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ABC AUTO PARTS LTD OCCUPATIONAL INJURY BENEFIT PLA N 401k Plan overview

Plan NameABC AUTO PARTS LTD OCCUPATIONAL INJURY BENEFIT PLA N
Plan identification number 501

ABC AUTO PARTS LTD OCCUPATIONAL INJURY BENEFIT PLA N Benefits

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

401k Sponsoring company profile

ABC AUTO PARTS, LTD. has sponsored the creation of one or more 401k plans.

Company Name:ABC AUTO PARTS, LTD.
Employer identification number (EIN):751306065
NAIC Classification:441300
NAIC Description: Automotive Parts, Accessories, and Tire Stores

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ABC AUTO PARTS LTD OCCUPATIONAL INJURY BENEFIT PLA N

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-02-01MARK SHREWSBURY2023-11-09
5012021-02-01
5012020-02-01
5012019-02-01
5012018-02-01
5012017-02-01KAREN CLOUD
5012016-02-01KAREN CLOUD
5012015-02-01KAREN CLOUD
5012015-01-01
5012014-02-01KAREN CLOUD
5012014-02-01KAREN CLOUD
5012014-01-01KAREN CLOUD KAREN CLOUD2015-06-22
5012013-02-01KAREN CLOUD
5012013-01-01KAREN CLOUD KAREN CLOUD2014-09-29
5012012-02-01KAREN CLOUD
5012012-01-01KAREN CLOUD KAREN CLOUD2013-07-22
5012011-02-01KAREN CLOUD
5012009-02-01KAREN CLOUD

Plan Statistics for ABC AUTO PARTS LTD OCCUPATIONAL INJURY BENEFIT PLA N

401k plan membership statisitcs for ABC AUTO PARTS LTD OCCUPATIONAL INJURY BENEFIT PLA N

