GREAT SOUTHERN BANK has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan GREAT SOUTHERN BANK CAFETERIA PLAN
| Measure | Date | Value |
|---|
| 2022: GREAT SOUTHERN BANK CAFETERIA PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-11-01 | 850 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-11-01 | 836 |
| Number of retired or separated participants receiving benefits | 2022-11-01 | 5 |
| Number of other retired or separated participants entitled to future benefits | 2022-11-01 | 2 |
| Total of all active and inactive participants | 2022-11-01 | 843 |
| 2021: GREAT SOUTHERN BANK CAFETERIA PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-11-01 | 824 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-11-01 | 818 |
| Number of retired or separated participants receiving benefits | 2021-11-01 | 4 |
| Number of other retired or separated participants entitled to future benefits | 2021-11-01 | 4 |
| Total of all active and inactive participants | 2021-11-01 | 826 |
| 2020: GREAT SOUTHERN BANK CAFETERIA PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-11-01 | 865 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-11-01 | 801 |
| Number of retired or separated participants receiving benefits | 2020-11-01 | 4 |
| Number of other retired or separated participants entitled to future benefits | 2020-11-01 | 4 |
| Total of all active and inactive participants | 2020-11-01 | 809 |
| 2019: GREAT SOUTHERN BANK CAFETERIA PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-11-01 | 854 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-11-01 | 834 |
| Number of retired or separated participants receiving benefits | 2019-11-01 | 1 |
| Number of other retired or separated participants entitled to future benefits | 2019-11-01 | 1 |
| Total of all active and inactive participants | 2019-11-01 | 836 |
| 2018: GREAT SOUTHERN BANK CAFETERIA PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-11-01 | 791 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-11-01 | 792 |
| Number of retired or separated participants receiving benefits | 2018-11-01 | 4 |
| Number of other retired or separated participants entitled to future benefits | 2018-11-01 | 4 |
| Total of all active and inactive participants | 2018-11-01 | 800 |
| 2017: GREAT SOUTHERN BANK CAFETERIA PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-11-01 | 810 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-11-01 | 775 |
| Number of retired or separated participants receiving benefits | 2017-11-01 | 1 |
| Number of other retired or separated participants entitled to future benefits | 2017-11-01 | 4 |
| Total of all active and inactive participants | 2017-11-01 | 780 |
| 2016: GREAT SOUTHERN BANK CAFETERIA PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-11-01 | 821 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-11-01 | 787 |
| Number of retired or separated participants receiving benefits | 2016-11-01 | 2 |
| Number of other retired or separated participants entitled to future benefits | 2016-11-01 | 2 |
| Total of all active and inactive participants | 2016-11-01 | 791 |
| 2015: GREAT SOUTHERN BANK CAFETERIA PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-11-01 | 819 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-11-01 | 786 |
| Number of retired or separated participants receiving benefits | 2015-11-01 | 4 |
| Number of other retired or separated participants entitled to future benefits | 2015-11-01 | 3 |
| Total of all active and inactive participants | 2015-11-01 | 793 |
| 2014: GREAT SOUTHERN BANK CAFETERIA PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-11-01 | 847 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-11-01 | 800 |
| Number of retired or separated participants receiving benefits | 2014-11-01 | 15 |
| Number of other retired or separated participants entitled to future benefits | 2014-11-01 | 2 |
| Total of all active and inactive participants | 2014-11-01 | 817 |
| 2013: GREAT SOUTHERN BANK CAFETERIA PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-11-01 | 787 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-11-01 | 818 |
| Number of retired or separated participants receiving benefits | 2013-11-01 | 10 |
| Number of other retired or separated participants entitled to future benefits | 2013-11-01 | 0 |
| Total of all active and inactive participants | 2013-11-01 | 828 |
| 2012: GREAT SOUTHERN BANK CAFETERIA PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-11-01 | 869 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-11-01 | 760 |
| Number of retired or separated participants receiving benefits | 2012-11-01 | 6 |
| Number of other retired or separated participants entitled to future benefits | 2012-11-01 | 0 |
| Total of all active and inactive participants | 2012-11-01 | 766 |
| 2011: GREAT SOUTHERN BANK CAFETERIA PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-11-01 | 724 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-11-01 | 820 |
| Number of retired or separated participants receiving benefits | 2011-11-01 | 9 |
| Total of all active and inactive participants | 2011-11-01 | 829 |
