LAUGHLIN MEMORIAL HOSPITAL has sponsored the creation of one or more 401k plans.
| Measure | Date | Value |
|---|
| 2016: EMPLOYEE GROUP LIFE INSURANCE 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-02-01 | 513 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-02-01 | 0 |
| Number of retired or separated participants receiving benefits | 2016-02-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2016-02-01 | 0 |
| Total of all active and inactive participants | 2016-02-01 | 0 |
| 2015: EMPLOYEE GROUP LIFE INSURANCE 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-02-01 | 508 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-02-01 | 513 |
| Number of retired or separated participants receiving benefits | 2015-02-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2015-02-01 | 0 |
| Total of all active and inactive participants | 2015-02-01 | 513 |
| 2014: EMPLOYEE GROUP LIFE INSURANCE 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-02-01 | 521 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-02-01 | 508 |
| Total of all active and inactive participants | 2014-02-01 | 508 |
| Total participants | 2014-02-01 | 508 |
| 2013: EMPLOYEE GROUP LIFE INSURANCE 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-02-01 | 535 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-02-01 | 521 |
| Total of all active and inactive participants | 2013-02-01 | 521 |
| Total participants | 2013-02-01 | 521 |
| 2012: EMPLOYEE GROUP LIFE INSURANCE 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-02-01 | 538 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-02-01 | 535 |
| Total of all active and inactive participants | 2012-02-01 | 535 |
| Total participants | 2012-02-01 | 535 |
| 2011: EMPLOYEE GROUP LIFE INSURANCE 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-02-01 | 431 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-02-01 | 538 |
| Total of all active and inactive participants | 2011-02-01 | 538 |
| Total participants | 2011-02-01 | 538 |
| 2010: EMPLOYEE GROUP LIFE INSURANCE 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-02-01 | 449 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-02-01 | 431 |
| Total of all active and inactive participants | 2010-02-01 | 431 |
| Total participants | 2010-02-01 | 431 |
| 2009: EMPLOYEE GROUP LIFE INSURANCE 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-02-01 | 433 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-02-01 | 449 |
| Total of all active and inactive participants | 2009-02-01 | 449 |
| Total participants | 2009-02-01 | 449 |
| 2016: EMPLOYEE GROUP LIFE INSURANCE 2016 form 5500 responses |
|---|
| 2016-02-01 | Type of plan entity | Single employer plan |
| 2016-02-01 | Submission has been amended | No |
| 2016-02-01 | This submission is the final filing | Yes |
| 2016-02-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2016-02-01 | Plan is a collectively bargained plan | No |
| 2016-02-01 | Plan funding arrangement – Insurance | Yes |
| 2016-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: EMPLOYEE GROUP LIFE INSURANCE 2015 form 5500 responses |
|---|
| 2015-02-01 | Type of plan entity | Single employer plan |
| 2015-02-01 | Submission has been amended | No |
| 2015-02-01 | This submission is the final filing | No |
| 2015-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-02-01 | Plan is a collectively bargained plan | No |
| 2015-02-01 | Plan funding arrangement – Insurance | Yes |
| 2015-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: EMPLOYEE GROUP LIFE INSURANCE 2014 form 5500 responses |
|---|
| 2014-02-01 | Type of plan entity | Single employer plan |
| 2014-02-01 | Submission has been amended | No |
| 2014-02-01 | This submission is the final filing | No |
| 2014-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-02-01 | Plan is a collectively bargained plan | No |
| 2014-02-01 | Plan funding arrangement – Insurance | Yes |
| 2014-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: EMPLOYEE GROUP LIFE INSURANCE 2013 form 5500 responses |
|---|
| 2013-02-01 | Type of plan entity | Single employer plan |
| 2013-02-01 | Submission has been amended | No |
| 2013-02-01 | This submission is the final filing | No |
| 2013-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-02-01 | Plan is a collectively bargained plan | No |
| 2013-02-01 | Plan funding arrangement – Insurance | Yes |
| 2013-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: EMPLOYEE GROUP LIFE INSURANCE 2012 form 5500 responses |
|---|
| 2012-02-01 | Type of plan entity | Single employer plan |
| 2012-02-01 | Submission has been amended | No |
| 2012-02-01 | This submission is the final filing | No |
| 2012-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-02-01 | Plan is a collectively bargained plan | No |
| 2012-02-01 | Plan funding arrangement – Insurance | Yes |