Measure Date Value
2022: ABC AUTO PARTS LTD OCCUPATIONAL INJURY BENEFIT PLA N 2022 401k membership
Total participants, beginning-of-year2022-02-01288
Total number of active participants reported on line 7a of the Form 55002022-02-01258
Number of retired or separated participants receiving benefits2022-02-010
Number of other retired or separated participants entitled to future benefits2022-02-010
Total of all active and inactive participants2022-02-01258
2021: ABC AUTO PARTS LTD OCCUPATIONAL INJURY BENEFIT PLA N 2021 401k membership
Total participants, beginning-of-year2021-02-01299
Total number of active participants reported on line 7a of the Form 55002021-02-01287
Number of retired or separated participants receiving benefits2021-02-011
Total of all active and inactive participants2021-02-01288
Total participants2021-02-01288
2020: ABC AUTO PARTS LTD OCCUPATIONAL INJURY BENEFIT PLA N 2020 401k membership
Total participants, beginning-of-year2020-02-01294
Total number of active participants reported on line 7a of the Form 55002020-02-01298
Number of other retired or separated participants entitled to future benefits2020-02-011
Total of all active and inactive participants2020-02-01299
Total participants2020-02-01299
2019: ABC AUTO PARTS LTD OCCUPATIONAL INJURY BENEFIT PLA N 2019 401k membership
Total participants, beginning-of-year2019-02-01284
Total number of active participants reported on line 7a of the Form 55002019-02-01293
Number of retired or separated participants receiving benefits2019-02-011
Total of all active and inactive participants2019-02-01294
Total participants2019-02-01294
2018: ABC AUTO PARTS LTD OCCUPATIONAL INJURY BENEFIT PLA N 2018 401k membership
Total participants, beginning-of-year2018-02-01261
Total number of active participants reported on line 7a of the Form 55002018-02-01284
Total of all active and inactive participants2018-02-01284
Total participants2018-02-01284
2017: ABC AUTO PARTS LTD OCCUPATIONAL INJURY BENEFIT PLA N 2017 401k membership
Total participants, beginning-of-year2017-02-01263
Total number of active participants reported on line 7a of the Form 55002017-02-01260
Number of retired or separated participants receiving benefits2017-02-011
Total of all active and inactive participants2017-02-01261
Total participants2017-02-01261
2016: ABC AUTO PARTS LTD OCCUPATIONAL INJURY BENEFIT PLA N 2016 401k membership
Total participants, beginning-of-year2016-02-01213
Total number of active participants reported on line 7a of the Form 55002016-02-01228
Total of all active and inactive participants2016-02-01228
Total participants2016-02-01228
2015: ABC AUTO PARTS LTD OCCUPATIONAL INJURY BENEFIT PLA N 2015 401k membership
Total participants, beginning-of-year2015-02-01224
Total number of active participants reported on line 7a of the Form 55002015-02-01213
Total of all active and inactive participants2015-02-01213
Total participants2015-02-010
Total participants, beginning-of-year2015-01-01349
Total number of active participants reported on line 7a of the Form 55002015-01-01338
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-010
Total of all active and inactive participants2015-01-01338
Total participants2015-01-01338
2014: ABC AUTO PARTS LTD OCCUPATIONAL INJURY BENEFIT PLA N 2014 401k membership
Total participants, beginning-of-year2014-02-010
Total number of active participants reported on line 7a of the Form 55002014-02-010
Total of all active and inactive participants2014-02-010
Total participants2014-02-010
Total participants, beginning-of-year2014-01-01354
Total number of active participants reported on line 7a of the Form 55002014-01-01349
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-010
Total of all active and inactive participants2014-01-01349
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
2013: ABC AUTO PARTS LTD OCCUPATIONAL INJURY BENEFIT PLA N 2013 401k membership
Total participants, beginning-of-year2013-02-0172
Total number of active participants reported on line 7a of the Form 55002013-02-0172
Total of all active and inactive participants2013-02-0172
Total participants, beginning-of-year2013-01-01353
Total number of active participants reported on line 7a of the Form 55002013-01-01354
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-010
Total of all active and inactive participants2013-01-01354
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
2012: ABC AUTO PARTS LTD OCCUPATIONAL INJURY BENEFIT PLA N 2012 401k membership
Total participants, beginning-of-year2012-02-0171
Total number of active participants reported on line 7a of the Form 55002012-02-0172
Total of all active and inactive participants2012-02-0172
Total participants, beginning-of-year2012-01-01340
Total number of active participants reported on line 7a of the Form 55002012-01-01351
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-010
Total of all active and inactive participants2012-01-01351
2011: ABC AUTO PARTS LTD OCCUPATIONAL INJURY BENEFIT PLA N 2011 401k membership
Total participants, beginning-of-year2011-02-0171
Total number of active participants reported on line 7a of the Form 55002011-02-0171
Total of all active and inactive participants2011-02-0171
2009: ABC AUTO PARTS LTD OCCUPATIONAL INJURY BENEFIT PLA N 2009 401k membership
Total participants, beginning-of-year2009-02-0174
Total number of active participants reported on line 7a of the Form 55002009-02-0169
Total of all active and inactive participants2009-02-0169