| 2009: GREAT SOUTHERN BANK CAFETERIA PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-11-01 | 613 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-11-01 | 609 |
| Number of retired or separated participants receiving benefits | 2009-11-01 | 15 |
| Number of other retired or separated participants entitled to future benefits | 2009-11-01 | 0 |
| Total of all active and inactive participants | 2009-11-01 | 624 |
| Total participants | 2009-11-01 | 0 |
| 2022: GREAT SOUTHERN BANK CAFETERIA PLAN 2022 form 5500 responses |
|---|
| 2022-11-01 | Type of plan entity | Single employer plan |
| 2022-11-01 | Submission has been amended | No |
| 2022-11-01 | This submission is the final filing | No |
| 2022-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2022-11-01 | Plan is a collectively bargained plan | No |
| 2022-11-01 | Plan funding arrangement – Insurance | Yes |
| 2022-11-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-11-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: GREAT SOUTHERN BANK CAFETERIA PLAN 2021 form 5500 responses |
|---|
| 2021-11-01 | Type of plan entity | Single employer plan |
| 2021-11-01 | Submission has been amended | No |
| 2021-11-01 | This submission is the final filing | No |
| 2021-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2021-11-01 | Plan is a collectively bargained plan | No |
| 2021-11-01 | Plan funding arrangement – Insurance | Yes |
| 2021-11-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-11-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: GREAT SOUTHERN BANK CAFETERIA PLAN 2020 form 5500 responses |
|---|
| 2020-11-01 | Type of plan entity | Single employer plan |
| 2020-11-01 | Submission has been amended | No |
| 2020-11-01 | This submission is the final filing | No |
| 2020-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2020-11-01 | Plan is a collectively bargained plan | No |
| 2020-11-01 | Plan funding arrangement – Insurance | Yes |
| 2020-11-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-11-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: GREAT SOUTHERN BANK CAFETERIA PLAN 2019 form 5500 responses |
|---|
| 2019-11-01 | Type of plan entity | Single employer plan |
| 2019-11-01 | Submission has been amended | No |
| 2019-11-01 | This submission is the final filing | No |
| 2019-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2019-11-01 | Plan is a collectively bargained plan | No |
| 2019-11-01 | Plan funding arrangement – Insurance | Yes |
| 2019-11-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-11-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: GREAT SOUTHERN BANK CAFETERIA PLAN 2018 form 5500 responses |
|---|
| 2018-11-01 | Type of plan entity | Single employer plan |
| 2018-11-01 | Submission has been amended | No |
| 2018-11-01 | This submission is the final filing | No |
| 2018-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2018-11-01 | Plan is a collectively bargained plan | No |
| 2018-11-01 | Plan funding arrangement – Insurance | Yes |
| 2018-11-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-11-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: GREAT SOUTHERN BANK CAFETERIA PLAN 2017 form 5500 responses |
|---|
| 2017-11-01 | Type of plan entity | Single employer plan |
| 2017-11-01 | Submission has been amended | No |
| 2017-11-01 | This submission is the final filing | No |
| 2017-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-11-01 | Plan is a collectively bargained plan | No |
| 2017-11-01 | Plan funding arrangement – Insurance | Yes |
| 2017-11-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-11-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: GREAT SOUTHERN BANK CAFETERIA PLAN 2016 form 5500 responses |
|---|
| 2016-11-01 | Type of plan entity | Single employer plan |
| 2016-11-01 | Submission has been amended | No |
| 2016-11-01 | This submission is the final filing | No |
| 2016-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-11-01 | Plan is a collectively bargained plan | No |
| 2016-11-01 | Plan funding arrangement – Insurance | Yes |
| 2016-11-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-11-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: GREAT SOUTHERN BANK CAFETERIA PLAN 2015 form 5500 responses |
|---|
| 2015-11-01 | Type of plan entity | Single employer plan |
| 2015-11-01 | Submission has been amended | No |
| 2015-11-01 | This submission is the final filing | No |
| 2015-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-11-01 | Plan is a collectively bargained plan | No |
| 2015-11-01 | Plan funding arrangement – Insurance | Yes |
| 2015-11-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-11-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: GREAT SOUTHERN BANK CAFETERIA PLAN 2014 form 5500 responses |
|---|
| 2014-11-01 | Type of plan entity | Single employer plan |
| 2014-11-01 | Submission has been amended | No |
| 2014-11-01 | This submission is the final filing | No |
| 2014-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-11-01 | Plan is a collectively bargained plan | No |
