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THE VILLAGE AT MARYMOUNT GROUP INSURANCE PLAN 401k Plan overview

Plan NameTHE VILLAGE AT MARYMOUNT GROUP INSURANCE PLAN
Plan identification number 501

THE VILLAGE AT MARYMOUNT GROUP INSURANCE PLAN Benefits

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

401k Sponsoring company profile

THE VILLAGE AT MARYMOUNT has sponsored the creation of one or more 401k plans.

Company Name:THE VILLAGE AT MARYMOUNT
Employer identification number (EIN):205652595
NAIC Classification:622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan THE VILLAGE AT MARYMOUNT GROUP INSURANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-07-01JEFFRY MYERS2023-12-20
5012021-07-01JEFFRY MYERS2023-02-20
5012020-07-01JEFFRY MYERS2022-02-25
5012019-07-01JEFFRY MYERS2021-01-20
5012018-07-01JEFFRY MYERS2020-01-30
5012017-07-01
5012016-07-01
5012015-07-01
5012014-07-01
5012013-07-01

Plan Statistics for THE VILLAGE AT MARYMOUNT GROUP INSURANCE PLAN

401k plan membership statisitcs for THE VILLAGE AT MARYMOUNT GROUP INSURANCE PLAN

Measure Date Value
2022: THE VILLAGE AT MARYMOUNT GROUP INSURANCE PLAN 2022 401k membership
Total participants, beginning-of-year2022-07-01198
Total number of active participants reported on line 7a of the Form 55002022-07-010
Number of retired or separated participants receiving benefits2022-07-010
Total of all active and inactive participants2022-07-010
2021: THE VILLAGE AT MARYMOUNT GROUP INSURANCE PLAN 2021 401k membership
Total participants, beginning-of-year2021-07-01186
Total number of active participants reported on line 7a of the Form 55002021-07-01197
Number of retired or separated participants receiving benefits2021-07-011
Total of all active and inactive participants2021-07-01198
2020: THE VILLAGE AT MARYMOUNT GROUP INSURANCE PLAN 2020 401k membership
Total participants, beginning-of-year2020-07-01167
Total number of active participants reported on line 7a of the Form 55002020-07-01185
Number of retired or separated participants receiving benefits2020-07-011
Total of all active and inactive participants2020-07-01186
2019: THE VILLAGE AT MARYMOUNT GROUP INSURANCE PLAN 2019 401k membership
Total participants, beginning-of-year2019-07-01188
Total number of active participants reported on line 7a of the Form 55002019-07-01165
Number of retired or separated participants receiving benefits2019-07-012
Total of all active and inactive participants2019-07-01167
2018: THE VILLAGE AT MARYMOUNT GROUP INSURANCE PLAN 2018 401k membership
Total participants, beginning-of-year2018-07-01189
Total number of active participants reported on line 7a of the Form 55002018-07-01188
Total of all active and inactive participants2018-07-01188
2017: THE VILLAGE AT MARYMOUNT GROUP INSURANCE PLAN 2017 401k membership
Total participants, beginning-of-year2017-07-01190
Total number of active participants reported on line 7a of the Form 55002017-07-01189
Total of all active and inactive participants2017-07-01189
2016: THE VILLAGE AT MARYMOUNT GROUP INSURANCE PLAN 2016 401k membership
Total participants, beginning-of-year2016-07-01188
Total number of active participants reported on line 7a of the Form 55002016-07-01190
Total of all active and inactive participants2016-07-01190
2015: THE VILLAGE AT MARYMOUNT GROUP INSURANCE PLAN 2015 401k membership
Total participants, beginning-of-year2015-07-01206
Total number of active participants reported on line 7a of the Form 55002015-07-01188
Total of all active and inactive participants2015-07-01188
2014: THE VILLAGE AT MARYMOUNT GROUP INSURANCE PLAN 2014 401k membership
Total participants, beginning-of-year2014-07-01198
Total number of active participants reported on line 7a of the Form 55002014-07-01206
Total of all active and inactive participants2014-07-01206
2013: THE VILLAGE AT MARYMOUNT GROUP INSURANCE PLAN 2013 401k membership
Total participants, beginning-of-year2013-07-01199
Total number of active participants reported on line 7a of the Form 55002013-07-01198
Number of retired or separated participants receiving benefits2013-07-010
Total of all active and inactive participants2013-07-01198

