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SIERRA BULLETS LLC HEALTH PLAN 401k Plan overview

Plan NameSIERRA BULLETS LLC HEALTH PLAN
Plan identification number 501

SIERRA BULLETS LLC HEALTH PLAN Benefits

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

401k Sponsoring company profile

SIERRA BULLETS LLC has sponsored the creation of one or more 401k plans.

Company Name:SIERRA BULLETS LLC
Employer identification number (EIN):954170056
NAIC Classification:339900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SIERRA BULLETS LLC HEALTH PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012021-09-01
5012020-09-01
5012019-09-01
5012018-09-01
5012017-09-01

Plan Statistics for SIERRA BULLETS LLC HEALTH PLAN

401k plan membership statisitcs for SIERRA BULLETS LLC HEALTH PLAN

Measure Date Value
2021: SIERRA BULLETS LLC HEALTH PLAN 2021 401k membership
Total participants, beginning-of-year2021-09-01168
Total number of active participants reported on line 7a of the Form 55002021-09-01161
Number of retired or separated participants receiving benefits2021-09-010
Number of other retired or separated participants entitled to future benefits2021-09-010
Total of all active and inactive participants2021-09-01161
2020: SIERRA BULLETS LLC HEALTH PLAN 2020 401k membership
Total participants, beginning-of-year2020-09-01129
Total number of active participants reported on line 7a of the Form 55002020-09-01168
Number of retired or separated participants receiving benefits2020-09-010
Number of other retired or separated participants entitled to future benefits2020-09-010
Total of all active and inactive participants2020-09-01168
2019: SIERRA BULLETS LLC HEALTH PLAN 2019 401k membership
Total participants, beginning-of-year2019-09-01145
Total number of active participants reported on line 7a of the Form 55002019-09-01129
Number of retired or separated participants receiving benefits2019-09-010
Number of other retired or separated participants entitled to future benefits2019-09-010
Total of all active and inactive participants2019-09-01129
2018: SIERRA BULLETS LLC HEALTH PLAN 2018 401k membership
Total participants, beginning-of-year2018-09-01135
Total number of active participants reported on line 7a of the Form 55002018-09-01145
Number of retired or separated participants receiving benefits2018-09-010
Number of other retired or separated participants entitled to future benefits2018-09-010
Total of all active and inactive participants2018-09-01145
2017: SIERRA BULLETS LLC HEALTH PLAN 2017 401k membership
Total participants, beginning-of-year2017-09-01134
Total number of active participants reported on line 7a of the Form 55002017-09-01132
Number of retired or separated participants receiving benefits2017-09-013
Number of other retired or separated participants entitled to future benefits2017-09-010
Total of all active and inactive participants2017-09-01135

Form 5500 Responses for SIERRA BULLETS LLC HEALTH PLAN

2021: SIERRA BULLETS LLC HEALTH PLAN 2021 form 5500 responses
2021-09-01Type of plan entitySingle employer plan
2021-09-01Plan funding arrangement – InsuranceYes
2021-09-01Plan benefit arrangement – InsuranceYes
2020: SIERRA BULLETS LLC HEALTH PLAN 2020 form 5500 responses
2020-09-01Type of plan entitySingle employer plan
2020-09-01Plan funding arrangement – InsuranceYes
2020-09-01Plan benefit arrangement – InsuranceYes
2019: SIERRA BULLETS LLC HEALTH PLAN 2019 form 5500 responses
2019-09-01Type of plan entitySingle employer plan
2019-09-01Plan funding arrangement – InsuranceYes
2019-09-01Plan benefit arrangement – InsuranceYes
2018: SIERRA BULLETS LLC HEALTH PLAN 2018 form 5500 responses
2018-09-01Type of plan entitySingle employer plan
2018-09-01Plan funding arrangement – InsuranceYes
2018-09-01Plan benefit arrangement – InsuranceYes
2017: SIERRA BULLETS LLC HEALTH PLAN 2017 form 5500 responses
2017-09-01Type of plan entitySingle employer plan
2017-09-01First time form 5500 has been submittedYes
2017-09-01Plan funding arrangement – InsuranceYes
2017-09-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

ADVANTICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 12278 )
Policy contract number21090021
Policy instance 7
Insurance contract or identification number21090021
Number of Individuals Covered229
Insurance policy start date2022-09-01
Insurance policy end date2023-08-31
Total amount of commissions paid to insurance brokerUSD $993
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $10,796
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $993
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number169276
Policy instance 1
Insurance contract or identification number169276
Number of Individuals Covered26
Insurance policy start date2022-09-01
Insurance policy end date2023-08-31
Total amount of commissions paid to insurance brokerUSD $449
Total amount of fees paid to insurance companyUSD $420
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $449
Amount paid for insurance broker fees420
Additional information about fees paid to insurance brokerADMINISTRATIVE
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number169276
Policy instance 2
Insurance contract or identification number169276
Number of Individuals Covered165
Insurance policy start date2022-09-01
Insurance policy end date2023-08-31
Total amount of commissions paid to insurance brokerUSD $6,831
Total amount of fees paid to insurance companyUSD $5,658
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,831
Amount paid for insurance broker fees5658
Additional information about fees paid to insurance brokerADMINISTRATIVE
Insurance broker organization code?3
DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 )
Policy contract number09210020
Policy instance 3
Insurance contract or identification number09210020
Number of Individuals Covered247
Insurance policy start date2022-09-01
Insurance policy end date2023-08-31
Total amount of commissions paid to insurance brokerUSD $6,939
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $56,790
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,939
Insurance broker organization code?3
BLUE CROSS AND BLUE SHIELD OF KANSAS CITY (National Association of Insurance Commissioners NAIC id number: 47171 )
Policy contract number40918000
Policy instance 4
Insurance contract or identification number40918000
Number of Individuals Covered275
Insurance policy start date2022-09-01
Insurance policy end date2023-08-31
Total amount of commissions paid to insurance brokerUSD $92,917
Total amount of fees paid to insurance companyUSD $18,693
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,346,387
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $92,917
Amount paid for insurance broker fees18693
Additional information about fees paid to insurance brokerADMINISTRATIVE SERVICES
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number169276
Policy instance 5
Insurance contract or identification number169276
Number of Individuals Covered88
Insurance policy start date2022-09-01
Insurance policy end date2023-08-31
Total amount of commissions paid to insurance brokerUSD $4,830
Total amount of fees paid to insurance companyUSD $2,781
Temporary Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,830
Amount paid for insurance broker fees2781
Additional information about fees paid to insurance brokerADMINISTRATIVE
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number169276
Policy instance 6
Insurance contract or identification number169276
Number of Individuals Covered50
Insurance policy start date2022-09-01
Insurance policy end date2023-08-31
Total amount of commissions paid to insurance brokerUSD $3,656
Total amount of fees paid to insurance companyUSD $97
Welfare Benefit Premiums Paid to CarrierUSD $14,866
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,656
Amount paid for insurance broker fees97
Additional information about fees paid to insurance brokerADMINISTRATIVE
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number169276
Policy instance 1
Insurance contract or identification number169276
Number of Individuals Covered44
Insurance policy start date2021-09-01
Insurance policy end date2022-08-31
Total amount of commissions paid to insurance brokerUSD $665
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $619
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number169276
Policy instance 2
Insurance contract or identification number169276
Number of Individuals Covered192
Insurance policy start date2021-09-01
Insurance policy end date2022-08-31
Total amount of commissions paid to insurance brokerUSD $9,856
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,102
Insurance broker organization code?3
DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 )
Policy contract number09210020
Policy instance 3
Insurance contract or identification number09210020
Number of Individuals Covered252
Insurance policy start date2021-09-01
Insurance policy end date2022-08-31