| 2014-11-01 | Plan funding arrangement – Insurance | Yes |
| 2014-11-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-11-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: GREAT SOUTHERN BANK CAFETERIA PLAN 2013 form 5500 responses |
|---|
| 2013-11-01 | Type of plan entity | Single employer plan |
| 2013-11-01 | Submission has been amended | No |
| 2013-11-01 | This submission is the final filing | No |
| 2013-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-11-01 | Plan is a collectively bargained plan | No |
| 2013-11-01 | Plan funding arrangement – Insurance | Yes |
| 2013-11-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-11-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2012: GREAT SOUTHERN BANK CAFETERIA PLAN 2012 form 5500 responses |
|---|
| 2012-11-01 | Type of plan entity | Single employer plan |
| 2012-11-01 | Submission has been amended | No |
| 2012-11-01 | This submission is the final filing | No |
| 2012-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-11-01 | Plan is a collectively bargained plan | No |
| 2012-11-01 | Plan funding arrangement – Insurance | Yes |
| 2012-11-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2012-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-11-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2011: GREAT SOUTHERN BANK CAFETERIA PLAN 2011 form 5500 responses |
|---|
| 2011-11-01 | Type of plan entity | Single employer plan |
| 2011-11-01 | Submission has been amended | No |
| 2011-11-01 | This submission is the final filing | No |
| 2011-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-11-01 | Plan is a collectively bargained plan | No |
| 2011-11-01 | Plan funding arrangement – Insurance | Yes |
| 2011-11-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2011-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-11-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2009: GREAT SOUTHERN BANK CAFETERIA PLAN 2009 form 5500 responses |
|---|
| 2009-11-01 | Type of plan entity | Single employer plan |
| 2009-11-01 | Submission has been amended | No |
| 2009-11-01 | This submission is the final filing | No |
| 2009-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-11-01 | Plan is a collectively bargained plan | No |
| 2009-11-01 | Plan funding arrangement – Insurance | Yes |
| 2009-11-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2009-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-11-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLTD0AXD7 |
| Policy instance | 8 |
| Insurance contract or identification number | GLTD0AXD7 | | Number of Individuals Covered | 713 | | Insurance policy start date | 2022-11-01 | | Insurance policy end date | 2023-10-31 | | Total amount of commissions paid to insurance broker | USD $9,052 | | Total amount of fees paid to insurance company | USD $5,928 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $90,520 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,052 | | Amount paid for insurance broker fees | 5928 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUDH0AXD7 |
| Policy instance | 1 |
| Insurance contract or identification number | GUDH0AXD7 | | Number of Individuals Covered | 275 | | Insurance policy start date | 2022-11-01 | | Insurance policy end date | 2023-10-31 | | Total amount of commissions paid to insurance broker | USD $7,223 | | Total amount of fees paid to insurance company | USD $3,201 | | Other welfare benefits provided | ACCIDENT VOLUNTARY | | Welfare Benefit Premiums Paid to Carrier | USD $48,155 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,223 | | Amount paid for insurance broker fees | 3201 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG0AXD7 |
| Policy instance | 2 |
| Insurance contract or identification number | GLUG0AXD7 | | Number of Individuals Covered | 890 | | Insurance policy start date | 2022-11-01 | | Insurance policy end date | 2023-10-31 | | Total amount of commissions paid to insurance broker | USD $9,450 | | Total amount of fees paid to insurance company | USD $6,576 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD & D | | Welfare Benefit Premiums Paid to Carrier | USD $94,505 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,450 | | Amount paid for insurance broker fees | 6576 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| COX HEALTH SYSTEMS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60040 ) |
| Policy contract number | CI660S |
| Policy instance | 3 |
| Insurance contract or identification number | CI660S | | Number of Individuals Covered | 1097 | | Insurance policy start date | 2022-11-01 | | Insurance policy end date | 2023-10-31 | | Total amount of commissions paid to insurance broker | USD $63,923 | | Total amount of fees paid to insurance company | USD $447,528 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $63,923 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 447528 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE FEES PAID |
|
| ADVANTICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 12278 ) |
| Policy contract number | 11118901 |
| Policy instance | 4 |