Form 5500 Responses for THE VILLAGE AT MARYMOUNT GROUP INSURANCE PLAN

2022: THE VILLAGE AT MARYMOUNT GROUP INSURANCE PLAN 2022 form 5500 responses
2022-07-01Type of plan entitySingle employer plan
2022-07-01This submission is the final filingYes
2022-07-01Plan funding arrangement – InsuranceYes
2022-07-01Plan funding arrangement – General assets of the sponsorYes
2022-07-01Plan benefit arrangement – InsuranceYes
2022-07-01Plan benefit arrangement – General assets of the sponsorYes
2021: THE VILLAGE AT MARYMOUNT GROUP INSURANCE PLAN 2021 form 5500 responses
2021-07-01Type of plan entitySingle employer plan
2021-07-01Plan funding arrangement – InsuranceYes
2021-07-01Plan funding arrangement – General assets of the sponsorYes
2021-07-01Plan benefit arrangement – InsuranceYes
2021-07-01Plan benefit arrangement – General assets of the sponsorYes
2020: THE VILLAGE AT MARYMOUNT GROUP INSURANCE PLAN 2020 form 5500 responses
2020-07-01Type of plan entitySingle employer plan
2020-07-01Plan funding arrangement – InsuranceYes
2020-07-01Plan funding arrangement – General assets of the sponsorYes
2020-07-01Plan benefit arrangement – InsuranceYes
2020-07-01Plan benefit arrangement – General assets of the sponsorYes
2019: THE VILLAGE AT MARYMOUNT GROUP INSURANCE PLAN 2019 form 5500 responses
2019-07-01Type of plan entitySingle employer plan
2019-07-01Plan funding arrangement – InsuranceYes
2019-07-01Plan funding arrangement – General assets of the sponsorYes
2019-07-01Plan benefit arrangement – InsuranceYes
2019-07-01Plan benefit arrangement – General assets of the sponsorYes
2018: THE VILLAGE AT MARYMOUNT GROUP INSURANCE PLAN 2018 form 5500 responses
2018-07-01Type of plan entitySingle employer plan
2018-07-01Plan funding arrangement – InsuranceYes
2018-07-01Plan funding arrangement – General assets of the sponsorYes
2018-07-01Plan benefit arrangement – InsuranceYes
2018-07-01Plan benefit arrangement – General assets of the sponsorYes
2017: THE VILLAGE AT MARYMOUNT GROUP INSURANCE PLAN 2017 form 5500 responses
2017-07-01Type of plan entitySingle employer plan
2017-07-01Plan funding arrangement – InsuranceYes
2017-07-01Plan funding arrangement – General assets of the sponsorYes
2017-07-01Plan benefit arrangement – InsuranceYes
2017-07-01Plan benefit arrangement – General assets of the sponsorYes
2016: THE VILLAGE AT MARYMOUNT GROUP INSURANCE PLAN 2016 form 5500 responses
2016-07-01Type of plan entitySingle employer plan
2016-07-01Plan funding arrangement – InsuranceYes
2016-07-01Plan funding arrangement – General assets of the sponsorYes
2016-07-01Plan benefit arrangement – InsuranceYes
2016-07-01Plan benefit arrangement – General assets of the sponsorYes
2015: THE VILLAGE AT MARYMOUNT GROUP INSURANCE PLAN 2015 form 5500 responses
2015-07-01Type of plan entitySingle employer plan
2015-07-01Plan funding arrangement – InsuranceYes
2015-07-01Plan funding arrangement – General assets of the sponsorYes
2015-07-01Plan benefit arrangement – InsuranceYes
2015-07-01Plan benefit arrangement – General assets of the sponsorYes
2014: THE VILLAGE AT MARYMOUNT GROUP INSURANCE PLAN 2014 form 5500 responses
2014-07-01Type of plan entitySingle employer plan
2014-07-01Plan funding arrangement – InsuranceYes
2014-07-01Plan funding arrangement – General assets of the sponsorYes
2014-07-01Plan benefit arrangement – InsuranceYes
2014-07-01Plan benefit arrangement – General assets of the sponsorYes
2013: THE VILLAGE AT MARYMOUNT GROUP INSURANCE PLAN 2013 form 5500 responses
2013-07-01Type of plan entitySingle employer plan
2013-07-01Plan funding arrangement – InsuranceYes
2013-07-01Plan funding arrangement – General assets of the sponsorYes
2013-07-01Plan benefit arrangement – InsuranceYes
2013-07-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000BKNG
Policy instance 6
Insurance contract or identification numberG000BKNG
Number of Individuals Covered45
Insurance policy start date2022-07-01
Insurance policy end date2023-06-30
Total amount of commissions paid to insurance brokerUSD $2,345
Total amount of fees paid to insurance companyUSD $683
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $23,445
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,345
Amount paid for insurance broker fees683
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000BKNG
Policy instance 5
Insurance contract or identification numberG000BKNG
Number of Individuals Covered57
Insurance policy start date2022-07-01
Insurance policy end date2023-06-30
Total amount of commissions paid to insurance brokerUSD $2,352
Total amount of fees paid to insurance companyUSD $467
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $15,683
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,352
Amount paid for insurance broker fees467
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000BKNG
Policy instance 4
Insurance contract or identification numberG000BKNG
Number of Individuals Covered54
Insurance policy start date2022-07-01
Insurance policy end date2023-06-30
Total amount of commissions paid to insurance brokerUSD $2,679
Total amount of fees paid to insurance companyUSD $699
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $26,786
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,679
Amount paid for insurance broker fees699
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000BKNG
Policy instance 3
Insurance contract or identification numberG000BKNG
Number of Individuals Covered216
Insurance policy start date2022-07-01
Insurance policy end date2023-06-30
Total amount of commissions paid to insurance brokerUSD $1,902
Total amount of fees paid to insurance companyUSD $326
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $12,678
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,902
Amount paid for insurance broker fees326
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
MEDICAL MUTUAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 29076 )
Policy contract number24780000001
Policy instance 2
Insurance contract or identification number24780000001
Number of Individuals Covered73
Insurance policy start date2022-07-01
Insurance policy end date2023-06-30
Total amount of commissions paid to insurance brokerUSD $32,144
Total amount of fees paid to insurance companyUSD $10,869
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $32,144
Amount paid for insurance broker fees10869
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?4
