement – InsuranceYes
2015-09-01Plan benefit arrangement – InsuranceYes
2012: PARENT/CHILD, INC. TSA PLAN 2012 form 5500 responses
2012-09-01Type of plan entitySingle employer plan
2012-09-01Submission has been amendedNo
2012-09-01This submission is the final filingNo
2012-09-01This return/report is a short plan year return/report (less than 12 months)No
2012-09-01Plan is a collectively bargained planNo
2012-09-01Plan funding arrangement – InsuranceYes
2012-09-01Plan benefit arrangement – InsuranceYes
2011: PARENT/CHILD, INC. TSA PLAN 2011 form 5500 responses
2011-09-01Type of plan entitySingle employer plan
2011-09-01Submission has been amendedNo
2011-09-01This submission is the final filingNo
2011-09-01This return/report is a short plan year return/report (less than 12 months)No
2011-09-01Plan is a collectively bargained planNo
2011-09-01Plan funding arrangement – InsuranceYes
2011-09-01Plan benefit arrangement – InsuranceYes
2009: PARENT/CHILD, INC. TSA PLAN 2009 form 5500 responses
2009-09-01Type of plan entitySingle employer plan
2009-09-01Submission has been amendedNo
2009-09-01This submission is the final filingNo
2009-09-01This return/report is a short plan year return/report (less than 12 months)No
2009-09-01Plan is a collectively bargained planNo
2009-09-01Plan funding arrangement – InsuranceYes
2009-09-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000BF5G
Policy instance 4
Insurance contract or identification numberG000BF5G
Number of Individuals Covered223
Insurance policy start date2021-10-01
Insurance policy end date2022-10-01
Total amount of commissions paid to insurance brokerUSD $984
Total amount of fees paid to insurance companyUSD $1,660
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT (AD&D) INSURANCE
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $6,569
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees1350
Additional information about fees paid to insurance brokerADMINISTRATION
Insurance broker organization code?5
Commission paid to Insurance BrokerUSD $984
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract numberEA84
Policy instance 1
Insurance contract or identification numberEA84
Number of Individuals Covered1433
Insurance policy start date2021-09-01
Insurance policy end date2022-08-31
Total amount of commissions paid to insurance brokerUSD $18,328
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?Yes
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Other information about contractGUARANTEED INTEREST OPTION
Commission paid to Insurance BrokerUSD $64
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerRELIASTAR INSURANCE COMMISSION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000BF5G
Policy instance 2
Insurance contract or identification numberG000BF5G
Number of Individuals Covered123
Insurance policy start date2021-10-01
Insurance policy end date2022-10-01
Total amount of commissions paid to insurance brokerUSD $1,125
Total amount of fees paid to insurance companyUSD $208
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $11,268
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees208
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000BF5G
Policy instance 3
Insurance contract or identification numberG000BF5G
Number of Individuals Covered222
Insurance policy start date2021-10-01
Insurance policy end date2022-10-01
Total amount of commissions paid to insurance brokerUSD $2,627
Total amount of fees paid to insurance companyUSD $1,209
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $17,547
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees1209
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $2,627
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000BF5G
Policy instance 5
Insurance contract or identification numberG000BF5G
Number of Individuals Covered145
Insurance policy start date2021-10-01
Insurance policy end date2022-10-01
Total amount of commissions paid to insurance brokerUSD $6,055
Total amount of fees paid to insurance companyUSD $3,712
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedSHORT TERM DISABILITY TEMPORARY
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $30,326
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees1662
Additional information about fees paid to insurance brokerADMINISTRATION
Insurance broker organization code?5
Commission paid to Insurance BrokerUSD $6,055
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000BF5G
Policy instance 6
Insurance contract or identification numberG000BF5G
Number of Individuals Covered110
Insurance policy start date2021-10-01
Insurance policy end date2022-10-01
Total amount of commissions paid to insurance brokerUSD $5,142
Total amount of fees paid to insurance companyUSD $470
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $51,482
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees470
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $5,142
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000BF5G
Policy instance 7
Insurance contract or identification numberG000BF5G
Number of Individuals Covered81
Insurance policy start date2021-10-01
Insurance policy end date2022-10-01
Total amount of commissions paid to insurance brokerUSD $3,505
Total amount of fees paid to insurance companyUSD $1,125
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedCRITICAL ILLNESS VOLUNTARY
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $17,558
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,505
Additional information about fees paid to insurance brokerAGENT OR BROKER OF RECORD
Insurance broker organization code?3
Amount paid for insurance broker fees1125
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000BF5G
Policy instance 8
Insurance contract or identification numberG000BF5G
Number of Individuals Covered88
Insurance policy start date2021-10-01
Insurance policy end date2022-10-01
Total amount of commissions paid to insurance brokerUSD $3,886
Total amount of fees paid to insurance companyUSD $1,251