| Insurance contract or identification number | 11118901 | | Number of Individuals Covered | 1020 | | Insurance policy start date | 2022-11-01 | | Insurance policy end date | 2023-10-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $70,769 | | 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 number | GVTL0AXD7 |
| Policy instance | 5 |
| Insurance contract or identification number | GVTL0AXD7 | | Number of Individuals Covered | 466 | | Insurance policy start date | 2022-11-01 | | Insurance policy end date | 2023-10-31 | | Total amount of commissions paid to insurance broker | USD $15,110 | | Total amount of fees paid to insurance company | USD $9,949 | | Other welfare benefits provided | TERM LIFE - VOLUNTARY | | Welfare Benefit Premiums Paid to Carrier | USD $151,102 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $15,110 | | Amount paid for insurance broker fees | 9949 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUC0AXD7 |
| Policy instance | 6 |
| Insurance contract or identification number | GUC0AXD7 | | Number of Individuals Covered | 225 | | Insurance policy start date | 2022-11-01 | | Insurance policy end date | 2023-10-31 | | Total amount of commissions paid to insurance broker | USD $10,716 | | Total amount of fees paid to insurance company | USD $6,873 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $107,162 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,716 | | Amount paid for insurance broker fees | 6873 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUDE0AXD7 |
| Policy instance | 7 |
| Insurance contract or identification number | GUDE0AXD7 | | Number of Individuals Covered | 186 | | Insurance policy start date | 2022-11-01 | | Insurance policy end date | 2023-10-31 | | Total amount of commissions paid to insurance broker | USD $5,947 | | Total amount of fees paid to insurance company | USD $2,482 | | Other welfare benefits provided | CRITICAL ILLNESS VOLUNTARY | | Welfare Benefit Premiums Paid to Carrier | USD $39,643 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,947 | | Amount paid for insurance broker fees | 2482 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUDE0AXD7 |
| Policy instance | 1 |
| Insurance contract or identification number | GUDE0AXD7 | | Number of Individuals Covered | 212 | | Insurance policy start date | 2021-11-01 | | Insurance policy end date | 2022-10-31 | | Total amount of commissions paid to insurance broker | USD $5,182 | | Total amount of fees paid to insurance company | USD $2,188 | | Other welfare benefits provided | CRITICAL ILLNESS VOLUNTARY | | Welfare Benefit Premiums Paid to Carrier | USD $34,545 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,182 | | Amount paid for insurance broker fees | 2188 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUC0AXD7 |
| Policy instance | 2 |
| Insurance contract or identification number | GUC0AXD7 | | Number of Individuals Covered | 217 | | Insurance policy start date | 2021-11-01 | | Insurance policy end date | 2022-10-31 | | Total amount of commissions paid to insurance broker | USD $9,628 | | Total amount of fees paid to insurance company | USD $6,020 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $96,280 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,628 | | Amount paid for insurance broker fees | 6020 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLTD0AXD7 |
| Policy instance | 3 |
| Insurance contract or identification number | GLTD0AXD7 | | Number of Individuals Covered | 706 | | Insurance policy start date | 2021-11-01 | | Insurance policy end date | 2022-10-31 | | Total amount of commissions paid to insurance broker | USD $8,358 | | Total amount of fees paid to insurance company | USD $5,606 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $83,576 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,358 | | Amount paid for insurance broker fees | 5606 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUDH0AXD7 |
| Policy instance | 4 |
| Insurance contract or identification number | GUDH0AXD7 | | Number of Individuals Covered | 261 | | Insurance policy start date | 2021-11-01 | | Insurance policy end date | 2022-10-31 | | Total amount of commissions paid to insurance broker | USD $6,800 | | Total amount of fees paid to insurance company | USD $2,980 | | Other welfare benefits provided | ACCIDENT VOLUNTARY | | Welfare Benefit Premiums Paid to Carrier | USD $45,332 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,800 | | Amount paid for insurance broker fees | 2980 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG0AXD7 |
| Policy instance | 5 |
| Insurance contract or identification number | GLUG0AXD7 | | Number of Individuals Covered | 889 | | Insurance policy start date | 2021-11-01 | | Insurance policy end date | 2022-10-31 | | Total amount of commissions paid to insurance broker | USD $9,351 | | Total amount of fees paid to insurance company | USD $6,515 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD & D | | Welfare Benefit Premiums Paid to Carrier | USD $93,508 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,351 | | Amount paid for insurance broker fees | 6515 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| ADVANTICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 12278 ) |