Financial Data on ABC AUTO PARTS LTD OCCUPATIONAL INJURY BENEFIT PLA N

Measure Date Value
2015 : ABC AUTO PARTS LTD OCCUPATIONAL INJURY BENEFIT PLA N 2015 401k financial data
Total income from all sources (including contributions)2015-01-31$1,751,139
Total of all expenses incurred2015-01-31$1,751,621
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-01-31$1,560,490
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-01-31$1,751,139
Value of total assets at end of year2015-01-31$320
Value of total assets at beginning of year2015-01-31$802
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-01-31$191,131
Total income from all sources2015-01-31$43,860
Expenses. Total of all expenses incurred2015-01-31$96,340
Benefits paid (including direct rollovers)2015-01-31$81,132
Total plan assets at end of year2015-01-31$320
Total plan assets at beginning of year2015-01-31$52,800
Expenses. Other expenses not covered elsewhere2015-01-31$15,208
Net income (gross income less expenses)2015-01-31$-52,480
Net plan assets at end of year (total assets less liabilities)2015-01-31$320
Net plan assets at beginning of year (total assets less liabilities)2015-01-31$52,800
Total contributions received or receivable from employer(s)2015-01-31$43,860
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-01-31No
Was this plan covered by a fidelity bond2015-01-31Yes
Value of fidelity bond cover2015-01-31$500,000
If this is an individual account plan, was there a blackout period2015-01-31No
Were there any nonexempt tranactions with any party-in-interest2015-01-31No
Contributions received from participants2015-01-31$685,278
Total non interest bearing cash at end of year2015-01-31$320
Total non interest bearing cash at beginning of year2015-01-31$802
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-01-31No
Value of net income/loss2015-01-31$-482
Value of net assets at end of year (total assets less liabilities)2015-01-31$320
Value of net assets at beginning of year (total assets less liabilities)2015-01-31$802
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-01-31No
Were any loans by the plan or fixed income obligations due to the plan in default2015-01-31No
Were any leases to which the plan was party in default or uncollectible2015-01-31No
Value of interest in common/collective trusts at end of year2015-01-31$0
Expenses. Payments to insurance carriers foe the provision of benefits2015-01-31$609,170
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-01-31No
Was there a failure to transmit to the plan any participant contributions2015-01-31No
Has the plan failed to provide any benefit when due under the plan2015-01-31No
Contributions received in cash from employer2015-01-31$1,065,861
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-01-31$951,320
Contract administrator fees2015-01-31$191,131
Did the plan have assets held for investment2015-01-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-01-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-01-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-01-31No
Opinion of an independent qualified public accountant for this plan2015-01-31Unqualified
Accountancy firm name2015-01-31CURTIS BLAKELY & CO., PC
Accountancy firm EIN2015-01-31751546734
2014 : ABC AUTO PARTS LTD OCCUPATIONAL INJURY BENEFIT PLA N 2014 401k financial data
Total income from all sources2014-01-31$1,734,937
Expenses. Total of all expenses incurred2014-01-31$1,683,957
Benefits paid (including direct rollovers)2014-01-31$1,637,079
Total plan assets at end of year2014-01-31$52,800
Total plan assets at beginning of year2014-01-31$1,820
Expenses. Other expenses not covered elsewhere2014-01-31$46,878
Net income (gross income less expenses)2014-01-31$50,980
Net plan assets at end of year (total assets less liabilities)2014-01-31$52,800
Net plan assets at beginning of year (total assets less liabilities)2014-01-31$1,820
Total contributions received or receivable from employer(s)2014-01-31$1,734,937
2013 : ABC AUTO PARTS LTD OCCUPATIONAL INJURY BENEFIT PLA N 2013 401k financial data
Total income from all sources2013-01-31$1,652,149
Expenses. Total of all expenses incurred2013-01-31$1,661,353
Benefits paid (including direct rollovers)2013-01-31$1,621,130
Total plan assets at end of year2013-01-31$1,820
Total plan assets at beginning of year2013-01-31$11,024
Expenses. Other expenses not covered elsewhere2013-01-31$40,223
Other income received2013-01-31$305,270
Net income (gross income less expenses)2013-01-31$-9,204
Net plan assets at end of year (total assets less liabilities)2013-01-31$1,820
Net plan assets at beginning of year (total assets less liabilities)2013-01-31$11,024
Total contributions received or receivable from employer(s)2013-01-31$1,346,879
2012 : ABC AUTO PARTS LTD OCCUPATIONAL INJURY BENEFIT PLA N 2012 401k financial data
Total plan liabilities at beginning of year2012-01-31$28,625
Total income from all sources2012-01-31$1,885,092
Expenses. Total of all expenses incurred2012-01-31$1,874,068
Benefits paid (including direct rollovers)2012-01-31$1,835,751
Total plan assets at end of year2012-01-31$11,024
Total plan assets at beginning of year2012-01-31$28,625
Other income received2012-01-31$561,445
Net income (gross income less expenses)2012-01-31$11,024
Net plan assets at end of year (total assets less liabilities)2012-01-31$11,024
Net plan assets at beginning of year (total assets less liabilities)2012-01-31$0
Total contributions received or receivable from employer(s)2012-01-31$1,323,647
Expenses. Administrative service providers (salaries,fees and commissions)2012-01-31$38,317
2011 : ABC AUTO PARTS LTD OCCUPATIONAL INJURY BENEFIT PLA N 2011 401k financial data
Total plan liabilities at end of year2011-01-31$28,625
Total plan liabilities at beginning of year2011-01-31$50,479
Total income from all sources2011-01-31$1,193,390
Expenses. Total of all expenses incurred2011-01-31$1,193,390
Benefits paid (including direct rollovers)2011-01-31$1,156,217
Total plan assets at end of year2011-01-31$28,625
Total plan assets at beginning of year2011-01-31$50,479
Other income received2011-01-31$179,192
Net income (gross income less expenses)2011-01-31$0
Net plan assets at end of year (total assets less liabilities)2011-01-31$0
Net plan assets at beginning of year (total assets less liabilities)2011-01-31$0
Total contributions received or receivable from employer(s)2011-01-31$1,014,198
Expenses. Administrative service providers (salaries,fees and commissions)2011-01-31$37,173

