COMMUNITY UNITED METHODIST HOSPITAL, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan HEALTH & WELFARE PLAN OF METHODIST HOSPITAL, HENDERSON & METHODIST HOSPITAL, UNION COUNTY
401k plan membership statisitcs for HEALTH & WELFARE PLAN OF METHODIST HOSPITAL, HENDERSON & METHODIST HOSPITAL, UNION COUNTY
| Measure | Date | Value |
|---|
| 2021 : HEALTH & WELFARE PLAN OF METHODIST HOSPITAL, HENDERSON & METHODIST HOSPITAL, UNION COUNTY 2021 401k financial data |
|---|
| Total income from all sources (including contributions) | 2021-12-31 | $76,333 |
| Total of all expenses incurred | 2021-12-31 | $478,193 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2021-12-31 | $495,024 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2021-12-31 | $76,333 |
| Value of total assets at end of year | 2021-12-31 | $0 |
| Value of total assets at beginning of year | 2021-12-31 | $401,860 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2021-12-31 | $-16,831 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2021-12-31 | Yes |
| Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan | 2021-12-31 | $783,549 |
| Was this plan covered by a fidelity bond | 2021-12-31 | Yes |
| Value of fidelity bond cover | 2021-12-31 | $5,000,000 |
| If this is an individual account plan, was there a blackout period | 2021-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2021-12-31 | No |
| Income. Received or receivable in cash from other sources (including rollovers) | 2021-12-31 | $76,333 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2021-12-31 | $495,024 |
| Total non interest bearing cash at end of year | 2021-12-31 | $0 |
| Total non interest bearing cash at beginning of year | 2021-12-31 | $401,859 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2021-12-31 | No |
| Value of net income/loss | 2021-12-31 | $-401,860 |
| Value of net assets at end of year (total assets less liabilities) | 2021-12-31 | $0 |
| Value of net assets at beginning of year (total assets less liabilities) | 2021-12-31 | $401,860 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2021-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2021-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2021-12-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2021-12-31 | $0 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2021-12-31 | $1 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2021-12-31 | $1 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2021-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2021-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2021-12-31 | No |
| Contract administrator fees | 2021-12-31 | $-16,831 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2021-12-31 | No |
| Did the plan have assets held for investment | 2021-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2021-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2021-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2021-12-31 | Unqualified |
| Accountancy firm name | 2021-12-31 | BLUE & CO., LLC |
| Accountancy firm EIN | 2021-12-31 | 351178661 |
| 2020 : HEALTH & WELFARE PLAN OF METHODIST HOSPITAL, HENDERSON & METHODIST HOSPITAL, UNION COUNTY 2020 401k financial data |
|---|
| Total income from all sources (including contributions) | 2020-12-31 | $7,178,360 |
| Total of all expenses incurred | 2020-12-31 | $7,199,182 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2020-12-31 | $6,856,194 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2020-12-31 | $7,178,360 |
| Value of total assets at end of year | 2020-12-31 | $401,860 |
| Value of total assets at beginning of year | 2020-12-31 | $422,682 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2020-12-31 | $342,988 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2020-12-31 | No |
| Was this plan covered by a fidelity bond | 2020-12-31 | Yes |
| Value of fidelity bond cover | 2020-12-31 | $5,000,000 |
| If this is an individual account plan, was there a blackout period | 2020-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2020-12-31 | No |
| Contributions received from participants | 2020-12-31 | $1,519,366 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2020-12-31 | $507,528 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2020-12-31 | $6,127,617 |
| Administrative expenses (other) incurred | 2020-12-31 | $207,459 |
| Total non interest bearing cash at end of year | 2020-12-31 | $401,859 |
| Total non interest bearing cash at beginning of year | 2020-12-31 | $422,681 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-12-31 | No |
| Value of net income/loss | 2020-12-31 | $-20,822 |
| Value of net assets at end of year (total assets less liabilities) | 2020-12-31 | $401,860 |
| Value of net assets at beginning of year (total assets less liabilities) | 2020-12-31 | $422,682 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2020-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2020-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2020-12-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2020-12-31 | $1 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2020-12-31 | $1 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2020-12-31 | $1 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2020-12-31 | $728,577 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2020-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2020-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2020-12-31 | No |
| Contributions received in cash from employer | 2020-12-31 | $5,151,466 |
| Contract administrator fees | 2020-12-31 | $135,529 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2020-12-31 | No |
| Did the plan have assets held for investment | 2020-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2020-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2020-12-31 | Unqualified |
| Accountancy firm name | 2020-12-31 | BLUE & CO., LLC |
| Accountancy firm EIN | 2020-12-31 | 351178661 |
| 2019 : HEALTH & WELFARE PLAN OF METHODIST HOSPITAL, HENDERSON & METHODIST HOSPITAL, UNION COUNTY 2019 401k financial data |
|---|
| Total income from all sources (including contributions) | 2019-12-31 | $10,086,258 |
| Total of all expenses incurred | 2019-12-31 | $10,150,072 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2019-12-31 | $9,491,645 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2019-12-31 | $10,086,258 |
| Value of total assets at end of year | 2019-12-31 | $422,682 |
| Value of total assets at beginning of year | 2019-12-31 | $486,496 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2019-12-31 | $658,427 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2019-12-31 | No |
| Was this plan covered by a fidelity bond | 2019-12-31 | Yes |
| Value of fidelity bond cover | 2019-12-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2019-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2019-12-31 | No |
| Contributions received from participants | 2019-12-31 | $3,227,779 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2019-12-31 | $885,752 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2019-12-31 | $8,023,871 |
| Administrative expenses (other) incurred | 2019-12-31 | $414,189 |
| Total non interest bearing cash at end of year | 2019-12-31 | $422,681 |
| Total non interest bearing cash at beginning of year | 2019-12-31 | $486,495 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-12-31 | No |
| Value of net income/loss | 2019-12-31 | $-63,814 |
| Value of net assets at end of year (total assets less liabilities) | 2019-12-31 | $422,682 |
| Value of net assets at beginning of year (total assets less liabilities) | 2019-12-31 | $486,496 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2019-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2019-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2019-12-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2019-12-31 | $1 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2019-12-31 | $1 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2019-12-31 | $1 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2019-12-31 | $1,467,774 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2019-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2019-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2019-12-31 | No |
| Contributions received in cash from employer | 2019-12-31 | $5,972,727 |
| Contract administrator fees | 2019-12-31 | $244,238 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2019-12-31 | No |
| Did the plan have assets held for investment | 2019-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2019-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2019-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2019-12-31 | Unqualified |
| Accountancy firm name | 2019-12-31 | BLUE & CO., LLC |
| Accountancy firm EIN | 2019-12-31 | 351178661 |
| 2018 : HEALTH & WELFARE PLAN OF METHODIST HOSPITAL, HENDERSON & METHODIST HOSPITAL, UNION COUNTY 2018 401k financial data |
|---|
| Total income from all sources (including contributions) | 2018-12-31 | $17,841,994 |
| Total of all expenses incurred | 2018-12-31 | $17,633,345 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2018-12-31 | $16,336,095 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2018-12-31 | $17,841,994 |
| Value of total assets at end of year | 2018-12-31 | $486,496 |
| Value of total assets at beginning of year | 2018-12-31 | $277,847 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2018-12-31 | $1,297,250 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2018-12-31 | No |