| Policy contract number | 11118901 |
| Policy instance | 6 |
| Insurance contract or identification number | 11118901 | | Number of Individuals Covered | 1016 | | Insurance policy start date | 2021-11-01 | | Insurance policy end date | 2022-10-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $69,295 | | 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 number | GVTL0AXD7 |
| Policy instance | 7 |
| Insurance contract or identification number | GVTL0AXD7 | | Number of Individuals Covered | 462 | | Insurance policy start date | 2021-11-01 | | Insurance policy end date | 2022-10-31 | | Total amount of commissions paid to insurance broker | USD $13,947 | | Total amount of fees paid to insurance company | USD $9,453 | | Other welfare benefits provided | TERM LIFE - VOLUNTARY | | Welfare Benefit Premiums Paid to Carrier | USD $139,467 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,947 | | Amount paid for insurance broker fees | 9453 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| COX HEALTH SYSTEMS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60040 ) |
| Policy contract number | CI660S |
| Policy instance | 8 |
| Insurance contract or identification number | CI660S | | Number of Individuals Covered | 1101 | | Insurance policy start date | 2021-11-01 | | Insurance policy end date | 2022-10-31 | | Total amount of commissions paid to insurance broker | USD $61,402 | | Total amount of fees paid to insurance company | USD $467,990 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $61,402 | | Amount paid for insurance broker fees | 5000 | | Additional information about fees paid to insurance broker | PERSISTENCY BONUS PAID | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLTD0AXD7 |
| Policy instance | 2 |
| Insurance contract or identification number | GLTD0AXD7 | | Number of Individuals Covered | 685 | | Insurance policy start date | 2020-11-01 | | Insurance policy end date | 2021-10-31 | | Total amount of commissions paid to insurance broker | USD $8,125 | | Total amount of fees paid to insurance company | USD $5,639 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $81,257 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,928 | | Amount paid for insurance broker fees | 5639 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUDE0AXD7 |
| Policy instance | 3 |
| Insurance contract or identification number | GUDE0AXD7 | | Number of Individuals Covered | 193 | | Insurance policy start date | 2020-11-01 | | Insurance policy end date | 2021-10-31 | | Total amount of commissions paid to insurance broker | USD $4,615 | | Total amount of fees paid to insurance company | USD $2,239 | | Other welfare benefits provided | CRITICAL ILLNESS VOLUNTARY | | Welfare Benefit Premiums Paid to Carrier | USD $30,768 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,734 | | Amount paid for insurance broker fees | 2239 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG0AXD7 |
| Policy instance | 4 |
| Insurance contract or identification number | GLUG0AXD7 | | Number of Individuals Covered | 864 | | Insurance policy start date | 2020-11-01 | | Insurance policy end date | 2021-10-31 | | Total amount of commissions paid to insurance broker | USD $9,275 | | Total amount of fees paid to insurance company | USD $6,353 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD & D | | Welfare Benefit Premiums Paid to Carrier | USD $92,752 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,464 | | Amount paid for insurance broker fees | 6353 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| COX HEALTH SYSTEMS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60040 ) |
| Policy contract number | CI660S |
| Policy instance | 5 |
| Insurance contract or identification number | CI660S | | Number of Individuals Covered | 1107 | | Insurance policy start date | 2020-11-01 | | Insurance policy end date | 2021-10-31 | | Total amount of commissions paid to insurance broker | USD $61,003 | | Total amount of fees paid to insurance company | USD $465,408 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $61,003 | | Amount paid for insurance broker fees | 7500 | | Additional information about fees paid to insurance broker | PERSISTENCY BONUS | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GVTL0AXD7 |
| Policy instance | 6 |
| Insurance contract or identification number | GVTL0AXD7 | | Number of Individuals Covered | 447 | | Insurance policy start date | 2020-11-01 | | Insurance policy end date | 2021-10-31 | | Total amount of commissions paid to insurance broker | USD $13,443 | | Total amount of fees paid to insurance company | USD $8,890 | | Other welfare benefits provided | TERM LIFE - VOLUNTARY | | Welfare Benefit Premiums Paid to Carrier | USD $134,427 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,054 | | Amount paid for insurance broker fees | 8890 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUC0AXD7 |
| Policy instance | 8 |