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00448820
Policy instance 1
Insurance contract or identification number00448820
Number of Individuals Covered65
Insurance policy start date2022-07-01
Insurance policy end date2023-06-30
Total amount of commissions paid to insurance brokerUSD $3,945
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $63,145
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,906
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00448820
Policy instance 1
Insurance contract or identification number00448820
Number of Individuals Covered73
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $3,836
Total amount of fees paid to insurance companyUSD $4,094
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $59,333
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,798
Amount paid for insurance broker fees4094
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
MEDICAL MUTUAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 29076 )
Policy contract number24780000001
Policy instance 2
Insurance contract or identification number24780000001
Number of Individuals Covered77
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $33,901
Total amount of fees paid to insurance companyUSD $12,832
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $33,901
Amount paid for insurance broker fees12832
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?4
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000BKNG
Policy instance 3
Insurance contract or identification numberG000BKNG
Number of Individuals Covered198
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $1,507
Total amount of fees paid to insurance companyUSD $251
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $10,048
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,507
Amount paid for insurance broker fees251
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 numberG000BKNG
Policy instance 4
Insurance contract or identification numberG000BKNG
Number of Individuals Covered55
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $2,150
Total amount of fees paid to insurance companyUSD $502
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $21,496
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,150
Amount paid for insurance broker fees502
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 numberG000BKNG
Policy instance 5
Insurance contract or identification numberG000BKNG
Number of Individuals Covered60
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $2,353
Total amount of fees paid to insurance companyUSD $315
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $15,689
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,353
Amount paid for insurance broker fees315
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 numberG000BKNG
Policy instance 6
Insurance contract or identification numberG000BKNG
Number of Individuals Covered49
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $2,229
Total amount of fees paid to insurance companyUSD $468
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $22,291
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,229
Amount paid for insurance broker fees468
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00448820
Policy instance 1
Insurance contract or identification number00448820
Number of Individuals Covered77
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $3,953
Total amount of fees paid to insurance companyUSD $3,048
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $62,537
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,914
Amount paid for insurance broker fees3048
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
MEDICAL MUTUAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 29076 )
Policy contract number24780000001
Policy instance 2
Insurance contract or identification number24780000001
Number of Individuals Covered84
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $36,903
Total amount of fees paid to insurance companyUSD $12,740
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $36,903
Amount paid for insurance broker fees12740
Additional information about fees paid to insurance brokerBONUS
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000BKNG
Policy instance 3
Insurance contract or identification numberG000BKNG
Number of Individuals Covered186
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $2,043
Total amount of fees paid to insurance companyUSD $110
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $13,623
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,043
Amount paid for insurance broker fees110
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000BKNG
Policy instance 4
Insurance contract or identification numberG000BKNG
Number of Individuals Covered55
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $2,650
Total amount of fees paid to insurance companyUSD $248
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $26,498
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,650
Amount paid for insurance broker fees248
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000BKNG
Policy instance 5
Insurance contract or identification numberG000BKNG
Number of Individuals Covered69
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $2,367
Total amount of fees paid to insurance companyUSD $168
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $15,783
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
Amount paid for insurance broker fees168
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000BKNG
Policy instance 6
Insurance contract or identification numberG000BKNG
Number of Individuals Covered50
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $2,599
Total amount of fees paid to insurance companyUSD $252
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $25,990
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,599
Amount paid for insurance broker fees252
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
MEDICAL MUTUAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 29076 )
Policy contract number24780000001
Policy instance 2
Insurance contract or identification number24780000001
Number of Individuals Covered98
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $42,834
Total amount of fees paid to insurance companyUSD $14,119
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $42,834
Amount paid for insurance broker fees14119