Form 5500 Responses for ABC AUTO PARTS LTD OCCUPATIONAL INJURY BENEFIT PLA N

2022: ABC AUTO PARTS LTD OCCUPATIONAL INJURY BENEFIT PLA N 2022 form 5500 responses
2022-02-01Type of plan entitySingle employer plan
2022-02-01Submission has been amendedNo
2022-02-01This submission is the final filingNo
2022-02-01This return/report is a short plan year return/report (less than 12 months)No
2022-02-01Plan is a collectively bargained planNo
2022-02-01Plan funding arrangement – InsuranceYes
2022-02-01Plan benefit arrangement – InsuranceYes
2022-02-01Plan benefit arrangement – General assets of the sponsorYes
2021: ABC AUTO PARTS LTD OCCUPATIONAL INJURY BENEFIT PLA N 2021 form 5500 responses
2021-02-01Type of plan entitySingle employer plan
2021-02-01Plan funding arrangement – InsuranceYes
2021-02-01Plan benefit arrangement – InsuranceYes
2021-02-01Plan benefit arrangement – General assets of the sponsorYes
2020: ABC AUTO PARTS LTD OCCUPATIONAL INJURY BENEFIT PLA N 2020 form 5500 responses
2020-02-01Type of plan entitySingle employer plan
2020-02-01Plan funding arrangement – InsuranceYes
2020-02-01Plan benefit arrangement – InsuranceYes
2020-02-01Plan benefit arrangement – General assets of the sponsorYes
2019: ABC AUTO PARTS LTD OCCUPATIONAL INJURY BENEFIT PLA N 2019 form 5500 responses
2019-02-01Type of plan entitySingle employer plan
2019-02-01Plan funding arrangement – InsuranceYes
2019-02-01Plan benefit arrangement – InsuranceYes
2019-02-01Plan benefit arrangement – General assets of the sponsorYes
2018: ABC AUTO PARTS LTD OCCUPATIONAL INJURY BENEFIT PLA N 2018 form 5500 responses
2018-02-01Type of plan entitySingle employer plan
2018-02-01Plan funding arrangement – InsuranceYes
2018-02-01Plan benefit arrangement – InsuranceYes
2018-02-01Plan benefit arrangement – General assets of the sponsorYes
2017: ABC AUTO PARTS LTD OCCUPATIONAL INJURY BENEFIT PLA N 2017 form 5500 responses
2017-02-01Type of plan entitySingle employer plan
2017-02-01Plan funding arrangement – InsuranceYes
2017-02-01Plan benefit arrangement – InsuranceYes
2017-02-01Plan benefit arrangement – General assets of the sponsorYes
2016: ABC AUTO PARTS LTD OCCUPATIONAL INJURY BENEFIT PLA N 2016 form 5500 responses
2016-02-01Type of plan entitySingle employer plan
2016-02-01Plan funding arrangement – InsuranceYes
2016-02-01Plan benefit arrangement – InsuranceYes
2016-02-01Plan benefit arrangement – General assets of the sponsorYes
2015: ABC AUTO PARTS LTD OCCUPATIONAL INJURY BENEFIT PLA N 2015 form 5500 responses
2015-02-01Type of plan entitySingle employer plan
2015-02-01Plan funding arrangement – InsuranceYes
2015-02-01Plan benefit arrangement – InsuranceYes
2015-02-01Plan benefit arrangement – General assets of the sponsorYes
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan funding arrangement – General assets of the sponsorYes
2015-01-01Plan benefit arrangement – General assets of the sponsorYes
2014: ABC AUTO PARTS LTD OCCUPATIONAL INJURY BENEFIT PLA N 2014 form 5500 responses
2014-02-01Type of plan entitySingle employer plan
2014-02-01Plan is a collectively bargained planYes
2014-02-01Plan funding arrangement – InsuranceYes
2014-02-01Plan funding arrangement – TrustYes
2014-02-01Plan benefit arrangement – InsuranceYes
2014-02-01Plan benefit arrangement - TrustYes
2014-02-01Plan benefit arrangement – General assets of the sponsorYes
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – General assets of the sponsorYes
2014-01-01Plan benefit arrangement – General assets of the sponsorYes
2013: ABC AUTO PARTS LTD OCCUPATIONAL INJURY BENEFIT PLA N 2013 form 5500 responses
2013-02-01Type of plan entitySingle employer plan
2013-02-01Plan funding arrangement – InsuranceYes
2013-02-01Plan funding arrangement – TrustYes
2013-02-01Plan benefit arrangement – InsuranceYes
2013-02-01Plan benefit arrangement - TrustYes
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – General assets of the sponsorYes
2013-01-01Plan benefit arrangement – General assets of the sponsorYes
2012: ABC AUTO PARTS LTD OCCUPATIONAL INJURY BENEFIT PLA N 2012 form 5500 responses
2012-02-01Type of plan entitySingle employer plan
2012-02-01Plan funding arrangement – InsuranceYes
2012-02-01Plan funding arrangement – TrustYes
2012-02-01Plan benefit arrangement – InsuranceYes
2012-02-01Plan benefit arrangement - TrustYes
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – General assets of the sponsorYes
2012-01-01Plan benefit arrangement – General assets of the sponsorYes
2011: ABC AUTO PARTS LTD OCCUPATIONAL INJURY BENEFIT PLA N 2011 form 5500 responses
2011-02-01Type of plan entitySingle employer plan
2011-02-01Plan funding arrangement – InsuranceYes