| Insurance contract or identification number | GUC0AXD7 | | Number of Individuals Covered | 198 | | Insurance policy start date | 2020-11-01 | | Insurance policy end date | 2021-10-31 | | Total amount of commissions paid to insurance broker | USD $8,365 | | Total amount of fees paid to insurance company | USD $5,588 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $83,659 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,928 | | Amount paid for insurance broker fees | 5588 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUDH0AXD7 |
| Policy instance | 1 |
| Insurance contract or identification number | GUDH0AXD7 | | Number of Individuals Covered | 238 | | Insurance policy start date | 2020-11-01 | | Insurance policy end date | 2021-10-31 | | Total amount of commissions paid to insurance broker | USD $6,286 | | Total amount of fees paid to insurance company | USD $2,550 | | Other welfare benefits provided | ACCIDENT VOLUNTARY | | Welfare Benefit Premiums Paid to Carrier | USD $41,907 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,773 | | Amount paid for insurance broker fees | 2550 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| ADVANTICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 12278 ) |
| Policy contract number | 11118901 |
| Policy instance | 7 |
| Insurance contract or identification number | 11118901 | | Number of Individuals Covered | 1015 | | Insurance policy start date | 2020-11-01 | | Insurance policy end date | 2021-10-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $70,108 | | 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 number | GUDH0AXD7 |
| Policy instance | 8 |
| Insurance contract or identification number | GUDH0AXD7 | | Number of Individuals Covered | 202 | | Insurance policy start date | 2019-11-01 | | Insurance policy end date | 2020-10-31 | | Total amount of commissions paid to insurance broker | USD $5,297 | | Total amount of fees paid to insurance company | USD $977 | | Other welfare benefits provided | ACCIDENT VOLUNTARY | | Welfare Benefit Premiums Paid to Carrier | USD $35,311 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,297 | | Amount paid for insurance broker fees | 977 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUC0AXD7 |
| Policy instance | 1 |
| Insurance contract or identification number | GUC0AXD7 | | Number of Individuals Covered | 184 | | Insurance policy start date | 2019-11-01 | | Insurance policy end date | 2020-10-31 | | Total amount of commissions paid to insurance broker | USD $7,903 | | Total amount of fees paid to insurance company | USD $2,382 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $79,032 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,903 | | Amount paid for insurance broker fees | 2382 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| ADVANTICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 12278 ) |
| Policy contract number | 11118901 |
| Policy instance | 3 |
| Insurance contract or identification number | 11118901 | | Number of Individuals Covered | 987 | | Insurance policy start date | 2019-11-01 | | Insurance policy end date | 2020-10-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $66,785 | | 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 number | GUDE0AXD7 |
| Policy instance | 2 |
| Insurance contract or identification number | GUDE0AXD7 | | Number of Individuals Covered | 179 | | Insurance policy start date | 2019-11-01 | | Insurance policy end date | 2020-10-31 | | Total amount of commissions paid to insurance broker | USD $4,787 | | Total amount of fees paid to insurance company | USD $940 | | Other welfare benefits provided | CRITICAL ILLNESS VOLUNTARY | | Welfare Benefit Premiums Paid to Carrier | USD $31,915 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,787 | | Amount paid for insurance broker fees | 940 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GVTL0AXD7 |
| Policy instance | 4 |
| Insurance contract or identification number | GVTL0AXD7 | | Number of Individuals Covered | 445 | | Insurance policy start date | 2019-11-01 | | Insurance policy end date | 2020-10-31 | | Total amount of commissions paid to insurance broker | USD $12,577 | | Total amount of fees paid to insurance company | USD $4,110 | | Other welfare benefits provided | TERM LIFE - VOLUNTARY | | Welfare Benefit Premiums Paid to Carrier | USD $125,769 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $12,577 | | Amount paid for insurance broker fees | 4110 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLTD0AXD7 |
| Policy instance | 5 |
| Insurance contract or identification number | GLTD0AXD7 | | Number of Individuals Covered | 716 | | Insurance policy start date | 2019-11-01 | | Insurance policy end date | 2020-10-31 | | Total amount of commissions paid to insurance broker | USD $7,857 | | Total amount of fees paid to insurance company | USD $2,599 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $78,570 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,857 | | Amount paid for insurance broker fees | 2599 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| COX HEALTH SYSTEMS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60040 ) |