| Was this plan covered by a fidelity bond | 2018-12-31 | Yes |
| Value of fidelity bond cover | 2018-12-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2018-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2018-12-31 | No |
| Contributions received from participants | 2018-12-31 | $3,286,884 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2018-12-31 | $2,308,013 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2018-12-31 | $14,734,395 |
| Administrative expenses (other) incurred | 2018-12-31 | $508,870 |
| Total non interest bearing cash at end of year | 2018-12-31 | $486,495 |
| Total non interest bearing cash at beginning of year | 2018-12-31 | $277,846 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-12-31 | No |
| Value of net income/loss | 2018-12-31 | $208,649 |
| Value of net assets at end of year (total assets less liabilities) | 2018-12-31 | $486,496 |
| Value of net assets at beginning of year (total assets less liabilities) | 2018-12-31 | $277,847 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2018-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2018-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2018-12-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2018-12-31 | $1 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2018-12-31 | $1 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2018-12-31 | $1 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2018-12-31 | $1,601,700 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2018-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2018-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2018-12-31 | No |
| Contributions received in cash from employer | 2018-12-31 | $12,247,097 |
| Contract administrator fees | 2018-12-31 | $788,380 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2018-12-31 | No |
| Did the plan have assets held for investment | 2018-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2018-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2018-12-31 | Yes |
| Opinion of an independent qualified public accountant for this plan | 2018-12-31 | Disclaimer |
| Accountancy firm name | 2018-12-31 | BLUE & CO., LLC |
| Accountancy firm EIN | 2018-12-31 | 351178661 |
| 2017 : HEALTH & WELFARE PLAN OF METHODIST HOSPITAL, HENDERSON & METHODIST HOSPITAL, UNION COUNTY 2017 401k financial data |
|---|
| Total income from all sources (including contributions) | 2017-12-31 | $16,600,156 |
| Total of all expenses incurred | 2017-12-31 | $16,609,407 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2017-12-31 | $15,434,900 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2017-12-31 | $16,600,156 |
| Value of total assets at end of year | 2017-12-31 | $277,847 |
| Value of total assets at beginning of year | 2017-12-31 | $287,098 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2017-12-31 | $1,174,507 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2017-12-31 | No |
| Was this plan covered by a fidelity bond | 2017-12-31 | Yes |
| Value of fidelity bond cover | 2017-12-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2017-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2017-12-31 | No |
| Contributions received from participants | 2017-12-31 | $3,235,678 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2017-12-31 | $723,435 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2017-12-31 | $13,672,188 |
| Administrative expenses (other) incurred | 2017-12-31 | $481,305 |
| Total non interest bearing cash at end of year | 2017-12-31 | $277,846 |
| Total non interest bearing cash at beginning of year | 2017-12-31 | $287,097 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2017-12-31 | No |
| Value of net income/loss | 2017-12-31 | $-9,251 |
| Value of net assets at end of year (total assets less liabilities) | 2017-12-31 | $277,847 |
| Value of net assets at beginning of year (total assets less liabilities) | 2017-12-31 | $287,098 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2017-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2017-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2017-12-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2017-12-31 | $1 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2017-12-31 | $1 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2017-12-31 | $1 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2017-12-31 | $1,762,712 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2017-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2017-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2017-12-31 | No |
| Contributions received in cash from employer | 2017-12-31 | $12,641,043 |
| Contract administrator fees | 2017-12-31 | $693,202 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2017-12-31 | No |
| Did the plan have assets held for investment | 2017-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2017-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2017-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2017-12-31 | Yes |
| Opinion of an independent qualified public accountant for this plan | 2017-12-31 | Disclaimer |
| Accountancy firm name | 2017-12-31 | BLUE & CO., LLC |
| Accountancy firm EIN | 2017-12-31 | 351178661 |
| 2016 : HEALTH & WELFARE PLAN OF METHODIST HOSPITAL, HENDERSON & METHODIST HOSPITAL, UNION COUNTY 2016 401k financial data |
|---|
| Total income from all sources (including contributions) | 2016-12-31 | $17,924,485 |
| Total of all expenses incurred | 2016-12-31 | $17,689,487 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2016-12-31 | $16,576,072 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2016-12-31 | $17,924,485 |
| Value of total assets at end of year | 2016-12-31 | $287,098 |
| Value of total assets at beginning of year | 2016-12-31 | $52,100 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2016-12-31 | $1,113,415 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2016-12-31 | No |
| Was this plan covered by a fidelity bond | 2016-12-31 | Yes |
| Value of fidelity bond cover | 2016-12-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2016-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2016-12-31 | No |
| Contributions received from participants | 2016-12-31 | $3,498,443 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2016-12-31 | $718,465 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2016-12-31 | $14,706,368 |
| Administrative expenses (other) incurred | 2016-12-31 | $404,776 |
| Total non interest bearing cash at end of year | 2016-12-31 | $287,097 |
| Total non interest bearing cash at beginning of year | 2016-12-31 | $52,099 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-12-31 | No |
| Value of net income/loss | 2016-12-31 | $234,998 |
| Value of net assets at end of year (total assets less liabilities) | 2016-12-31 | $287,098 |
| Value of net assets at beginning of year (total assets less liabilities) | 2016-12-31 | $52,100 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2016-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2016-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2016-12-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2016-12-31 | $1 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2016-12-31 | $1 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2016-12-31 | $1 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2016-12-31 | $1,869,704 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2016-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2016-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2016-12-31 | No |
| Contributions received in cash from employer | 2016-12-31 | $13,707,577 |
| Contract administrator fees | 2016-12-31 | $708,639 |
| Did the plan have assets held for investment | 2016-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2016-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2016-12-31 | Yes |
| Opinion of an independent qualified public accountant for this plan | 2016-12-31 | Disclaimer |
| Accountancy firm name | 2016-12-31 | BLUE & CO., LLC |
| Accountancy firm EIN | 2016-12-31 | 351178661 |
| 2015 : HEALTH & WELFARE PLAN OF METHODIST HOSPITAL, HENDERSON & METHODIST HOSPITAL, UNION COUNTY 2015 401k financial data |
|---|
| Total income from all sources (including contributions) | 2015-12-31 | $16,741,987 |
| Total of all expenses incurred | 2015-12-31 | $16,978,003 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2015-12-31 | $15,774,616 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2015-12-31 | $16,741,987 |
| Value of total assets at end of year | 2015-12-31 | $52,100 |
| Value of total assets at beginning of year | 2015-12-31 | $288,116 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2015-12-31 | $1,203,387 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2015-12-31 | No |
| Was this plan covered by a fidelity bond | 2015-12-31 | Yes |
| Value of fidelity bond cover | 2015-12-31 | $5,000,000 |
| If this is an individual account plan, was there a blackout period | 2015-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2015-12-31 | No |
| Contributions received from participants | 2015-12-31 | $3,361,897 |
| Assets. Other investments not covered elsewhere at beginning of year | 2015-12-31 | $69 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2015-12-31 | $13,710,166 |
| Administrative expenses (other) incurred | 2015-12-31 | $408,171 |
| Total non interest bearing cash at end of year | 2015-12-31 | $52,099 |
| Total non interest bearing cash at beginning of year | 2015-12-31 | $288,046 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-12-31 | No |