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000BKNG
Policy instance 6
Insurance contract or identification numberG000BKNG
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $2,309
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $23,088
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,309
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000BKNG
Policy instance 5
Insurance contract or identification numberG000BKNG
Number of Individuals Covered82
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $2,734
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $18,229
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,734
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000BKNG
Policy instance 4
Insurance contract or identification numberG000BKNG
Number of Individuals Covered60
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $2,477
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $24,774
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,477
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000BKNG
Policy instance 3
Insurance contract or identification numberG000BKNG
Number of Individuals Covered167
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $1,596
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $10,640
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,596
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00448820
Policy instance 1
Insurance contract or identification number00448820
Number of Individuals Covered80
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $4,276
Total amount of fees paid to insurance companyUSD $4,425
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $73,318
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,235
Amount paid for insurance broker fees4425
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00448820
Policy instance 1
Insurance contract or identification number00448820
Number of Individuals Covered91
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $4,356
Total amount of fees paid to insurance companyUSD $5,672
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $77,685
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,356
Amount paid for insurance broker fees5672
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number400001000 05445
Policy instance 5
Insurance contract or identification number400001000 05445
Number of Individuals Covered60
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $1,617
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $10,781
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,617
Insurance broker organization code?3
MEDICAL MUTUAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 29076 )
Policy contract number24780000001
Policy instance 4
Insurance contract or identification number24780000001
Number of Individuals Covered106
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $46,385
Total amount of fees paid to insurance companyUSD $14,663
Welfare Benefit Premiums Paid to CarrierUSD $200,196
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $46,385
Amount paid for insurance broker fees14663
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number10079778
Policy instance 3
Insurance contract or identification number10079778
Number of Individuals Covered42
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $2,111
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedWEEKLY INCOME
Welfare Benefit Premiums Paid to CarrierUSD $22,519
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,111
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number10079777
Policy instance 2
Insurance contract or identification number10079777
Number of Individuals Covered188
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $2,242
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $24,698
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,242
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number448820
Policy instance 1
Insurance contract or identification number448820
Number of Individuals Covered117
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $4,688
Total amount of fees paid to insurance companyUSD $5,572
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $87,630
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,688
Amount paid for insurance broker fees5572
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
Insurance broker nameTHE FEDELI GROUP
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number10079777
Policy instance 2
Insurance contract or identification number10079777
Number of Individuals Covered189
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $2,469
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $29,177
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,469
Insurance broker organization code?3
Insurance broker nameFEDELI GROUP, INC.
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number10079778
Policy instance 3
Insurance contract or identification number10079778
Number of Individuals Covered31
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $2,939
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedWEEKLY INCOME
Welfare Benefit Premiums Paid to CarrierUSD $51,921
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,939
Insurance broker organization code?3
Insurance broker nameFEDELI GROUP, INC.
MEDICAL MUTUAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 29076 )
Policy contract number24780000001
Policy instance 4
Insurance contract or identification number24780000001
Number of Individuals Covered124
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $51,985
Total amount of fees paid to insurance companyUSD $18,311
Welfare Benefit Premiums Paid to CarrierUSD $261,751
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $51,985
Amount paid for insurance broker fees18311
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
Insurance broker nameFEDELI GROUP, INC.
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number400001000 05445
Policy instance 5
Insurance contract or identification number400001000 05445
Number of Individuals Covered58
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $1,583
Total amount of fees paid to insurance companyUSD $191
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $10,552
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,583
Amount paid for insurance broker fees191
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