| Policy contract number | CI660S |
| Policy instance | 6 |
| Insurance contract or identification number | CI660S | | Number of Individuals Covered | 1153 | | Insurance policy start date | 2019-11-01 | | Insurance policy end date | 2020-10-31 | | Total amount of commissions paid to insurance broker | USD $58,675 | | Total amount of fees paid to insurance company | USD $443,173 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $58,675 | | Amount paid for insurance broker fees | 2500 | | Additional information about fees paid to insurance broker | PERSISTENCY BONUS | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG0AXD7 |
| Policy instance | 7 |
| Insurance contract or identification number | GLUG0AXD7 | | Number of Individuals Covered | 890 | | Insurance policy start date | 2019-11-01 | | Insurance policy end date | 2020-10-31 | | Total amount of commissions paid to insurance broker | USD $9,090 | | Total amount of fees paid to insurance company | USD $3,154 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD & D | | Welfare Benefit Premiums Paid to Carrier | USD $90,902 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,090 | | Amount paid for insurance broker fees | 3154 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| ADVANTICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 12278 ) |
| Policy contract number | 11118901 |
| Policy instance | 1 |
| Insurance contract or identification number | 11118901 | | Number of Individuals Covered | 955 | | Insurance policy start date | 2018-11-01 | | Insurance policy end date | 2019-10-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $64,057 | | 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 number | GUDH0AXD7 |
| Policy instance | 2 |
| Insurance contract or identification number | GUDH0AXD7 | | Number of Individuals Covered | 158 | | Insurance policy start date | 2018-11-01 | | Insurance policy end date | 2019-10-31 | | Total amount of commissions paid to insurance broker | USD $3,932 | | Total amount of fees paid to insurance company | USD $659 | | Other welfare benefits provided | ACCIDENT VOLUNTARY | | Welfare Benefit Premiums Paid to Carrier | USD $26,216 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,932 | | Amount paid for insurance broker fees | 659 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| COX HEALTH SYSTEMS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60040 ) |
| Policy contract number | CI660S |
| Policy instance | 3 |
| Insurance contract or identification number | CI660S | | Number of Individuals Covered | 1121 | | Insurance policy start date | 2018-11-01 | | Insurance policy end date | 2019-10-31 | | Total amount of commissions paid to insurance broker | USD $58,384 | | Total amount of fees paid to insurance company | USD $442,940 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $58,384 | | Amount paid for insurance broker fees | 5000 | | Additional information about fees paid to insurance broker | PERSISTENCY BONUS | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GVTL0AXD7 |
| Policy instance | 4 |
| Insurance contract or identification number | GVTL0AXD7 | | Number of Individuals Covered | 442 | | Insurance policy start date | 2018-11-01 | | Insurance policy end date | 2019-10-31 | | Total amount of commissions paid to insurance broker | USD $11,491 | | Total amount of fees paid to insurance company | USD $2,675 | | Other welfare benefits provided | VOLUNTARY LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $114,906 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,491 | | Amount paid for insurance broker fees | 2675 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLTD0AXD7 |
| Policy instance | 5 |
| Insurance contract or identification number | GLTD0AXD7 | | Number of Individuals Covered | 698 | | Insurance policy start date | 2018-11-01 | | Insurance policy end date | 2019-10-31 | | Total amount of commissions paid to insurance broker | USD $7,373 | | Total amount of fees paid to insurance company | USD $1,793 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $73,733 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,373 | | Amount paid for insurance broker fees | 1793 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG0AXD7 |
| Policy instance | 6 |
| Insurance contract or identification number | GLUG0AXD7 | | Number of Individuals Covered | 876 | | Insurance policy start date | 2018-11-01 | | Insurance policy end date | 2019-10-31 | | Total amount of commissions paid to insurance broker | USD $9,000 | | Total amount of fees paid to insurance company | USD $2,272 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD & D | | Welfare Benefit Premiums Paid to Carrier | USD $89,995 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,000 | | Amount paid for insurance broker fees | 2272 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUC0AXD7 |
| Policy instance | 7 |