| Value of net income/loss | 2015-12-31 | $-236,016 |
| Value of net assets at end of year (total assets less liabilities) | 2015-12-31 | $52,100 |
| Value of net assets at beginning of year (total assets less liabilities) | 2015-12-31 | $288,116 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2015-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2015-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2015-12-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2015-12-31 | $1 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2015-12-31 | $1 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2015-12-31 | $1 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2015-12-31 | $1,766,844 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2015-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2015-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2015-12-31 | No |
| Contributions received in cash from employer | 2015-12-31 | $13,380,090 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2015-12-31 | $297,606 |
| Contract administrator fees | 2015-12-31 | $795,216 |
| Did the plan have assets held for investment | 2015-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2015-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2015-12-31 | Yes |
| Opinion of an independent qualified public accountant for this plan | 2015-12-31 | Disclaimer |
| Accountancy firm name | 2015-12-31 | MCELROY, MITCHELL & ASSOCIATES, LLP |
| Accountancy firm EIN | 2015-12-31 | 611457054 |
| 2014 : HEALTH & WELFARE PLAN OF METHODIST HOSPITAL, HENDERSON & METHODIST HOSPITAL, UNION COUNTY 2014 401k financial data |
|---|
| Total income from all sources (including contributions) | 2014-12-31 | $15,332,198 |
| Total of all expenses incurred | 2014-12-31 | $15,524,478 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2014-12-31 | $14,453,442 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2014-12-31 | $15,332,198 |
| Value of total assets at end of year | 2014-12-31 | $288,116 |
| Value of total assets at beginning of year | 2014-12-31 | $480,396 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2014-12-31 | $1,071,036 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2014-12-31 | No |
| Was this plan covered by a fidelity bond | 2014-12-31 | Yes |
| Value of fidelity bond cover | 2014-12-31 | $5,000,000 |
| If this is an individual account plan, was there a blackout period | 2014-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2014-12-31 | No |
| Contributions received from participants | 2014-12-31 | $3,407,523 |
| Assets. Other investments not covered elsewhere at end of year | 2014-12-31 | $69 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2014-12-31 | $12,230,946 |
| Administrative expenses (other) incurred | 2014-12-31 | $365,269 |
| Total non interest bearing cash at end of year | 2014-12-31 | $288,046 |
| Total non interest bearing cash at beginning of year | 2014-12-31 | $480,395 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-12-31 | No |
| Value of net income/loss | 2014-12-31 | $-192,280 |
| Value of net assets at end of year (total assets less liabilities) | 2014-12-31 | $288,116 |
| Value of net assets at beginning of year (total assets less liabilities) | 2014-12-31 | $480,396 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2014-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2014-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2014-12-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2014-12-31 | $1 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2014-12-31 | $1 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2014-12-31 | $1 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2014-12-31 | $1,880,926 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2014-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2014-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2014-12-31 | No |
| Contributions received in cash from employer | 2014-12-31 | $11,924,675 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2014-12-31 | $341,570 |
| Contract administrator fees | 2014-12-31 | $705,767 |
| Did the plan have assets held for investment | 2014-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2014-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2014-12-31 | Yes |
| Opinion of an independent qualified public accountant for this plan | 2014-12-31 | Disclaimer |
| Accountancy firm name | 2014-12-31 | MCELROY, MITCHELL & ASSOCIATES, LLP |
| Accountancy firm EIN | 2014-12-31 | 611457054 |
| 2013 : HEALTH & WELFARE PLAN OF METHODIST HOSPITAL, HENDERSON & METHODIST HOSPITAL, UNION COUNTY 2013 401k financial data |
|---|
| Total income from all sources (including contributions) | 2013-12-31 | $17,692,951 |
| Total of all expenses incurred | 2013-12-31 | $17,442,501 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2013-12-31 | $16,071,076 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2013-12-31 | $17,692,951 |
| Value of total assets at end of year | 2013-12-31 | $480,396 |
| Value of total assets at beginning of year | 2013-12-31 | $229,946 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2013-12-31 | $1,371,425 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2013-12-31 | No |
| Was this plan covered by a fidelity bond | 2013-12-31 | Yes |
| Value of fidelity bond cover | 2013-12-31 | $5,000,000 |
| If this is an individual account plan, was there a blackout period | 2013-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2013-12-31 | No |
| Contributions received from participants | 2013-12-31 | $3,520,648 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2013-12-31 | $13,853,477 |
| Administrative expenses (other) incurred | 2013-12-31 | $584,300 |
| Total non interest bearing cash at end of year | 2013-12-31 | $480,395 |
| Total non interest bearing cash at beginning of year | 2013-12-31 | $229,445 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-12-31 | No |
| Value of net income/loss | 2013-12-31 | $250,450 |
| Value of net assets at end of year (total assets less liabilities) | 2013-12-31 | $480,396 |
| Value of net assets at beginning of year (total assets less liabilities) | 2013-12-31 | $229,946 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2013-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2013-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2013-12-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2013-12-31 | $1 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2013-12-31 | $501 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2013-12-31 | $501 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2013-12-31 | $15,616,105 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2013-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2013-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2013-12-31 | No |
| Contributions received in cash from employer | 2013-12-31 | $14,172,303 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2013-12-31 | $454,971 |
| Contract administrator fees | 2013-12-31 | $787,125 |
| Did the plan have assets held for investment | 2013-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2013-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2013-12-31 | Yes |
| Opinion of an independent qualified public accountant for this plan | 2013-12-31 | Disclaimer |
| Accountancy firm name | 2013-12-31 | MCELROY, MITCHELL & ASSOCIATES, LLP |
| Accountancy firm EIN | 2013-12-31 | 611457054 |
| 2012 : HEALTH & WELFARE PLAN OF METHODIST HOSPITAL, HENDERSON & METHODIST HOSPITAL, UNION COUNTY 2012 401k financial data |
|---|
| Total income from all sources (including contributions) | 2012-12-31 | $15,524,035 |
| Total of all expenses incurred | 2012-12-31 | $15,407,324 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2012-12-31 | $14,279,699 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2012-12-31 | $15,524,035 |
| Value of total assets at end of year | 2012-12-31 | $229,946 |
| Value of total assets at beginning of year | 2012-12-31 | $113,235 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2012-12-31 | $1,127,625 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2012-12-31 | No |
| Was this plan covered by a fidelity bond | 2012-12-31 | Yes |
| Value of fidelity bond cover | 2012-12-31 | $5,000,000 |
| If this is an individual account plan, was there a blackout period | 2012-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2012-12-31 | No |
| Contributions received from participants | 2012-12-31 | $2,716,104 |
| Administrative expenses (other) incurred | 2012-12-31 | $506,774 |
| Total non interest bearing cash at end of year | 2012-12-31 | $229,445 |
| Total non interest bearing cash at beginning of year | 2012-12-31 | $112,234 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-12-31 | No |
| Value of net income/loss | 2012-12-31 | $116,711 |
| Value of net assets at end of year (total assets less liabilities) | 2012-12-31 | $229,946 |
| Value of net assets at beginning of year (total assets less liabilities) | 2012-12-31 | $113,235 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2012-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2012-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2012-12-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2012-12-31 | $501 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2012-12-31 | $1,001 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2012-12-31 | $1,001 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2012-12-31 | $13,821,358 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2012-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2012-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2012-12-31 | No |