2011-02-01Plan funding arrangement – TrustYes
2011-02-01Plan benefit arrangement – InsuranceYes
2011-02-01Plan benefit arrangement - TrustYes
2009: ABC AUTO PARTS LTD OCCUPATIONAL INJURY BENEFIT PLA N 2009 form 5500 responses
2009-02-01Type of plan entitySingle employer plan
2009-02-01This submission is the final filingNo
2009-02-01Plan funding arrangement – InsuranceYes
2009-02-01Plan funding arrangement – TrustYes
2009-02-01Plan benefit arrangement – InsuranceYes
2009-02-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number133970
Policy instance 3
Insurance contract or identification number133970
Number of Individuals Covered230
Insurance policy start date2022-02-01
Insurance policy end date2023-01-31
Total amount of commissions paid to insurance brokerUSD $35,837
Total amount of fees paid to insurance companyUSD $8,952
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 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 $476,092
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $35,837
Amount paid for insurance broker fees8458
Additional information about fees paid to insurance brokerSPECIAL PROGRAMS
Insurance broker organization code?3
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number307460
Policy instance 2
Insurance contract or identification number307460
Number of Individuals Covered258
Insurance policy start date2022-02-01
Insurance policy end date2023-01-31
Total amount of commissions paid to insurance brokerUSD $3,096
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 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 $30,733
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,077
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0870H
Policy instance 1
Insurance contract or identification numberGLUG0870H
Number of Individuals Covered214
Insurance policy start date2022-02-01
Insurance policy end date2023-01-31
Total amount of commissions paid to insurance brokerUSD $2,029
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 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 $10,142
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,029
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000870H
Policy instance 1
Insurance contract or identification numberG000870H
Number of Individuals Covered217
Insurance policy start date2021-02-01
Insurance policy end date2022-01-31
Total amount of commissions paid to insurance brokerUSD $2,035
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $10,175
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,035
Insurance broker organization code?3
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number307460
Policy instance 2
Insurance contract or identification number307460
Number of Individuals Covered258
Insurance policy start date2021-02-01
Insurance policy end date2022-01-31
Total amount of commissions paid to insurance brokerUSD $3,113
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $31,134
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,113
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000870H
Policy instance 1
Insurance contract or identification numberG000870H
Number of Individuals Covered220
Insurance policy start date2020-02-01
Insurance policy end date2021-01-31
Total amount of commissions paid to insurance brokerUSD $2,041
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $10,204
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,041
Insurance broker organization code?3
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number307460
Policy instance 2
Insurance contract or identification number307460
Number of Individuals Covered238
Insurance policy start date2020-02-01
Insurance policy end date2021-01-31
Total amount of commissions paid to insurance brokerUSD $2,998
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $29,977
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,998
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000870H
Policy instance 1
Insurance contract or identification numberG000870H
Number of Individuals Covered233
Insurance policy start date2019-02-01
Insurance policy end date2020-01-31
Total amount of commissions paid to insurance brokerUSD $2,045
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $10,224
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,045
Insurance broker organization code?3
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number307460
Policy instance 2
Insurance contract or identification number307460
Number of Individuals Covered232
Insurance policy start date2019-02-01
Insurance policy end date2020-01-31
Total amount of commissions paid to insurance brokerUSD $2,773
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $27,734