Insurance broker nameTHE FEDELI GROUP
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number10079778
Policy instance 3
Insurance contract or identification number10079778
Number of Individuals Covered188
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $2,782
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedWEEKLY INCOME
Welfare Benefit Premiums Paid to CarrierUSD $43,578
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,782
Insurance broker organization code?3
Insurance broker nameFEDELI GROUP, INC.
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number448820
Policy instance 1
Insurance contract or identification number448820
Number of Individuals Covered128
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $5,402
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $90,842
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,402
Insurance broker organization code?3
Insurance broker nameTHE FEDELI GROUP
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number10079777
Policy instance 2
Insurance contract or identification number10079777
Number of Individuals Covered188
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $2,296
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $25,729
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,296
Insurance broker organization code?3
Insurance broker nameFEDELI GROUP, INC.
MEDICAL MUTUAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 29076 )
Policy contract number24780000001
Policy instance 4
Insurance contract or identification number24780000001
Number of Individuals Covered122
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $52,058
Total amount of fees paid to insurance companyUSD $14,368
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $195,489
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $52,058
Amount paid for insurance broker fees14368
Additional information about fees paid to insurance brokerADMINISTRATIVE FEES
Insurance broker organization code?3
Insurance broker nameFEDELI GROUP, INC.
MEDICAL MUTUAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 29076 )
Policy contract number24780000001
Policy instance 4
Insurance contract or identification number24780000001
Number of Individuals Covered108
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $47,447
Total amount of fees paid to insurance companyUSD $9,898
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $141,411
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $47,447
Amount paid for insurance broker fees9898
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
Insurance broker nameFEDELI GROUP, INC.
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number10079777
Policy instance 2
Insurance contract or identification number10079777
Number of Individuals Covered206
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $2,345
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 providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $26,693
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,345
Insurance broker organization code?3
Insurance broker nameFEDELI GROUP, INC.
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number448820
Policy instance 1
Insurance contract or identification number448820
Number of Individuals Covered109
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $4,576
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
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $86,000
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,576
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameTHE FEDELI GROUP
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number10079778
Policy instance 3
Insurance contract or identification number10079778
Number of Individuals Covered206
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $2,803
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 providedWEEKLY INCOME
Welfare Benefit Premiums Paid to CarrierUSD $44,650
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,803
Insurance broker organization code?3
Insurance broker nameFEDELI GROUP, INC.
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number448820
Policy instance 1
Insurance contract or identification number448820
Number of Individuals Covered107
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $4,063
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
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $61,619
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,607
Insurance broker organization code?3
Insurance broker nameTHE FEDELI GROUP
MEDICAL MUTUAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 29076 )
Policy contract number24780000001
Policy instance 4
Insurance contract or identification number24780000001
Number of Individuals Covered107
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $38,325
Total amount of fees paid to insurance companyUSD $5,758
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,669
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,180
Amount paid for insurance broker fees5754
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
Insurance broker nameFEDELI GROUP, INC.
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number10079777
Policy instance 3
Insurance contract or identification number10079777
Number of Individuals Covered198
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $2,185
Total amount of fees paid to insurance companyUSD $260
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 providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $23,759
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,558
Amount paid for insurance broker fees260
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
Insurance broker nameFEDELI GROUP, INC.
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number10079778
Policy instance 2
Insurance contract or identification number10079778
Number of Individuals Covered198
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $2,691
Total amount of fees paid to insurance companyUSD $434
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedWEEKLY INCOME
Welfare Benefit Premiums Paid to CarrierUSD $39,065
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,161
Amount paid for insurance broker fees434
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
Insurance broker nameFEDELI GROUP, INC.

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