| Contributions received in cash from employer | 2012-12-31 | $12,807,931 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2012-12-31 | $458,341 |
| Contract administrator fees | 2012-12-31 | $620,851 |
| Did the plan have assets held for investment | 2012-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2012-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2012-12-31 | Yes |
| Opinion of an independent qualified public accountant for this plan | 2012-12-31 | Disclaimer |
| Accountancy firm name | 2012-12-31 | MCELROY, MITCHELL & ASSOCIATES, LLP |
| Accountancy firm EIN | 2012-12-31 | 611457054 |
| 2011 : HEALTH & WELFARE PLAN OF METHODIST HOSPITAL, HENDERSON & METHODIST HOSPITAL, UNION COUNTY 2011 401k financial data |
|---|
| Total income from all sources (including contributions) | 2011-12-31 | $14,763,743 |
| Total of all expenses incurred | 2011-12-31 | $14,845,481 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2011-12-31 | $13,814,019 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2011-12-31 | $14,763,741 |
| Value of total assets at end of year | 2011-12-31 | $113,235 |
| Value of total assets at beginning of year | 2011-12-31 | $194,973 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2011-12-31 | $1,031,462 |
| Total interest from all sources | 2011-12-31 | $2 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2011-12-31 | No |
| Was this plan covered by a fidelity bond | 2011-12-31 | Yes |
| Value of fidelity bond cover | 2011-12-31 | $5,000,000 |
| If this is an individual account plan, was there a blackout period | 2011-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2011-12-31 | No |
| Contributions received from participants | 2011-12-31 | $2,898,830 |
| Administrative expenses (other) incurred | 2011-12-31 | $435,601 |
| Total non interest bearing cash at end of year | 2011-12-31 | $112,234 |
| Total non interest bearing cash at beginning of year | 2011-12-31 | $193,973 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-12-31 | No |
| Value of net income/loss | 2011-12-31 | $-81,738 |
| Value of net assets at end of year (total assets less liabilities) | 2011-12-31 | $113,235 |
| Value of net assets at beginning of year (total assets less liabilities) | 2011-12-31 | $194,973 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2011-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2011-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2011-12-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2011-12-31 | $1,001 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2011-12-31 | $1,000 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2011-12-31 | $1,000 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2011-12-31 | $2 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2011-12-31 | $13,323,702 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2011-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2011-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2011-12-31 | No |
| Contributions received in cash from employer | 2011-12-31 | $11,864,911 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2011-12-31 | $490,317 |
| Contract administrator fees | 2011-12-31 | $595,861 |
| Did the plan have assets held for investment | 2011-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2011-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2011-12-31 | Yes |
| Opinion of an independent qualified public accountant for this plan | 2011-12-31 | Disclaimer |
| Accountancy firm name | 2011-12-31 | MCELROY, MITCHELL & ASSOCIATES, LLP |
| Accountancy firm EIN | 2011-12-31 | 611457054 |
| 2010 : HEALTH & WELFARE PLAN OF METHODIST HOSPITAL, HENDERSON & METHODIST HOSPITAL, UNION COUNTY 2010 401k financial data |
|---|
| Total income from all sources (including contributions) | 2010-12-31 | $14,165,971 |
| Total of all expenses incurred | 2010-12-31 | $14,805,531 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2010-12-31 | $13,905,606 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2010-12-31 | $14,165,945 |
| Value of total assets at end of year | 2010-12-31 | $194,973 |
| Value of total assets at beginning of year | 2010-12-31 | $834,533 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2010-12-31 | $899,925 |
| Total interest from all sources | 2010-12-31 | $26 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2010-12-31 | No |
| Was this plan covered by a fidelity bond | 2010-12-31 | Yes |
| Value of fidelity bond cover | 2010-12-31 | $5,000,000 |
| If this is an individual account plan, was there a blackout period | 2010-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2010-12-31 | No |
| Contributions received from participants | 2010-12-31 | $2,641,675 |
| Administrative expenses (other) incurred | 2010-12-31 | $331,930 |
| Total non interest bearing cash at end of year | 2010-12-31 | $193,973 |
| Total non interest bearing cash at beginning of year | 2010-12-31 | $188,816 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2010-12-31 | No |
| Value of net income/loss | 2010-12-31 | $-639,560 |
| Value of net assets at end of year (total assets less liabilities) | 2010-12-31 | $194,973 |
| Value of net assets at beginning of year (total assets less liabilities) | 2010-12-31 | $834,533 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2010-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2010-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2010-12-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2010-12-31 | $1,000 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2010-12-31 | $645,717 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2010-12-31 | $645,717 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2010-12-31 | $26 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2010-12-31 | $13,386,718 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2010-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2010-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2010-12-31 | No |
| Contributions received in cash from employer | 2010-12-31 | $11,524,270 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2010-12-31 | $518,888 |
| Contract administrator fees | 2010-12-31 | $567,995 |
| Did the plan have assets held for investment | 2010-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2010-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2010-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2010-12-31 | Yes |
| Opinion of an independent qualified public accountant for this plan | 2010-12-31 | Disclaimer |
| Accountancy firm name | 2010-12-31 | MCELROY, MITCHELL & ASSOCIATES, LLP |
| Accountancy firm EIN | 2010-12-31 | 611457054 |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0212842 |
| Policy instance | 3 |
| Insurance contract or identification number | 0212842 | | Number of Individuals Covered | 7 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $697 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $496 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $388 | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0212843 |
| Policy instance | 2 |
| Insurance contract or identification number | 0212843 | | Number of Individuals Covered | 13 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $977 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $894 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $544 | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0212841 |
| Policy instance | 1 |
| Insurance contract or identification number | 0212841 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $1,128 | | Other welfare benefits provided | CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $-1,162 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $630 | | Insurance broker organization code? | 3 |
|
| ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 ) |
| Policy contract number | KY2058 |
| Policy instance | 1 |
| Insurance contract or identification number | KY2058 | | Number of Individuals Covered | 1268 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-06-30 | | Welfare Benefit Premiums Paid to Carrier | USD $207,459 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HEALTH RESOURCES INC (National Association of Insurance Commissioners NAIC id number: 96687 ) |
| Policy contract number | 806933583513 |
| Policy instance | 2 |
| Insurance contract or identification number | 806933583513 | | Number of Individuals Covered | 674 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $5,274 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $70,326 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,274 | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00555618 |
| Policy instance | 3 |
| Insurance contract or identification number | 00555618 | | Number of Individuals Covered | 559 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-06-30 | | Total amount of fees paid to insurance company | USD $5,098 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $44,466 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 5098 | | Additional information about fees paid to insurance broker | FEES | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLX968369 |
| Policy instance | 4 |
| Insurance contract or identification number | FLX968369 | | Number of Individuals Covered | 579 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $4,572 | | Total amount of fees paid to insurance company | USD $1,353 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $45,718 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,572 | | Amount paid for insurance broker fees | 1353 | | Additional information about fees paid to insurance broker | OVERRIDE | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLX968188 |