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,773
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000870H
Policy instance 1
Insurance contract or identification numberG000870H
Number of Individuals Covered234
Insurance policy start date2018-02-01
Insurance policy end date2019-01-31
Total amount of commissions paid to insurance brokerUSD $1,975
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $9,877
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,975
Insurance broker organization code?3
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number307460
Policy instance 2
Insurance contract or identification number307460
Number of Individuals Covered206
Insurance policy start date2018-02-01
Insurance policy end date2019-01-31
Total amount of commissions paid to insurance brokerUSD $2,791
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $27,909
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,791
Insurance broker organization code?3
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number307460
Policy instance 2
Insurance contract or identification number307460
Number of Individuals Covered195
Insurance policy start date2017-02-01
Insurance policy end date2018-01-31
Total amount of commissions paid to insurance brokerUSD $2,869
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $29,488
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,869
Insurance broker organization code?3
Insurance broker nameRANDALL SCOTT WARD
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000870H
Policy instance 1
Insurance contract or identification numberG000870H
Number of Individuals Covered211
Insurance policy start date2017-02-01
Insurance policy end date2018-01-31
Total amount of commissions paid to insurance brokerUSD $1,956
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $9,781
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,956
Insurance broker organization code?3
Insurance broker nameRANDALL SCOTT WARD
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number307460-5
Policy instance 2
Insurance contract or identification number307460-5
Number of Individuals Covered203
Insurance policy start date2015-02-01
Insurance policy end date2016-01-31
Total amount of commissions paid to insurance brokerUSD $2,367
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $25,717
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,367
Insurance broker organization code?3
Insurance broker nameRANDALL SCOTT WARD
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000870H
Policy instance 1
Insurance contract or identification numberG000870H
Number of Individuals Covered201
Insurance policy start date2015-02-01
Insurance policy end date2016-01-31
Total amount of commissions paid to insurance brokerUSD $1,860
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $9,302
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,860
Insurance broker organization code?3
Insurance broker nameRANDALL SCOTT WARD
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number307460-5
Policy instance 2
Insurance contract or identification number307460-5
Number of Individuals Covered154
Insurance policy start date2014-02-01
Insurance policy end date2015-01-31
Total amount of commissions paid to insurance brokerUSD $252
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $21,315
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $252
Insurance broker organization code?3
Insurance broker nameRANDALL SCOTT WARD
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000870H
Policy instance 1
Insurance contract or identification numberG000870H
Number of Individuals Covered181
Insurance policy start date2014-02-01
Insurance policy end date2015-01-31
Total amount of commissions paid to insurance brokerUSD $1,440
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $7,202
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,440
Insurance broker organization code?3
Insurance broker nameRANDALL SCOTT WARD
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract numberHCL31015
Policy instance 3
Insurance contract or identification numberHCL31015
Number of Individuals Covered181
Insurance policy start date2014-02-01
Insurance policy end date2015-01-31
Total amount of commissions paid to insurance brokerUSD $29,033
Welfare Benefit Premiums Paid to CarrierUSD $580,653
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $29,033
Insurance broker organization code?3
Insurance broker nameCENTERSTONE INS & FIN SERVICES, INC
MULTIPLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNOT AVAILABLE
Policy instance 3
Insurance contract or identification numberNOT AVAILABLE
Number of Individuals Covered72