Total amount of commissions paid to insurance brokerUSD $4,951
Total amount of fees paid to insurance companyUSD $109
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $62,436
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,951
Amount paid for insurance broker fees109
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
BLUE CROSS AND BLUE SHIELD OF KANSAS CITY (National Association of Insurance Commissioners NAIC id number: 47171 )
Policy contract number40918000
Policy instance 4
Insurance contract or identification number40918000
Number of Individuals Covered301
Insurance policy start date2021-09-01
Insurance policy end date2022-08-31
Total amount of commissions paid to insurance brokerUSD $92,917
Total amount of fees paid to insurance companyUSD $18,693
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,346,387
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $92,917
Amount paid for insurance broker fees18693
Additional information about fees paid to insurance brokerADMINISTRATIVE SERVICES
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number169276
Policy instance 5
Insurance contract or identification number169276
Number of Individuals Covered110
Insurance policy start date2021-09-01
Insurance policy end date2022-08-31
Total amount of commissions paid to insurance brokerUSD $6,038
Temporary Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,677
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number169276
Policy instance 6
Insurance contract or identification number169276
Number of Individuals Covered51
Insurance policy start date2021-09-01
Insurance policy end date2022-08-31
Total amount of commissions paid to insurance brokerUSD $9,498
Welfare Benefit Premiums Paid to CarrierUSD $13,254
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,362
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLTD0B7K8
Policy instance 1
Insurance contract or identification numberGLTD0B7K8
Number of Individuals Covered25
Insurance policy start date2020-09-01
Insurance policy end date2021-08-31
Total amount of commissions paid to insurance brokerUSD $423
Total amount of fees paid to insurance companyUSD $412
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $4,225
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $423
Amount paid for insurance broker fees275
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 numberGLUG0B7K8
Policy instance 2
Insurance contract or identification numberGLUG0B7K8
Number of Individuals Covered161
Insurance policy start date2020-09-01
Insurance policy end date2021-08-31
Total amount of commissions paid to insurance brokerUSD $1,841
Total amount of fees paid to insurance companyUSD $1,794
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $18,407
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,841
Amount paid for insurance broker fees1196
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 numberGVTL0B7K8
Policy instance 3
Insurance contract or identification numberGVTL0B7K8
Number of Individuals Covered83
Insurance policy start date2020-09-01
Insurance policy end date2021-08-31
Total amount of commissions paid to insurance brokerUSD $3,427
Total amount of fees paid to insurance companyUSD $3,342
Other welfare benefits providedLIFE & AD&D - VOLUNTARY
Welfare Benefit Premiums Paid to CarrierUSD $34,273
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,427
Amount paid for insurance broker fees2228
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number931345
Policy instance 4
Insurance contract or identification number931345
Number of Individuals Covered94
Insurance policy start date2020-09-01
Insurance policy end date2021-08-31
Total amount of commissions paid to insurance brokerUSD $5,397
Dental Insurance Welfare BenefitYes
Other welfare benefits providedPREPAID DENTAL
Welfare Benefit Premiums Paid to CarrierUSD $53,884
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,397
Insurance broker organization code?3
BLUE CROSS AND BLUE SHIELD OF KANSAS CITY (National Association of Insurance Commissioners NAIC id number: 47171 )
Policy contract number40918000
Policy instance 5
Insurance contract or identification number40918000
Number of Individuals Covered318
Insurance policy start date2020-09-01
Insurance policy end date2021-08-31
Total amount of commissions paid to insurance brokerUSD $75,125
Total amount of fees paid to insurance companyUSD $16,740
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,897,679
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $75,125
Amount paid for insurance broker fees16740
Additional information about fees paid to insurance brokerADMINISTRATIVE SERVICES
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUC 0B7K8
Policy instance 6
Insurance contract or identification numberGUC 0B7K8
Number of Individuals Covered85
Insurance policy start date2020-09-01
Insurance policy end date2021-08-31
Total amount of commissions paid to insurance brokerUSD $4,313