| Policy instance | 5 |
| Insurance contract or identification number | FLX968188 | | Number of Individuals Covered | 721 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $6,958 | | Total amount of fees paid to insurance company | USD $2,116 | | Other welfare benefits provided | VOLUNTARY LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $69,578 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,958 | | Amount paid for insurance broker fees | 2116 | | Additional information about fees paid to insurance broker | OVERRIDE | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | OK 969664 |
| Policy instance | 6 |
| Insurance contract or identification number | OK 969664 | | Number of Individuals Covered | 346 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $1,693 | | Total amount of fees paid to insurance company | USD $550 | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $16,931 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,693 | | Amount paid for insurance broker fees | 550 | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | VDT962469 |
| Policy instance | 7 |
| Insurance contract or identification number | VDT962469 | | Number of Individuals Covered | 317 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $11,943 | | Total amount of fees paid to insurance company | USD $3,339 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $119,428 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,943 | | Amount paid for insurance broker fees | 3339 | | Additional information about fees paid to insurance broker | OVERRIDE | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | LK 965551 |
| Policy instance | 8 |
| Insurance contract or identification number | LK 965551 | | Number of Individuals Covered | 113 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $5,793 | | Total amount of fees paid to insurance company | USD $1,711 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $57,928 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,793 | | Amount paid for insurance broker fees | 1711 | | Additional information about fees paid to insurance broker | OVERRIDE | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0212841 |
| Policy instance | 9 |
| Insurance contract or identification number | 0212841 | | Number of Individuals Covered | 352 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $8,334 | | Total amount of fees paid to insurance company | USD $1,330 | | Other welfare benefits provided | CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $40,326 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,668 | | Amount paid for insurance broker fees | 1330 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | LK 965551 |
| Policy instance | 8 |
| Insurance contract or identification number | LK 965551 | | Number of Individuals Covered | 238 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $11,695 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $116,953 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,695 | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | VDT962469 |
| Policy instance | 7 |
| Insurance contract or identification number | VDT962469 | | Number of Individuals Covered | 328 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $22,703 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $227,033 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $22,703 | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | OK 969664 |
| Policy instance | 6 |
| Insurance contract or identification number | OK 969664 | | Number of Individuals Covered | 394 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $3,715 | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $37,147 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,715 | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLX968369 |
| Policy instance | 4 |
| Insurance contract or identification number | FLX968369 | | Number of Individuals Covered | 736 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $9,347 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $93,470 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,347 | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLX968188 |
| Policy instance | 5 |
| Insurance contract or identification number | FLX968188 | | Number of Individuals Covered | 742 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $14,418 | | Other welfare benefits provided | SUPP LIFE/DEPENDENT LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $144,177 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $14,418 | | Insurance broker organization code? | 3 |
|
| ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 ) |
| Policy contract number | KY2058 |
| Policy instance | 1 |
| Insurance contract or identification number | KY2058 | | Number of Individuals Covered | 1299 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $414,278 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00555618 |
| Policy instance | 3 |
| Insurance contract or identification number | 00555618 | | Number of Individuals Covered | 577 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $79,047 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HEALTH RESOURCES INC (National Association of Insurance Commissioners NAIC id number: 96687 ) |
| Policy contract number | 806933583513 |
| Policy instance | 2 |
| Insurance contract or identification number | 806933583513 | | Number of Individuals Covered | 750 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $16,046 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $320,919 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $16,046 | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLX968188 |
| Policy instance | 6 |
| Insurance contract or identification number | FLX968188 | | Number of Individuals Covered | 816 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $12,352 | | Total amount of fees paid to insurance company | USD $7,758 | | Other welfare benefits provided | SUPP LIFE/DEPENDENT LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $123,517 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $12,352 | | Amount paid for insurance broker fees | 7758 | | Additional information about fees paid to insurance broker | OVERRIDE | | Insurance broker organization code? | 3 |
|
| SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
| Policy contract number | 417005411273 |
| Policy instance | 1 |
| Insurance contract or identification number | 417005411273 | | Number of Individuals Covered | 721 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $508,873 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 30790-1258,1373 |
| Policy instance | 3 |
| Insurance contract or identification number | 30790-1258,1373 | | Number of Individuals Covered | 1500 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $9,918 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $99,330 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,753 | | Insurance broker organization code? | 3 |
|
| HEALTH RESOURCES INC (National Association of Insurance Commissioners NAIC id number: 96687 ) |
| Policy contract number | 806933583513 |
| Policy instance | 2 |
| Insurance contract or identification number | 806933583513 | | Number of Individuals Covered | 847 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $17,189 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $343,779 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $17,189 | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | R0453548 |
| Policy instance | 10 |
| Insurance contract or identification number | R0453548 | | Number of Individuals Covered | 493 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $7,828 | | Total amount of fees paid to insurance company | USD $910 | | Other welfare benefits provided | GCIEE, GRPACCVO, GRPHSPVO | | Welfare Benefit Premiums Paid to Carrier | USD $18,339 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,158 | | Amount paid for insurance broker fees | 717 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | LK 965551 |
| Policy instance | 9 |
| Insurance contract or identification number | LK 965551 | | Number of Individuals Covered | 272 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $9,980 | | Total amount of fees paid to insurance company | USD $3,950 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $99,803 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,980 | | Amount paid for insurance broker fees | 3950 | | Additional information about fees paid to insurance broker | OVERRIDE | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | VDT962469 |
| Policy instance | 8 |
| Insurance contract or identification number | VDT962469 | | Number of Individuals Covered | 368 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $19,664 | | Total amount of fees paid to insurance company | USD $8,288 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $196,639 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $19,664 | | Amount paid for insurance broker fees | 8288 | | Additional information about fees paid to insurance broker | OVERRIDE | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | OK 969664 |
| Policy instance | 7 |