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENT ONLY VOLUNTARY
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $19,463
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,886
Additional information about fees paid to insurance brokerAGENT OR BROKER OF RECORD
Insurance broker organization code?3
Amount paid for insurance broker fees1251
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000BF5G
Policy instance 9
Insurance contract or identification numberG000BF5G
Number of Individuals Covered114
Insurance policy start date2021-10-01
Insurance policy end date2022-10-01
Total amount of commissions paid to insurance brokerUSD $8,862
Total amount of fees paid to insurance companyUSD $4,668
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedTERM LIFE VOLUNTARY
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $44,392
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees1662
Additional information about fees paid to insurance brokerADMINISTRATION
Insurance broker organization code?5
Commission paid to Insurance BrokerUSD $8,862
WESTPOINT INSURANCE CORPORATION (National Association of Insurance Commissioners NAIC id number: 39845 )
Policy contract numberESL110039400
Policy instance 10
Insurance contract or identification numberESL110039400
Number of Individuals Covered118
Insurance policy start date2021-10-01
Insurance policy end date2022-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedTRANSPLANT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $15,247
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
WESTPOINT INSURANCE CORPORATION (National Association of Insurance Commissioners NAIC id number: 39845 )
Policy contract numberESL100154000
Policy instance 11
Insurance contract or identification numberESL100154000
Number of Individuals Covered118
Insurance policy start date2021-10-01
Insurance policy end date2022-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $124,204
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000BF5G
Policy instance 2
Insurance contract or identification numberG000BF5G
Number of Individuals Covered215
Insurance policy start date2020-10-01
Insurance policy end date2021-10-01
Total amount of commissions paid to insurance brokerUSD $2,776
Total amount of fees paid to insurance companyUSD $1,459
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $18,504
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees1459
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $2,776
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract numberEA84
Policy instance 1
Insurance contract or identification numberEA84
Number of Individuals Covered1495
Insurance policy start date2020-09-01
Insurance policy end date2021-08-31
Total amount of commissions paid to insurance brokerUSD $23,027
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?Yes
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Other information about contractGUARANTEED INTEREST OPTION
Commission paid to Insurance BrokerUSD $22,689
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerRELIA LIFE INSURANCE COMPANY COMMISSION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000BF5G
Policy instance 7
Insurance contract or identification numberG000BF5G
Number of Individuals Covered112
Insurance policy start date2020-10-01
Insurance policy end date2021-10-01
Total amount of commissions paid to insurance brokerUSD $8,883
Total amount of fees paid to insurance companyUSD $4,535
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedTERM LIFE - VOLUNTARY
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $44,413
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees1662
Additional information about fees paid to insurance brokerADMINISTRATION
Insurance broker organization code?5
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000BF5G
Policy instance 3
Insurance contract or identification numberG000BF5G
Number of Individuals Covered215
Insurance policy start date2020-10-01
Insurance policy end date2021-10-01
Total amount of commissions paid to insurance brokerUSD $626
Total amount of fees paid to insurance companyUSD $2,003
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT (AD&D) INSURANCE
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $4,176
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees1662
Additional information about fees paid to insurance brokerADMINISTRATION
Insurance broker organization code?5
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000BF5G
Policy instance 4
Insurance contract or identification numberG000BF5G
Number of Individuals Covered144
Insurance policy start date2020-10-01
Insurance policy end date2021-10-01
Total amount of commissions paid to insurance brokerUSD $6,243
Total amount of fees paid to insurance companyUSD $3,810
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedSHORT TERM DISABILITY VOLUNTARY
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $31,217
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees1662
Additional information about fees paid to insurance brokerADMINISTRATION
Insurance broker organization code?5
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000BF5G
Policy instance 5
Insurance contract or identification numberG000BF5G
Number of Individuals Covered85
Insurance policy start date2020-10-01
Insurance policy end date2021-10-01
Total amount of commissions paid to insurance brokerUSD $3,410
Total amount of fees paid to insurance companyUSD $1,095
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedCRITICAL ILLNESS VOLUNTARY
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $17,050
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,410
Additional information about fees paid to insurance brokerAGENT OR BROKER OF RECORD
Insurance broker organization code?3
Amount paid for insurance broker fees1095
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000BF5G
Policy instance 6
Insurance contract or identification numberG000BF5G