Total amount of fees paid to insurance companyUSD $2,803
Other welfare benefits providedVOLUNATRY SHORT-TERM DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $28,754
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,313
Amount paid for insurance broker fees1869
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 numberGUDE0B7K8
Policy instance 7
Insurance contract or identification numberGUDE0B7K8
Number of Individuals Covered19
Insurance policy start date2020-09-01
Insurance policy end date2021-08-31
Total amount of commissions paid to insurance brokerUSD $712
Total amount of fees paid to insurance companyUSD $462
Other welfare benefits providedVOLUNTARY CRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $4,746
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $712
Amount paid for insurance broker fees308
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 numberGUDH0B7K8
Policy instance 8
Insurance contract or identification numberGUDH0B7K8
Number of Individuals Covered21
Insurance policy start date2020-09-01
Insurance policy end date2021-08-31
Total amount of commissions paid to insurance brokerUSD $790
Total amount of fees paid to insurance companyUSD $529
Other welfare benefits providedVOLUNTARY COMPENSATION
Welfare Benefit Premiums Paid to CarrierUSD $5,269
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $790
Amount paid for insurance broker fees353
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 numberGUC 0B7K8
Policy instance 6
Insurance contract or identification numberGUC 0B7K8
Number of Individuals Covered85
Insurance policy start date2019-09-01
Insurance policy end date2020-08-31
Total amount of commissions paid to insurance brokerUSD $4,300
Total amount of fees paid to insurance companyUSD $2,140
Other welfare benefits providedVOLUNATRY SHORT-TERM DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $28,668
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,300
Amount paid for insurance broker fees1284
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 numberGLTD0B7K8
Policy instance 1
Insurance contract or identification numberGLTD0B7K8
Number of Individuals Covered27
Insurance policy start date2019-09-01
Insurance policy end date2020-08-31
Total amount of commissions paid to insurance brokerUSD $423
Total amount of fees paid to insurance companyUSD $300
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $4,227
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $423
Amount paid for insurance broker fees180
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 numberGLUG0B7K8
Policy instance 2
Insurance contract or identification numberGLUG0B7K8
Number of Individuals Covered127
Insurance policy start date2019-09-01
Insurance policy end date2020-08-31
Total amount of commissions paid to insurance brokerUSD $1,843
Total amount of fees paid to insurance companyUSD $1,398
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $18,431
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,843
Amount paid for insurance broker fees839
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 numberGVTL0B7K8
Policy instance 3
Insurance contract or identification numberGVTL0B7K8
Number of Individuals Covered83
Insurance policy start date2019-09-01
Insurance policy end date2020-08-31
Total amount of commissions paid to insurance brokerUSD $3,422
Total amount of fees paid to insurance companyUSD $2,508
Other welfare benefits providedLIFE & AD&D - VOLUNTARY
Welfare Benefit Premiums Paid to CarrierUSD $34,221
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,422
Amount paid for insurance broker fees1505
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number931345
Policy instance 4
Insurance contract or identification number931345
Number of Individuals Covered54
Insurance policy start date2019-09-01
Insurance policy end date2020-08-31
Total amount of commissions paid to insurance brokerUSD $3,334
Dental Insurance Welfare BenefitYes
Other welfare benefits providedPREPAID DENTAL
Welfare Benefit Premiums Paid to CarrierUSD $33,316
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,334
Insurance broker organization code?3
BLUE CROSS AND BLUE SHIELD OF KANSAS CITY (National Association of Insurance Commissioners NAIC id number: 47171 )
Policy contract number40918000
Policy instance 5
Insurance contract or identification number40918000
Number of Individuals Covered247
Insurance policy start date2019-09-01
Insurance policy end date2020-08-31
Total amount of commissions paid to insurance brokerUSD $58,789
Total amount of fees paid to insurance companyUSD $14,733
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,495,915
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $58,789
Amount paid for insurance broker fees14733
Additional information about fees paid to insurance brokerADMINISTRATIVE SERVICES
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUDE0B7K8