| Insurance contract or identification number | GUC0AXD7 | | Number of Individuals Covered | 167 | | Insurance policy start date | 2018-11-01 | | Insurance policy end date | 2019-10-31 | | Total amount of commissions paid to insurance broker | USD $6,569 | | Total amount of fees paid to insurance company | USD $1,547 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $65,686 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,569 | | Amount paid for insurance broker fees | 1547 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUDE0AXD7 |
| Policy instance | 8 |
| Insurance contract or identification number | GUDE0AXD7 | | Number of Individuals Covered | 173 | | Insurance policy start date | 2018-11-01 | | Insurance policy end date | 2019-10-31 | | Total amount of commissions paid to insurance broker | USD $3,884 | | Total amount of fees paid to insurance company | USD $573 | | Other welfare benefits provided | CRITICAL ILLNESS VOLUNTARY | | Welfare Benefit Premiums Paid to Carrier | USD $25,893 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,884 | | Amount paid for insurance broker fees | 573 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GVTL0AXD7 |
| Policy instance | 1 |
| Insurance contract or identification number | GVTL0AXD7 | | Number of Individuals Covered | 417 | | Insurance policy start date | 2017-11-01 | | Insurance policy end date | 2018-10-31 | | Total amount of commissions paid to insurance broker | USD $10,527 | | Total amount of fees paid to insurance company | USD $4,909 | | Other welfare benefits provided | VOLUNTARY LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $105,270 | | 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 number | GUDE0AXD7 |
| Policy instance | 3 |
| Insurance contract or identification number | GUDE0AXD7 | | Number of Individuals Covered | 147 | | Insurance policy start date | 2017-11-01 | | Insurance policy end date | 2018-10-31 | | Total amount of commissions paid to insurance broker | USD $3,371 | | Total amount of fees paid to insurance company | USD $1,126 | | Other welfare benefits provided | CRITICAL ILLNESS VOLUNTARY | | Welfare Benefit Premiums Paid to Carrier | USD $22,474 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ADVANTICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 12278 ) |
| Policy contract number | 11118901 |
| Policy instance | 4 |
| Insurance contract or identification number | 11118901 | | Number of Individuals Covered | 957 | | Insurance policy start date | 2017-11-01 | | Insurance policy end date | 2018-10-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $63,420 | | 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 number | GLTD0AXD7 |
| Policy instance | 5 |
| Insurance contract or identification number | GLTD0AXD7 | | Number of Individuals Covered | 692 | | Insurance policy start date | 2017-11-01 | | Insurance policy end date | 2018-10-31 | | Total amount of commissions paid to insurance broker | USD $7,135 | | Total amount of fees paid to insurance company | USD $3,474 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $71,347 | | 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 number | GUC0AXD7 |
| Policy instance | 6 |
| Insurance contract or identification number | GUC0AXD7 | | Number of Individuals Covered | 151 | | Insurance policy start date | 2017-11-01 | | Insurance policy end date | 2018-10-31 | | Total amount of commissions paid to insurance broker | USD $6,120 | | Total amount of fees paid to insurance company | USD $3,054 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $61,202 | | 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 number | GLUG0AXD7 |
| Policy instance | 7 |
| Insurance contract or identification number | GLUG0AXD7 | | Number of Individuals Covered | 871 | | Insurance policy start date | 2017-11-01 | | Insurance policy end date | 2018-10-31 | | Total amount of commissions paid to insurance broker | USD $9,117 | | Total amount of fees paid to insurance company | USD $4,568 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD & D | | Welfare Benefit Premiums Paid to Carrier | USD $91,173 | | 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 number | GUDH0AXD7 |
| Policy instance | 8 |
| Insurance contract or identification number | GUDH0AXD7 | | Number of Individuals Covered | 145 | | Insurance policy start date | 2017-11-01 | | Insurance policy end date | 2018-10-31 | | Total amount of commissions paid to insurance broker | USD $3,939 | | Total amount of fees paid to insurance company | USD $1,319 | | Other welfare benefits provided | ACCIDENT VOLUNTARY | | Welfare Benefit Premiums Paid to Carrier | USD $26,259 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| COX HEALTH SYSTEMS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60040 ) |
| Policy contract number | CI660S |
| Policy instance | 2 |
| Insurance contract or identification number | CI660S | | Number of Individuals Covered | 1161 | | Insurance policy start date | 2017-11-01 | | Insurance policy end date | 2018-10-31 | | Total amount of commissions paid to insurance broker | USD $64,587 | | Total amount of fees paid to insurance company | USD $428,630 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