Insurance policy start date2013-02-01
Insurance policy end date2014-01-31
Total amount of commissions paid to insurance brokerUSD $1,906
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $7,877
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,906
Insurance broker organization code?5
Insurance broker nameIMA, INC.
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 )
Policy contract numberNOT AVAILABLE
Policy instance 2
Insurance contract or identification numberNOT AVAILABLE
Number of Individuals Covered72
Insurance policy start date2013-02-01
Insurance policy end date2014-01-31
Total amount of commissions paid to insurance brokerUSD $548
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD AND D
Welfare Benefit Premiums Paid to CarrierUSD $2,701
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $548
Insurance broker organization code?5
Insurance broker nameIMA, INC.
IPROCERT (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNOT AVAILABLE
Policy instance 1
Insurance contract or identification numberNOT AVAILABLE
Number of Individuals Covered72
Insurance policy start date2013-02-01
Insurance policy end date2014-01-31
Total amount of commissions paid to insurance brokerUSD $699
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedPRE-CERTIFICATION
Welfare Benefit Premiums Paid to CarrierUSD $3,366
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $699
Insurance broker organization code?5
Insurance broker nameIMA, INC.
GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 )
Policy contract numberNOT AVAILABLE
Policy instance 4
Insurance contract or identification numberNOT AVAILABLE
Number of Individuals Covered72
Insurance policy start date2013-02-01
Insurance policy end date2014-01-31
Total amount of commissions paid to insurance brokerUSD $81,056
Total amount of fees paid to insurance companyUSD $42,431
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Other welfare benefits providedCOMPLIANCE
Welfare Benefit Premiums Paid to CarrierUSD $537,272
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $81,056
Amount paid for insurance broker fees34811
Additional information about fees paid to insurance brokerTHIRD PARTY ADMIN FEES
Insurance broker organization code?5
Insurance broker nameRANDALL SCOTT
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 )
Policy contract numberNOT AVAILABLE
Policy instance 2
Insurance contract or identification numberNOT AVAILABLE
Number of Individuals Covered72
Insurance policy start date2012-02-01
Insurance policy end date2013-01-31
Total amount of commissions paid to insurance brokerUSD $540
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD AND D
Welfare Benefit Premiums Paid to CarrierUSD $2,663
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $540
Insurance broker organization code?5
Insurance broker nameINSURANCE MANAGEMENT ADMINISTRATORS
BEECHSTREET (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNOT AVAILABLE
Policy instance 3
Insurance contract or identification numberNOT AVAILABLE
Number of Individuals Covered72
Insurance policy start date2012-02-01
Insurance policy end date2013-01-31
Total amount of commissions paid to insurance brokerUSD $1,021
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $4,751
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,021
Insurance broker organization code?5
Insurance broker nameINSURANCE MANAGEMENT ADMINISTRATORS
IPROCERT (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNOT AVAILABLE
Policy instance 1
Insurance contract or identification numberNOT AVAILABLE
Number of Individuals Covered72
Insurance policy start date2012-02-01
Insurance policy end date2013-01-31
Total amount of commissions paid to insurance brokerUSD $488
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedPRE-CERTIFICATION
Welfare Benefit Premiums Paid to CarrierUSD $2,353
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $488
Insurance broker organization code?5
Insurance broker nameINSURANCE MANAGEMENT ADMINISTRATORS
TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 )
Policy contract numberNOT AVAILABLE
Policy instance 4
Insurance contract or identification numberNOT AVAILABLE
Number of Individuals Covered72
Insurance policy start date2012-02-01
Insurance policy end date2013-01-31
Total amount of commissions paid to insurance brokerUSD $43,641
Total amount of fees paid to insurance companyUSD $30,273
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Other welfare benefits providedCOMPLIANCE
Welfare Benefit Premiums Paid to CarrierUSD $288,419
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $43,641
Amount paid for insurance broker fees24945
Additional information about fees paid to insurance brokerTHIRD PARTY ADMIN FEES