Number of Individuals Covered78
Insurance policy start date2020-10-01
Insurance policy end date2021-10-01
Total amount of commissions paid to insurance brokerUSD $3,918
Total amount of fees paid to insurance companyUSD $1,454
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENT ONLY VOLUNTARY
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $19,589
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,918
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerAGENT OR BROKER OF RECORD
Insurance broker organization code?3
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number0109513
Policy instance 8
Insurance contract or identification number0109513
Number of Individuals Covered202
Insurance policy start date2020-10-01
Insurance policy end date2021-09-30
Total amount of commissions paid to insurance brokerUSD $6,635
Total amount of fees paid to insurance companyUSD $5,025
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $841,012
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees4020
Additional information about fees paid to insurance broker2020 PINNACLE MEDICAL RETENTION INCENTIVE RISK
Insurance broker organization code?3
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number0109513
Policy instance 2
Insurance contract or identification number0109513
Number of Individuals Covered372
Insurance policy start date2019-10-01
Insurance policy end date2020-09-30
Total amount of commissions paid to insurance brokerUSD $7,508
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $919,029
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,508
Additional information about fees paid to insurance brokerAETNA LIFE INSURANCE CO. COMMISSION, SERVICE FEES, DIRECT AND INDIRECT COMPENSATION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000BF5G
Policy instance 3
Insurance contract or identification numberG000BF5G
Number of Individuals Covered268
Insurance policy start date2019-10-01
Insurance policy end date2020-10-01
Total amount of commissions paid to insurance brokerUSD $3,071
Total amount of fees paid to insurance companyUSD $1,244
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $20,473
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,071
Additional information about fees paid to insurance brokerAGENT OR BROKER OF RECORD
Insurance broker organization code?3
Amount paid for insurance broker fees1244
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000BF5G
Policy instance 4
Insurance contract or identification numberG000BF5G
Number of Individuals Covered145
Insurance policy start date2019-10-01
Insurance policy end date2020-10-01
Total amount of commissions paid to insurance brokerUSD $5,854
Total amount of fees paid to insurance companyUSD $3,250
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedSHORT TERM DISABILITY VOLUNTARY
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $29,271
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees1416
Additional information about fees paid to insurance brokerADMINISTRATION
Insurance broker organization code?5
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000BF5G
Policy instance 5
Insurance contract or identification numberG000BF5G
Number of Individuals Covered268
Insurance policy start date2019-10-01
Insurance policy end date2020-10-01
Total amount of commissions paid to insurance brokerUSD $730
Total amount of fees paid to insurance companyUSD $1,719
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $4,867
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees1416
Additional information about fees paid to insurance brokerADMINISTRATION
Insurance broker organization code?5
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000BF5G
Policy instance 6
Insurance contract or identification numberG000BF5G
Number of Individuals Covered74
Insurance policy start date2019-10-01
Insurance policy end date2020-10-01
Total amount of commissions paid to insurance brokerUSD $2,857
Total amount of fees paid to insurance companyUSD $1,306
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedCRITICAL ILLNESS VOLUNTARY
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $14,286
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,857
Amount paid for insurance broker fees0
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 numberG000BF5G
Policy instance 8
Insurance contract or identification numberG000BF5G
Number of Individuals Covered120
Insurance policy start date2019-10-01
Insurance policy end date2020-10-01
Total amount of commissions paid to insurance brokerUSD $7,942
Total amount of fees paid to insurance companyUSD $4,140
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedTERM LIFE VOLUNTARY
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $39,708
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees1416
Additional information about fees paid to insurance brokerADMINISTRATION
Insurance broker organization code?5
Commission paid to Insurance BrokerUSD $0
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract numberEA84
Policy instance 1
Insurance contract or identification numberEA84
Number of Individuals Covered1425
Insurance policy start date2019-09-01
Insurance policy end date2020-08-31
Total amount of commissions paid to insurance brokerUSD $15,603
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?Yes
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Other information about contractGUARANTEED INTEREST OPTION
Commission paid to Insurance BrokerUSD $70
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerRELIASTAR LIFE INSURANCE COMPANY COMMISSION
Insurance broker organization code?3
UNITED OF OMAHA LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000BF5G
Policy instance 7
Insurance contract or identification numberG000BF5G
Number of Individuals Covered81
Insurance policy start date2019-10-01
Insurance policy end date2020-10-01
Total amount of commissions paid to insurance brokerUSD $3,933
Total amount of fees paid to insurance companyUSD $1,349