| Insurance contract or identification number | OK 969664 | | Number of Individuals Covered | 433 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $3,592 | | Total amount of fees paid to insurance company | USD $1,649 | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $35,923 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,592 | | Amount paid for insurance broker fees | 1649 | | Additional information about fees paid to insurance broker | OVERRIDE | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLX968369 |
| Policy instance | 5 |
| Insurance contract or identification number | FLX968369 | | Number of Individuals Covered | 821 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $7,713 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $77,134 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,713 | | Insurance broker organization code? | 3 |
|
| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
| Policy contract number | R0453548 |
| Policy instance | 4 |
| Insurance contract or identification number | R0453548 | | Number of Individuals Covered | 1202 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $47,632 | | Total amount of fees paid to insurance company | USD $5,350 | | Other welfare benefits provided | ISWL STND, WHOLE LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $236,414 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $28,028 | | Amount paid for insurance broker fees | 2500 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
| Policy contract number | 417005411273 |
| Policy instance | 1 |
| Insurance contract or identification number | 417005411273 | | Number of Individuals Covered | 808 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $481,497 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HEALTH RESOURCES INC (National Association of Insurance Commissioners NAIC id number: 96687 ) |
| Policy contract number | 806933583513 |
| Policy instance | 2 |
| Insurance contract or identification number | 806933583513 | | Number of Individuals Covered | 1821 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $27,588 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $554,791 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $27,588 | | Insurance broker organization code? | 3 | | Insurance broker name | WLA INSURANCE LLC |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 30790-1258,1373 |
| Policy instance | 3 |
| Insurance contract or identification number | 30790-1258,1373 | | Number of Individuals Covered | 1611 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $11,839 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $121,746 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,014 | | Insurance broker organization code? | 3 | | Insurance broker name | GIBSON INSURANCE AGENCY, INC. |
|
| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
| Policy contract number | R0453548 |
| Policy instance | 4 |
| Insurance contract or identification number | R0453548 | | Number of Individuals Covered | 1049 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $42,708 | | Total amount of fees paid to insurance company | USD $2,834 | | Other welfare benefits provided | ISWL STND, WHOLE LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $257,476 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $27,893 | | Amount paid for insurance broker fees | 2243 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION PAID | | Insurance broker organization code? | 3 | | Insurance broker name | WLA INSURANCE LLC DBA ALTMAN INS |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 ) |
| Policy contract number | 000010211476 |
| Policy instance | 5 |
| Insurance contract or identification number | 000010211476 | | Number of Individuals Covered | 917 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $115,761 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 ) |
| Policy contract number | 000010211478 |
| Policy instance | 6 |
| Insurance contract or identification number | 000010211478 | | Number of Individuals Covered | 374 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $23,095 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $230,950 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $21,192 | | Insurance broker organization code? | 3 | | Insurance broker name | GIBSON INSURANCE AGENCY, INC. |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 ) |
| Policy contract number | 000010211477 |
| Policy instance | 7 |
| Insurance contract or identification number | 000010211477 | | Number of Individuals Covered | 156 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $87,215 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 ) |
| Policy contract number | 000403005455 |
| Policy instance | 8 |
| Insurance contract or identification number | 000403005455 | | Number of Individuals Covered | 471 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $5,372 | | Other welfare benefits provided | VOLUNTARY AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $35,809 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,891 | | Insurance broker organization code? | 3 | | Insurance broker name | GIBSON INSURANCE AGENCY, INC. |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 ) |
| Policy contract number | 400001000 20586 |
| Policy instance | 9 |
| Insurance contract or identification number | 400001000 20586 | | Number of Individuals Covered | 833 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $23,471 | | Other welfare benefits provided | VOLUNTARY LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $156,471 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $21,843 | | Insurance broker organization code? | 3 | | Insurance broker name | GIBSON INSURANCE AGENCY, INC. |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 ) |
| Policy contract number | 000010211840 |
| Policy instance | 10 |
| Insurance contract or identification number | 000010211840 | | Number of Individuals Covered | 123 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $7,735 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $77,348 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,021 | | Insurance broker organization code? | 3 | | Insurance broker name | GIBSON INSURANCE AGENCY, INC. |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | R0453548 |
| Policy instance | 11 |
| Insurance contract or identification number | R0453548 | | Number of Individuals Covered | 633 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $49,678 | | Total amount of fees paid to insurance company | USD $5,966 | | Other welfare benefits provided | GCIEE, GRPACCVO, GRPHSPVO | | Welfare Benefit Premiums Paid to Carrier | USD $199,307 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $32,872 | | Amount paid for insurance broker fees | 4679 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION PAID | | Insurance broker organization code? | 3 | | Insurance broker name | WLA INSURANCE LLC DBA ALTMAN INS |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG0ANMS |
| Policy instance | 5 |
| Insurance contract or identification number | GLUG0ANMS | | Number of Individuals Covered | 1009 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of fees paid to insurance company | USD $4,400 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $106,619 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 4400 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | GIBSON INSURANCE AGENCY, INC |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUPR0ANMS |
| Policy instance | 6 |
| Insurance contract or identification number | GUPR0ANMS | | Number of Individuals Covered | 140 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $5,181 | | Total amount of fees paid to insurance company | USD $2,039 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $51,808 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,181 | | Amount paid for insurance broker fees | 2039 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | GIBSON INSURANCE AGENCY INC |
|
| HEALTH RESOURCES INC (National Association of Insurance Commissioners NAIC id number: 96687 ) |
| Policy contract number | 8069-3358-3513 |
| Policy instance | 1 |
| Insurance contract or identification number | 8069-3358-3513 | | Number of Individuals Covered | 2010 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $28,923 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $578,462 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $28,923 | | Insurance broker organization code? | 3 | | Insurance broker name | WESLEY MANTOOTH |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 30790-1258 |
| Policy instance | 2 |
| Insurance contract or identification number | 30790-1258 | | Number of Individuals Covered | 1604 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $11,493 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $116,623 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,493 | | Insurance broker organization code? | 3 | | Insurance broker name | GIBSON INSURANCE- WESLEY MANTOOTH |
|
| SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
| Policy contract number | 417005411273 |
| Policy instance | 3 |
| Insurance contract or identification number | 417005411273 | | Number of Individuals Covered | 886 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $30,613 | | Welfare Benefit Premiums Paid to Carrier | USD $408,107 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $30,613 | | Additional information about fees paid to insurance broker | MANAGING PRODUCER FEE | | Insurance broker organization code? | 3 | | Insurance broker name | GIBSON INSURANCE AGENCY, INC. |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | R0453548 |
| Policy instance | 4 |