Insurance broker organization code?5
Insurance broker nameHIGGINBOTHAM
TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 )
Policy contract numberNOT AVAILABLE
Policy instance 4
Insurance contract or identification numberNOT AVAILABLE
Number of Individuals Covered71
Insurance policy start date2011-02-01
Insurance policy end date2012-01-31
Total amount of commissions paid to insurance brokerUSD $35,364
Total amount of fees paid to insurance companyUSD $28,878
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Other welfare benefits providedCOMPLIANCE
Welfare Benefit Premiums Paid to CarrierUSD $233,084
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
IPROCERT (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNOT AVAILABLE
Policy instance 1
Insurance contract or identification numberNOT AVAILABLE
Number of Individuals Covered71
Insurance policy start date2011-02-01
Insurance policy end date2012-01-31
Total amount of commissions paid to insurance brokerUSD $468
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedPRE-CERTIFICATION
Welfare Benefit Premiums Paid to CarrierUSD $2,255
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: 71412 )
Policy contract numberNOT AVAILABLE
Policy instance 2
Insurance contract or identification numberNOT AVAILABLE
Number of Individuals Covered71
Insurance policy start date2011-02-01
Insurance policy end date2012-01-31
Total amount of commissions paid to insurance brokerUSD $527
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD AND D
Welfare Benefit Premiums Paid to CarrierUSD $2,600
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BEECHSTREET (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNOT AVAILABLE
Policy instance 3
Insurance contract or identification numberNOT AVAILABLE
Number of Individuals Covered71
Insurance policy start date2011-02-01
Insurance policy end date2012-01-31
Total amount of commissions paid to insurance brokerUSD $979
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $4,383
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BEECHSTREET (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNOT AVAILABLE
Policy instance 3
Insurance contract or identification numberNOT AVAILABLE
Number of Individuals Covered71
Insurance policy start date2010-02-01
Insurance policy end date2011-01-31
Total amount of commissions paid to insurance brokerUSD $1,034
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $4,630
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,034
Insurance broker organization code?5
Insurance broker nameINSURANCE MANAGEMENT ADMINISTRATORS
IPROCERT (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNOT AVAILABLE
Policy instance 1
Insurance contract or identification numberNOT AVAILABLE
Number of Individuals Covered71
Insurance policy start date2010-02-01
Insurance policy end date2011-01-31
Total amount of commissions paid to insurance brokerUSD $494
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedPRE-CERTIFICATION
Welfare Benefit Premiums Paid to CarrierUSD $2,382
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $494
Insurance broker organization code?5
Insurance broker nameINSURANCE MANAGEMENT ADMINISTRATORS
AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )
Policy contract numberNOT AVAILABLE
Policy instance 4
Insurance contract or identification numberNOT AVAILABLE
Number of Individuals Covered71
Insurance policy start date2010-02-01
Insurance policy end date2011-01-31
Total amount of commissions paid to insurance brokerUSD $30,197
Total amount of fees paid to insurance companyUSD $26,531
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Other welfare benefits providedCOMPLIANCE
Welfare Benefit Premiums Paid to CarrierUSD $199,031
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $30,197
Amount paid for insurance broker fees21137
Additional information about fees paid to insurance brokerTHIRD PARTY ADMINISTRATION FEES
Insurance broker organization code?5
Insurance broker nameCHARLES JOHNSON
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 )
Policy contract numberNOT AVAILABLE
Policy instance 2
Insurance contract or identification numberNOT AVAILABLE
Number of Individuals Covered71
Insurance policy start date2010-02-01
Insurance policy end date2011-01-31
Total amount of commissions paid to insurance brokerUSD $544
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD AND D
Welfare Benefit Premiums Paid to CarrierUSD $2,682
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $544
Insurance broker organization code?5
Insurance broker nameINSURANCE MANAGEMENT ADMINISTRATORS

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