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENT ONLY VOLUNTARY
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $19,633
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees1349
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract numberEA84
Policy instance 3
Insurance contract or identification numberEA84
Number of Individuals Covered1425
Insurance policy start date2018-09-01
Insurance policy end date2019-08-31
Total amount of commissions paid to insurance brokerUSD $14,155
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?Yes
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Other information about contractGUARANTEED INTEREST OPTION
Commission paid to Insurance BrokerUSD $69
Additional information about fees paid to insurance brokerRELIASTAR LIFE INSURANCE COMPANY COMMISSION
Insurance broker organization code?3
Amount paid for insurance broker fees0
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000BF5G
Policy instance 1
Insurance contract or identification numberG000BF5G
Number of Individuals Covered229
Insurance policy start date2018-10-01
Insurance policy end date2019-10-01
Total amount of commissions paid to insurance brokerUSD $23,203
Total amount of fees paid to insurance companyUSD $6,392
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedSHORT TERM DISABILITY ,CRITICAL ILLNESS, ACCIDENT ONLY, TERM LIFE
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $121,114
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees4248
Additional information about fees paid to insurance brokerMUTUAL OF OMAHA INSURANCE COMPANY COMMISSION AND FEES
Insurance broker organization code?3
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number0109513
Policy instance 2
Insurance contract or identification number0109513
Number of Individuals Covered209
Insurance policy start date2018-10-01
Insurance policy end date2019-09-30
Total amount of commissions paid to insurance brokerUSD $6,007
Total amount of fees paid to insurance companyUSD $7,040
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $828,811
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,007
Amount paid for insurance broker fees7040
Additional information about fees paid to insurance brokerAETNA LIFE INSURANCE CO. COMMISSION, SERVICE FEES, DIRECT AND INDIRECT COMPENSATION.
Insurance broker organization code?3
HUMANA HEALTH PLAN OF TEXAS, INC. (National Association of Insurance Commissioners NAIC id number: 95024 )
Policy contract number747310
Policy instance 2
Insurance contract or identification number747310
Number of Individuals Covered100
Insurance policy start date2017-10-01
Insurance policy end date2018-09-30
Total amount of commissions paid to insurance brokerUSD $35,109
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $702,174
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00491050
Policy instance 1
Insurance contract or identification number00491050
Number of Individuals Covered196
Insurance policy start date2017-10-01
Insurance policy end date2018-09-30
Total amount of commissions paid to insurance brokerUSD $25,414
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENT,VOLUNTARY CRITICAL ILLNESS
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $157,114
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract numberEA84
Policy instance 3
Insurance contract or identification numberEA84
Number of Individuals Covered1449
Insurance policy start date2017-09-01
Insurance policy end date2018-08-31
Total amount of commissions paid to insurance brokerUSD $14,365
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AHAD
Policy instance 2
Insurance contract or identification numberG000AHAD
Number of Individuals Covered78
Insurance policy start date2012-10-01
Insurance policy end date2013-10-01
Total amount of commissions paid to insurance brokerUSD $483
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $2,413
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $483
Insurance broker organization code?3
Insurance broker nameHAMSTRA BENEFIT SOLUTIONS LLC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AHAD
Policy instance 3
Insurance contract or identification numberG000AHAD
Number of Individuals Covered60
Insurance policy start date2012-10-01
Insurance policy end date2013-10-01
Total amount of commissions paid to insurance brokerUSD $2,753
Are there contracts with allocated funds for individual policies?Yes
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedPREFERRED CHOICE VOLUNTARY STD
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $13,767
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,753
Insurance broker organization code?3
Insurance broker nameHAMSTRA BENEFIT SOLUTIONS LLC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AHAD
Policy instance 4
Insurance contract or identification numberG000AHAD
Number of Individuals Covered55
Insurance policy start date2012-10-01
Insurance policy end date2013-10-01
Total amount of commissions paid to insurance brokerUSD $2,923
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $14,613
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,923
Insurance broker organization code?3
Insurance broker nameHAMSTRA BENEFIT SOLUTIONS LLC
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberPC1D1251
Policy instance 5
Insurance contract or identification numberPC1D1251
Number of Individuals Covered34
Insurance policy start date2012-10-01
Insurance policy end date2013-09-30
Total amount of commissions paid to insurance brokerUSD $1,753
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $17,557
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,753
Insurance broker nameJANNA L HAMSTRA
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number10774-1019
Policy instance 6
Insurance contract or identification number10774-1019
Number of Individuals Covered90
Insurance policy start date2012-10-01
Insurance policy end date2013-09-30
Total amount of commissions paid to insurance brokerUSD $507