| Insurance contract or identification number | R0453548 | | Number of Individuals Covered | 499 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $36,328 | | Total amount of fees paid to insurance company | USD $4,301 | | Other welfare benefits provided | GCIEE | | Welfare Benefit Premiums Paid to Carrier | USD $149,373 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,894 | | Amount paid for insurance broker fees | 1338 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | BEAU D BOUDREAUX |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLTD0ANMS |
| Policy instance | 7 |
| Insurance contract or identification number | GLTD0ANMS | | Number of Individuals Covered | 176 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of fees paid to insurance company | USD $1,727 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $57,460 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 1727 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | GIBSON INSURANCE AGENCY, INC. |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUC0ANMS |
| Policy instance | 8 |
| Insurance contract or identification number | GUC0ANMS | | Number of Individuals Covered | 435 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $23,543 | | Total amount of fees paid to insurance company | USD $10,170 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $235,431 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $23,543 | | Amount paid for insurance broker fees | 10170 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | GIBSON INSURANCE AGENCY INC |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GVTL0ANMS |
| Policy instance | 9 |
| Insurance contract or identification number | GVTL0ANMS | | Number of Individuals Covered | 504 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $25,509 | | Total amount of fees paid to insurance company | USD $8,306 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $170,062 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $25,509 | | Amount paid for insurance broker fees | 8306 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | GIBSON INSURANCE AGENCY INC |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 ) |
| Policy contract number | T66BA-P-052726 |
| Policy instance | 10 |
| Insurance contract or identification number | T66BA-P-052726 | | Number of Individuals Covered | 525 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $2,443 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $48,853 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,443 | | Insurance broker organization code? | 3 | | Insurance broker name | GIBSON INSURANCE AGENCY INC |
|
| HEALTH RESOURCES INC (National Association of Insurance Commissioners NAIC id number: 96687 ) |
| Policy contract number | 8069-3358-3513 |
| Policy instance | 1 |
| Insurance contract or identification number | 8069-3358-3513 | | Number of Individuals Covered | 1905 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $31,819 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $636,379 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $31,819 | | Insurance broker organization code? | 3 | | Insurance broker name | WESLEY MANTOOTH |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 30790-1258 |
| Policy instance | 2 |
| Insurance contract or identification number | 30790-1258 | | Number of Individuals Covered | 1589 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $13,766 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $137,657 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,766 | | Insurance broker organization code? | 3 | | Insurance broker name | GIBSON INSURANCE- WESLEY MANTOOTH |
|
| SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
| Policy contract number | 417005411273 |
| Policy instance | 4 |
| Insurance contract or identification number | 417005411273 | | Number of Individuals Covered | 924 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $29,928 | | Welfare Benefit Premiums Paid to Carrier | USD $398,787 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $29,928 | | Additional information about fees paid to insurance broker | MANAGING PRODUCER FEE | | Insurance broker organization code? | 3 | | Insurance broker name | GIBSON INSURANCE AGENCY, INC. |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | R0453548 |
| Policy instance | 5 |
| Insurance contract or identification number | R0453548 | | Number of Individuals Covered | 492 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $49,155 | | Total amount of fees paid to insurance company | USD $7,780 | | Other welfare benefits provided | GCIEE | | Welfare Benefit Premiums Paid to Carrier | USD $137,627 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $14,735 | | Amount paid for insurance broker fees | 118 | | Insurance broker organization code? | 3 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker name | BEAU D BOUDREAUX |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUPR0ANMS |
| Policy instance | 7 |
| Insurance contract or identification number | GUPR0ANMS | | Number of Individuals Covered | 151 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $5,097 | | Total amount of fees paid to insurance company | USD $3,300 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $50,971 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,097 | | Amount paid for insurance broker fees | 3300 | | Insurance broker organization code? | 3 | | Insurance broker name | GIBSON INSURANCE AGENCY INC |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLTD0ANMS |
| Policy instance | 8 |
| Insurance contract or identification number | GLTD0ANMS | | Number of Individuals Covered | 174 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of fees paid to insurance company | USD $1,955 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $43,178 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 1955 | | Insurance broker organization code? | 3 | | Insurance broker name | GIBSON INSURANCE AGENCY, INC. |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUC0ANMS |
| Policy instance | 9 |
| Insurance contract or identification number | GUC0ANMS | | Number of Individuals Covered | 460 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $26,704 | | Total amount of fees paid to insurance company | USD $7,500 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $267,045 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $26,704 | | Amount paid for insurance broker fees | 7500 | | Insurance broker organization code? | 3 | | Insurance broker name | GIBSON INSURANCE AGENCY INC |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GVTL0ANMS |
| Policy instance | 10 |
| Insurance contract or identification number | GVTL0ANMS | | Number of Individuals Covered | 596 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $31,149 | | Total amount of fees paid to insurance company | USD $2,029 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $207,657 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $31,149 | | Amount paid for insurance broker fees | 2029 | | Insurance broker organization code? | 3 | | Insurance broker name | GIBSON INSURANCE AGENCY INC |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 ) |
| Policy contract number | T66BA-P-052726 |
| Policy instance | 11 |
| Insurance contract or identification number | T66BA-P-052726 | | Number of Individuals Covered | 495 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $2,791 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $55,826 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,791 | | Insurance broker organization code? | 3 | | Insurance broker name | GIBSON INSURANCE AGENCY INC |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG0ANMS |
| Policy instance | 6 |
| Insurance contract or identification number | GLUG0ANMS | | Number of Individuals Covered | 974 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $3,150 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $110,005 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,150 | | Insurance broker organization code? | 3 | | Insurance broker name | GIBSON INSURANCE AGENCY, INC |
|
| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
| Policy contract number | 9606411 |
| Policy instance | 3 |
| Insurance contract or identification number | 9606411 | | Number of Individuals Covered | 943 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $65,656 | | Total amount of fees paid to insurance company | USD $2,389 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | VWB (ISWL STND) | | Welfare Benefit Premiums Paid to Carrier | USD $250,772 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $19,697 | | Amount paid for insurance broker fees | 158 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | BEAU D BOUDREAUX |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 677185G |
| Policy instance | 3 |
| Insurance contract or identification number | 677185G | | Number of Individuals Covered | 1291 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $109,838 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 417003411273 |
| Policy instance | 4 |
| Insurance contract or identification number | 417003411273 | | Number of Individuals Covered | 1006 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $584,721 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 417003411273 |
| Policy instance | 5 |
| Insurance contract or identification number | 417003411273 | | Number of Individuals Covered | 1006 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $584,721 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 30790-1258 |
| Policy instance | 2 |