| 2012-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: EMPLOYEE GROUP LIFE INSURANCE 2011 form 5500 responses |
|---|
| 2011-02-01 | Type of plan entity | Single employer plan |
| 2011-02-01 | Submission has been amended | No |
| 2011-02-01 | This submission is the final filing | No |
| 2011-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-02-01 | Plan is a collectively bargained plan | No |
| 2011-02-01 | Plan funding arrangement – Insurance | Yes |
| 2011-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2010: EMPLOYEE GROUP LIFE INSURANCE 2010 form 5500 responses |
|---|
| 2010-02-01 | Type of plan entity | Single employer plan |
| 2010-02-01 | Submission has been amended | No |
| 2010-02-01 | This submission is the final filing | No |
| 2010-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2010-02-01 | Plan is a collectively bargained plan | No |
| 2010-02-01 | Plan funding arrangement – Insurance | Yes |
| 2010-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: EMPLOYEE GROUP LIFE INSURANCE 2009 form 5500 responses |
|---|
| 2009-02-01 | Type of plan entity | Single employer plan |
| 2009-02-01 | Submission has been amended | No |
| 2009-02-01 | This submission is the final filing | No |
| 2009-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-02-01 | Plan is a collectively bargained plan | No |
| 2009-02-01 | Plan funding arrangement – Insurance | Yes |
| 2009-02-01 | Plan benefit arrangement – Insurance | Yes |
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000665F |
| Policy instance | 1 |
| Insurance contract or identification number | G000665F | | Number of Individuals Covered | 513 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Total amount of commissions paid to insurance broker | USD $30,927 | | Total amount of fees paid to insurance company | USD $16,700 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $257,727 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $30,927 | | Amount paid for insurance broker fees | 16700 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | VAN METER INSURANCE AGENCY INC |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000665F |
| Policy instance | 2 |
| Insurance contract or identification number | G000665F | | Number of Individuals Covered | 508 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-07-01 | | Total amount of commissions paid to insurance broker | USD $9,496 | | Total amount of fees paid to insurance company | USD $2,795 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $79,131 | | Commission paid to Insurance Broker | USD $9,496 | | Amount paid for insurance broker fees | 2795 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | VAN METER INSURANCE AGENCY INC |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000665F |
| Policy instance | 1 |
| Insurance contract or identification number | G000665F | | Number of Individuals Covered | 502 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-07-01 | | Total amount of commissions paid to insurance broker | USD $21,811 | | Total amount of fees paid to insurance company | USD $6,402 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $181,755 | | Commission paid to Insurance Broker | USD $21,811 | | Amount paid for insurance broker fees | 6402 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | VAN METER INSURANCE AGENCY INC |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000665F |
| Policy instance | 4 |
| Insurance contract or identification number | G000665F | | Number of Individuals Covered | 102 | | Insurance policy start date | 2012-08-01 | | Insurance policy end date | 2013-08-01 | | Total amount of commissions paid to insurance broker | USD $7,622 | | Total amount of fees paid to insurance company | USD $2,061 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $50,816 | | Commission paid to Insurance Broker | USD $7,622 | | Amount paid for insurance broker fees | 2061 | | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD; OTHER COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | VAN METER INSURANCE AGENCY |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000665F |
| Policy instance | 1 |
| Insurance contract or identification number | G000665F | | Number of Individuals Covered | 521 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-07-01 | | Total amount of commissions paid to insurance broker | USD $9,637 | | Total amount of fees paid to insurance company | USD $2,808 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $80,312 | | Commission paid to Insurance Broker | USD $9,637 | | Amount paid for insurance broker fees | 2808 | | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD; OTHER COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | VAN METER INSURANCE AGENCY |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000665F |
| Policy instance | 2 |