Policy instance 7
Insurance contract or identification numberGUDE0B7K8
Number of Individuals Covered19
Insurance policy start date2019-09-01
Insurance policy end date2020-08-31
Total amount of commissions paid to insurance brokerUSD $725
Total amount of fees paid to insurance companyUSD $433
Other welfare benefits providedVOLUNTARY CRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $4,836
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $725
Amount paid for insurance broker fees260
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 numberGUDH0B7K8
Policy instance 8
Insurance contract or identification numberGUDH0B7K8
Number of Individuals Covered21
Insurance policy start date2019-09-01
Insurance policy end date2020-08-31
Total amount of commissions paid to insurance brokerUSD $867
Total amount of fees paid to insurance companyUSD $520
Other welfare benefits providedVOLUNTARY COMPENSATION
Welfare Benefit Premiums Paid to CarrierUSD $5,780
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $867
Amount paid for insurance broker fees312
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 numberGUDE0B7K8
Policy instance 8
Insurance contract or identification numberGUDE0B7K8
Insurance policy start date2018-09-01
Insurance policy end date2019-08-31
Total amount of commissions paid to insurance brokerUSD $928
Total amount of fees paid to insurance companyUSD $396
Other welfare benefits providedVOLUNTARY CRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $6,189
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $928
Amount paid for insurance broker fees332
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 numberGUC 0B7K8
Policy instance 7
Insurance contract or identification numberGUC 0B7K8
Number of Individuals Covered9
Insurance policy start date2018-09-01
Insurance policy end date2019-08-31
Total amount of commissions paid to insurance brokerUSD $4,184
Total amount of fees paid to insurance companyUSD $1,653
Other welfare benefits providedVOLUNATRY SHORT-TERM DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $27,891
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,184
Amount paid for insurance broker fees890
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 numberGLUG0B7K8
Policy instance 2
Insurance contract or identification numberGLUG0B7K8
Number of Individuals Covered15
Insurance policy start date2018-09-01
Insurance policy end date2019-08-31
Total amount of commissions paid to insurance brokerUSD $1,812
Total amount of fees paid to insurance companyUSD $1,079
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $18,119
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,812
Amount paid for insurance broker fees581
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 numberGUDH0B7K8
Policy instance 9
Insurance contract or identification numberGUDH0B7K8
Number of Individuals Covered2
Insurance policy start date2018-09-01
Insurance policy end date2019-08-31
Total amount of commissions paid to insurance brokerUSD $1,077
Total amount of fees paid to insurance companyUSD $445
Other welfare benefits providedVOLUNTARY COMPENSATION
Welfare Benefit Premiums Paid to CarrierUSD $7,181
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,077
Amount paid for insurance broker fees373
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
BLUE CROSS AND BLUE SHIELD OF KANSAS CITY (National Association of Insurance Commissioners NAIC id number: 47171 )
Policy contract number40918000
Policy instance 6
Insurance contract or identification number40918000
Number of Individuals Covered271
Insurance policy start date2018-09-01
Insurance policy end date2019-08-31
Total amount of commissions paid to insurance brokerUSD $68,641
Total amount of fees paid to insurance companyUSD $15,480
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,760,027
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $68,641
Amount paid for insurance broker fees15480
Additional information about fees paid to insurance brokerADMINISTRATIVE SERVICES
Insurance broker organization code?3
UNITED DENTAL CARE OF MISSOURI, INC. (National Association of Insurance Commissioners NAIC id number: 47044 )
Policy contract number5487346
Policy instance 5
Insurance contract or identification number5487346
Number of Individuals Covered35
Insurance policy start date2018-09-01
Insurance policy end date2019-08-31
Total amount of commissions paid to insurance brokerUSD $648
Total amount of fees paid to insurance companyUSD $141
Other welfare benefits providedPREPAID DENTAL
Welfare Benefit Premiums Paid to CarrierUSD $6,476
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $648
Amount paid for insurance broker fees98
Additional information about fees paid to insurance brokerFEES AND OTHER COMMISSIONS
Insurance broker organization code?3
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5487346
Policy instance 4