| Insurance contract or identification number | 30790-1258 | | Number of Individuals Covered | 1739 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $109,583 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 | | Insurance broker name | GIBSON INSURANCE- WESLEY MANTOOTH |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | R0453548 |
| Policy instance | 6 |
| Insurance contract or identification number | R0453548 | | Number of Individuals Covered | 313 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $58,175 | | Total amount of fees paid to insurance company | USD $5,526 | | Other welfare benefits provided | GRPACCVO | | Welfare Benefit Premiums Paid to Carrier | USD $89,512 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $19,797 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 5526 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker name | BEAU D BOUDREAUX |
|
| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
| Policy contract number | 9606411 |
| Policy instance | 3 |
| Insurance contract or identification number | 9606411 | | Number of Individuals Covered | 835 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $226,449 | | Total amount of fees paid to insurance company | USD $20,439 | | Other welfare benefits provided | VWB (ISWL STND) | | Welfare Benefit Premiums Paid to Carrier | USD $252,218 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $77,031 | | Amount paid for insurance broker fees | 2969 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | BEAU D BOUDREAUX |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 677185G |
| Policy instance | 4 |
| Insurance contract or identification number | 677185G | | Number of Individuals Covered | 1291 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $109,838 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 | | Insurance broker name | GIBSON INS AGCY INC |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG0ANMS |
| Policy instance | 7 |
| Insurance contract or identification number | GLUG0ANMS | | Number of Individuals Covered | 1032 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $103,607 | | 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 | GUPR0ANMS |
| Policy instance | 8 |
| Insurance contract or identification number | GUPR0ANMS | | Number of Individuals Covered | 162 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $5,431 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $54,308 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,431 | | Insurance broker organization code? | 3 | | Insurance broker name | GIBSON INSURANCE AGENCY INC |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLTD0ANMS |
| Policy instance | 9 |
| Insurance contract or identification number | GLTD0ANMS | | Number of Individuals Covered | 152 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $39,177 | | 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 | GUC0ANMS |
| Policy instance | 10 |
| Insurance contract or identification number | GUC0ANMS | | Number of Individuals Covered | 525 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $27,683 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $276,829 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $27,683 | | Insurance broker organization code? | 3 | | Insurance broker name | GIBSON INSURANCE AGENCY INC |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GVTL0ANMS |
| Policy instance | 11 |
| Insurance contract or identification number | GVTL0ANMS | | Number of Individuals Covered | 530 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $28,782 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $191,879 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $28,782 | | Insurance broker organization code? | 3 | | Insurance broker name | GIBSON INSURANCE AGENCY INC |
|
| HEALTH RESOURCES INC (National Association of Insurance Commissioners NAIC id number: 96687 ) |
| Policy contract number | 8069-3358-3513 |
| Policy instance | 1 |
| Insurance contract or identification number | 8069-3358-3513 | | Number of Individuals Covered | 1068 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $33,269 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $665,380 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $33,269 | | Insurance broker organization code? | 3 | | Insurance broker name | WESLEY MANTOOTH |
|
| HEALTH RESOURCES INC (National Association of Insurance Commissioners NAIC id number: 96687 ) |
| Policy contract number | 8069-3358-3513 |
| Policy instance | 1 |
| Insurance contract or identification number | 8069-3358-3513 | | Number of Individuals Covered | 969 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $33,659 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $679,949 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $33,659 | | Insurance broker organization code? | 3 | | Insurance broker name | WESLEY MANTOOTH |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 30790-1258 |
| Policy instance | 2 |
| Insurance contract or identification number | 30790-1258 | | Number of Individuals Covered | 1739 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $11,577 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $115,765 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,577 | | Insurance broker organization code? | 3 | | Insurance broker name | GIBSON INSURANCE- WESLEY MANTOOTH |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 10341 |
| Policy instance | 3 |
| Insurance contract or identification number | 10341 | | Number of Individuals Covered | 963 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $506,774 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 5 | | Insurance broker name | MEDICAL BENEFITS ADMINISTRATORS |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 677185G |
| Policy instance | 4 |
| Insurance contract or identification number | 677185G | | Number of Individuals Covered | 1042 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $40,341 | | Total amount of fees paid to insurance company | USD $4,215 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $696,968 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 4215 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION PAID | | Insurance broker organization code? | 3 | | Commission paid to Insurance Broker | USD $40,341 | | Insurance broker name | GIBSON INS AGCY INC |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 221485 |
| Policy instance | 5 |
| Insurance contract or identification number | 221485 | | Number of Individuals Covered | 1926 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $25,342 | | Total amount of fees paid to insurance company | USD $2,455 | | Other welfare benefits provided | STOP LOSS SPECIFIC | | Welfare Benefit Premiums Paid to Carrier | USD $506,849 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $25,342 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 2455 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker name | GIBSON INSURANCE AGENCY INC |
|
| HEALTH RESOURCES INC (National Association of Insurance Commissioners NAIC id number: 96687 ) |
| Policy contract number | 8069-3358-3513 |
| Policy instance | 1 |
| Insurance contract or identification number | 8069-3358-3513 | | Number of Individuals Covered | 969 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $4,888 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $584,911 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 30790-1258 |
| Policy instance | 3 |
| Insurance contract or identification number | 30790-1258 | | Number of Individuals Covered | 1742 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $16,781 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $104,139 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 677185G |
| Policy instance | 5 |
| Insurance contract or identification number | 677185G | | Number of Individuals Covered | 998 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $28,523 | | Total amount of fees paid to insurance company | USD $5,676 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $570,466 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | ADDS07976 |
| Policy instance | 2 |
| Insurance contract or identification number | ADDS07976 | | Number of Individuals Covered | 985 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $130 | | Other welfare benefits provided | ACCIDENTAL DEATH DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $2,605 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 677185G |
| Policy instance | 2 |
| Insurance contract or identification number | 677185G | | Number of Individuals Covered | 985 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $25,370 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $507,409 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HEALTH RESOURCES INC (National Association of Insurance Commissioners NAIC id number: 96687 ) |
| Policy contract number | 8069-3358-3513 |
| Policy instance | 1 |
| Insurance contract or identification number | 8069-3358-3513 | | Number of Individuals Covered | 1017 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $30,353 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $607,576 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 30790-1258 |
| Policy instance | 3 |
| Insurance contract or identification number | 30790-1258 | | Number of Individuals Covered | 814 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $15,540 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $103,599 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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