| Insurance contract or identification number | G000665F | | Number of Individuals Covered | 515 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-07-01 | | Total amount of commissions paid to insurance broker | USD $22,091 | | Total amount of fees paid to insurance company | USD $6,438 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $184,095 | | Commission paid to Insurance Broker | USD $22,091 | | Amount paid for insurance broker fees | 6438 | | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD; OTHER COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | VAN METER INSURANCE AGENCY, INC |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000665F |
| Policy instance | 3 |
| Insurance contract or identification number | G000665F | | Number of Individuals Covered | 196 | | Insurance policy start date | 2012-08-01 | | Insurance policy end date | 2013-08-01 | | Total amount of commissions paid to insurance broker | USD $8,815 | | Total amount of fees paid to insurance company | USD $1,994 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $58,767 | | Commission paid to Insurance Broker | USD $881 | | Amount paid for insurance broker fees | 1994 | | Additional information about fees paid to insurance broker | AGENT OR BORKER OF RECORD; OTHER COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | VAN METER INSURANCE AGENCY INC |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000665F |
| Policy instance | 1 |
| Insurance contract or identification number | G000665F | | Number of Individuals Covered | 535 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-07-01 | | Total amount of commissions paid to insurance broker | USD $14,239 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Welfare Benefit Premiums Paid to Carrier | USD $78,993 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $14,239 | | Insurance broker organization code? | 3 | | Insurance broker name | VAN METER INS AGENCY |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000665F |
| Policy instance | 4 |
| Insurance contract or identification number | G000665F | | Number of Individuals Covered | 140 | | Insurance policy start date | 2011-08-01 | | Insurance policy end date | 2012-08-01 | | Total amount of commissions paid to insurance broker | USD $12,720 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $60,705 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $12,720 | | Insurance broker organization code? | 3 | | Insurance broker name | VAN METER INSURANCE AGENCY |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000665F |
| Policy instance | 3 |
| Insurance contract or identification number | G000665F | | Number of Individuals Covered | 198 | | Insurance policy start date | 2011-08-01 | | Insurance policy end date | 2012-08-01 | | Total amount of commissions paid to insurance broker | USD $11,391 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $55,129 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,391 | | Insurance broker organization code? | 3 | | Insurance broker name | VAN METER INSURANCE AGENCY |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000665L |
| Policy instance | 2 |
| Insurance contract or identification number | G000665L | | Number of Individuals Covered | 534 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-07-01 | | Total amount of commissions paid to insurance broker | USD $32,754 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $181,538 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $32,754 | | Insurance broker organization code? | 3 | | Insurance broker name | VAN METER INS AGENCY |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000665F |
| Policy instance | 1 |
| Insurance contract or identification number | G000665F | | Number of Individuals Covered | 538 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-06-30 | | Total amount of commissions paid to insurance broker | USD $36,866 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $294,153 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000665F |
| Policy instance | 2 |
| Insurance contract or identification number | G000665F | | Number of Individuals Covered | 200 | | Insurance policy start date | 2010-08-01 | | Insurance policy end date | 2011-08-01 | | Total amount of commissions paid to insurance broker | USD $20,319 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $114,799 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000665F |
| Policy instance | 1 |
| Insurance contract or identification number | G000665F | | Number of Individuals Covered | 431 | | Insurance policy start date | 2009-07-01 | | Insurance policy end date | 2010-07-01 | | Total amount of commissions paid to insurance broker | USD $14,073 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $168,992 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $35,483 | | Amount paid for insurance broker fees | 0 | | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD | | Insurance broker organization code? | 3 | | Insurance broker name | VAN METER INSURANCE AGENCY |
|