Insurance contract or identification number5487346
Number of Individuals Covered55
Insurance policy start date2018-09-01
Insurance policy end date2019-08-31
Total amount of commissions paid to insurance brokerUSD $3,119
Total amount of fees paid to insurance companyUSD $619
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $30,747
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,119
Amount paid for insurance broker fees423
Additional information about fees paid to insurance brokerFEES AND OTHER COMMISSIONS
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGVTL0B7K8
Policy instance 3
Insurance contract or identification numberGVTL0B7K8
Number of Individuals Covered9
Insurance policy start date2018-09-01
Insurance policy end date2019-08-31
Total amount of commissions paid to insurance brokerUSD $3,273
Total amount of fees paid to insurance companyUSD $2,091
Other welfare benefits providedLIFE & AD&D - VOLUNTARY
Welfare Benefit Premiums Paid to CarrierUSD $32,726
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,273
Amount paid for insurance broker fees1126
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 numberGLTD0B7K8
Policy instance 1
Insurance contract or identification numberGLTD0B7K8
Number of Individuals Covered5
Insurance policy start date2018-09-01
Insurance policy end date2019-08-31
Total amount of commissions paid to insurance brokerUSD $392
Total amount of fees paid to insurance companyUSD $247
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,924
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees114
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $392
BLUE CROSS AND BLUE SHIELD OF KANSAS CITY (National Association of Insurance Commissioners NAIC id number: 47171 )
Policy contract number40918000
Policy instance 6
Insurance contract or identification number40918000
Number of Individuals Covered252
Insurance policy start date2017-09-01
Insurance policy end date2018-08-31
Total amount of commissions paid to insurance brokerUSD $75,619
Total amount of fees paid to insurance companyUSD $4,770
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,543,262
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 numberGLTD0B7K8
Policy instance 1
Insurance contract or identification numberGLTD0B7K8
Number of Individuals Covered23
Insurance policy start date2017-09-01
Insurance policy end date2018-08-31
Total amount of commissions paid to insurance brokerUSD $385
Total amount of fees paid to insurance companyUSD $97
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,848
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 numberGLUG0B7K8
Policy instance 2
Insurance contract or identification numberGLUG0B7K8
Number of Individuals Covered130
Insurance policy start date2017-09-01
Insurance policy end date2018-08-31
Total amount of commissions paid to insurance brokerUSD $1,651
Total amount of fees paid to insurance companyUSD $392
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $16,513
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 numberGVTL0B7K8
Policy instance 3
Insurance contract or identification numberGVTL0B7K8
Number of Individuals Covered95
Insurance policy start date2017-09-01
Insurance policy end date2018-08-31
Total amount of commissions paid to insurance brokerUSD $3,260
Total amount of fees paid to insurance companyUSD $781
Other welfare benefits providedLIFE & AD&D - VOLUNTARY
Welfare Benefit Premiums Paid to CarrierUSD $32,597
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 numberGUC 0B7K8
Policy instance 7
Insurance contract or identification numberGUC 0B7K8
Number of Individuals Covered90
Insurance policy start date2017-09-01
Insurance policy end date2018-08-31
Total amount of commissions paid to insurance brokerUSD $3,709
Total amount of fees paid to insurance companyUSD $591
Other welfare benefits providedVOLUNATRY SHORT-TERM DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $24,726
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITED DENTAL CARE OF MISSOURI, INC. (National Association of Insurance Commissioners NAIC id number: 47044 )
Policy contract number5487346
Policy instance 5
Insurance contract or identification number5487346
Number of Individuals Covered28
Insurance policy start date2017-09-01
Insurance policy end date2018-08-31
Total amount of commissions paid to insurance brokerUSD $564
Other welfare benefits providedPREPAID DENTAL
Welfare Benefit Premiums Paid to CarrierUSD $5,644
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5487346
Policy instance 4
Insurance contract or identification number5487346
Number of Individuals Covered49
Insurance policy start date2017-09-01
Insurance policy end date2018-08-31
Total amount of commissions paid to insurance brokerUSD $2,681
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $26,812
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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