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $5,065
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $507
Insurance broker nameHAMSTRA BENEFITS
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract numberPTO 40082209
Policy instance 7
Insurance contract or identification numberPTO 40082209
Number of Individuals Covered1515
Insurance policy start date2012-09-01
Insurance policy end date2013-08-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?Yes
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AHAD
Policy instance 1
Insurance contract or identification numberG000AHAD
Number of Individuals Covered78
Insurance policy start date2012-10-01
Insurance policy end date2013-10-01
Total amount of commissions paid to insurance brokerUSD $1,967
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $9,833
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,967
Insurance broker organization code?3
Insurance broker nameHAMSTRA BENEFIT SOLUTIONS LLC
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberFG1D1291
Policy instance 1
Insurance contract or identification numberFG1D1291
Number of Individuals Covered32
Insurance policy start date2011-10-01
Insurance policy end date2012-09-30
Total amount of commissions paid to insurance brokerUSD $1,391
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $13,880
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract numberPTO 40082209
Policy instance 7
Insurance contract or identification numberPTO 40082209
Number of Individuals Covered651
Insurance policy start date2011-09-01
Insurance policy end date2012-08-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AHAD
Policy instance 6
Insurance contract or identification numberG000AHAD
Number of Individuals Covered56
Insurance policy start date2011-10-01
Insurance policy end date2012-10-01
Total amount of commissions paid to insurance brokerUSD $2,729
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $13,647
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 numberG000AHAD
Policy instance 5
Insurance contract or identification numberG000AHAD
Number of Individuals Covered84
Insurance policy start date2011-10-01
Insurance policy end date2012-10-01
Total amount of commissions paid to insurance brokerUSD $2,025
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $10,125
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 numberG000AHAD
Policy instance 4
Insurance contract or identification numberG000AHAD
Number of Individuals Covered84
Insurance policy start date2011-10-01
Insurance policy end date2012-10-01
Total amount of commissions paid to insurance brokerUSD $495
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $2,475
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 numberG000AHAD
Policy instance 3
Insurance contract or identification numberG000AHAD
Number of Individuals Covered60
Insurance policy start date2011-10-01
Insurance policy end date2012-10-01
Total amount of commissions paid to insurance brokerUSD $2,668
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $13,341
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number10774-1019
Policy instance 2
Insurance contract or identification number10774-1019
Number of Individuals Covered79
Insurance policy start date2011-10-01
Insurance policy end date2012-09-30
Total amount of commissions paid to insurance brokerUSD $511
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $5,109
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 number545266
Policy instance 1
Insurance contract or identification number545266
Number of Individuals Covered53
Insurance policy start date2010-10-01
Insurance policy end date2011-09-30
Total amount of commissions paid to insurance brokerUSD $3,667
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGOOOAHAD
Policy instance 2
Insurance contract or identification numberGOOOAHAD
Number of Individuals Covered45
Insurance policy start date2010-10-01
Insurance policy end date2011-10-01
Total amount of commissions paid to insurance brokerUSD $2,206
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $11,030
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 numberGOOOAHAD
Policy instance 3
Insurance contract or identification numberGOOOAHAD
Number of Individuals Covered81
Insurance policy start date2010-10-01
Insurance policy end date2011-10-01
Total amount of commissions paid to insurance brokerUSD $1,970
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $9,851
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 numberGOOOAHAD
Policy instance 4
Insurance contract or identification numberGOOOAHAD
Number of Individuals Covered81
Insurance policy start date2010-10-01
Insurance policy end date2011-10-01
Total amount of commissions paid to insurance brokerUSD $482
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $2,412
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 numberGOOOAHAD
Policy instance 5
Insurance contract or identification numberGOOOAHAD
Number of Individuals Covered60
Insurance policy start date2010-10-01
Insurance policy end date2011-10-01
Total amount of commissions paid to insurance brokerUSD $2,530
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $12,649
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number10774-1019
Policy instance 6
Insurance contract or identification number10774-1019
Number of Individuals Covered69
Insurance policy start date2010-10-01
Insurance policy end date2011-09-30
Total amount of commissions paid to insurance brokerUSD $463
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $4,627
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract numberPTO 40082209
Policy instance 7
Insurance contract or identification numberPTO 40082209
Number of Individuals Covered1736
Insurance policy start date2010-09-01
Insurance policy end date2011-08-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?Yes
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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