ROYAL OAKS COUNTRY CLUB has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan ROYAL OAKS COUNTRY CLUB EMPLOYEE LIFE & ADD BENEFIT PLAN
401k plan membership statisitcs for ROYAL OAKS COUNTRY CLUB EMPLOYEE LIFE & ADD BENEFIT PLAN
| Measure | Date | Value |
|---|
| 2021: ROYAL OAKS COUNTRY CLUB EMPLOYEE LIFE & ADD BENEFIT PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 124 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 0 |
| Number of retired or separated participants receiving benefits | 2021-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-01-01 | 0 |
| Total of all active and inactive participants | 2021-01-01 | 0 |
| Number of employers contributing to the scheme | 2021-01-01 | 0 |
| 2020: ROYAL OAKS COUNTRY CLUB EMPLOYEE LIFE & ADD BENEFIT PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 141 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 124 |
| Number of retired or separated participants receiving benefits | 2020-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2020-01-01 | 0 |
| Total of all active and inactive participants | 2020-01-01 | 124 |
| Number of employers contributing to the scheme | 2020-01-01 | 0 |
| 2019: ROYAL OAKS COUNTRY CLUB EMPLOYEE LIFE & ADD BENEFIT PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 114 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 141 |
| Number of retired or separated participants receiving benefits | 2019-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-01-01 | 0 |
| Total of all active and inactive participants | 2019-01-01 | 141 |
| Number of employers contributing to the scheme | 2019-01-01 | 0 |
| 2018: ROYAL OAKS COUNTRY CLUB EMPLOYEE LIFE & ADD BENEFIT PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 125 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 114 |
| Number of retired or separated participants receiving benefits | 2018-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-01-01 | 0 |
| Total of all active and inactive participants | 2018-01-01 | 114 |
| Number of employers contributing to the scheme | 2018-01-01 | 0 |
| 2017: ROYAL OAKS COUNTRY CLUB EMPLOYEE LIFE & ADD BENEFIT PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 123 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 125 |
| Number of retired or separated participants receiving benefits | 2017-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-01-01 | 0 |
| Total of all active and inactive participants | 2017-01-01 | 125 |
| Number of employers contributing to the scheme | 2017-01-01 | 0 |
| 2016: ROYAL OAKS COUNTRY CLUB EMPLOYEE LIFE & ADD BENEFIT PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 129 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 123 |
| Number of retired or separated participants receiving benefits | 2016-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2016-01-01 | 0 |
| Total of all active and inactive participants | 2016-01-01 | 123 |
| Number of employers contributing to the scheme | 2016-01-01 | 0 |
| 2015: ROYAL OAKS COUNTRY CLUB EMPLOYEE LIFE & ADD BENEFIT PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 98 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 129 |
| Number of retired or separated participants receiving benefits | 2015-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2015-01-01 | 0 |
| Total of all active and inactive participants | 2015-01-01 | 129 |
| Number of employers contributing to the scheme | 2015-01-01 | 0 |
| 2014: ROYAL OAKS COUNTRY CLUB EMPLOYEE LIFE & ADD BENEFIT PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-05-01 | 100 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-05-01 | 98 |
| Number of retired or separated participants receiving benefits | 2014-05-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2014-05-01 | 0 |
| Total of all active and inactive participants | 2014-05-01 | 98 |
| Number of employers contributing to the scheme | 2014-05-01 | 0 |
| 2013: ROYAL OAKS COUNTRY CLUB EMPLOYEE LIFE & ADD BENEFIT PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-05-01 | 167 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-05-01 | 100 |
| Number of retired or separated participants receiving benefits | 2013-05-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2013-05-01 | 0 |
| Total of all active and inactive participants | 2013-05-01 | 100 |
| Number of employers contributing to the scheme | 2013-05-01 | 0 |
| 2012: ROYAL OAKS COUNTRY CLUB EMPLOYEE LIFE & ADD BENEFIT PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-05-01 | 134 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-05-01 | 167 |
| Number of retired or separated participants receiving benefits | 2012-05-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2012-05-01 | 0 |
| Total of all active and inactive participants | 2012-05-01 | 167 |
| Number of employers contributing to the scheme | 2012-05-01 | 0 |
| 2011: ROYAL OAKS COUNTRY CLUB EMPLOYEE LIFE & ADD BENEFIT PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-05-01 | 134 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-05-01 | 134 |
| Number of retired or separated participants receiving benefits | 2011-05-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2011-05-01 | 0 |
| Total of all active and inactive participants | 2011-05-01 | 134 |
| Number of employers contributing to the scheme | 2011-05-01 | 0 |
| 2010: ROYAL OAKS COUNTRY CLUB EMPLOYEE LIFE & ADD BENEFIT PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-10-01 | 134 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-10-01 | 134 |
| Number of retired or separated participants receiving benefits | 2010-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2010-10-01 | 0 |
| Total of all active and inactive participants | 2010-10-01 | 134 |
| Number of employers contributing to the scheme | 2010-10-01 | 0 |
| 2009: ROYAL OAKS COUNTRY CLUB EMPLOYEE LIFE & ADD BENEFIT PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-10-01 | 134 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-10-01 | 134 |
| Number of retired or separated participants receiving benefits | 2009-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2009-10-01 | 0 |
| Total of all active and inactive participants | 2009-10-01 | 134 |
| Number of employers contributing to the scheme | 2009-10-01 | 0 |
| 2008: ROYAL OAKS COUNTRY CLUB EMPLOYEE LIFE & ADD BENEFIT PLAN 2008 401k membership |
|---|
| Total participants, beginning-of-year | 2008-10-01 | 134 |
| Total number of active participants reported on line 7a of the Form 5500 | 2008-10-01 | 134 |
| Number of retired or separated participants receiving benefits | 2008-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2008-10-01 | 0 |
| Total of all active and inactive participants | 2008-10-01 | 134 |
| Number of employers contributing to the scheme | 2008-10-01 | 0 |
| 2007: ROYAL OAKS COUNTRY CLUB EMPLOYEE LIFE & ADD BENEFIT PLAN 2007 401k membership |
|---|
| Total participants, beginning-of-year | 2007-10-01 | 138 |
| Total number of active participants reported on line 7a of the Form 5500 | 2007-10-01 | 134 |
| Number of retired or separated participants receiving benefits | 2007-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2007-10-01 | 0 |
| Total of all active and inactive participants | 2007-10-01 | 134 |
| Number of employers contributing to the scheme | 2007-10-01 | 0 |
| 2006: ROYAL OAKS COUNTRY CLUB EMPLOYEE LIFE & ADD BENEFIT PLAN 2006 401k membership |
|---|
| Total participants, beginning-of-year | 2006-10-01 | 138 |
| Total number of active participants reported on line 7a of the Form 5500 | 2006-10-01 | 134 |
| Number of retired or separated participants receiving benefits | 2006-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2006-10-01 | 0 |
| Total of all active and inactive participants | 2006-10-01 | 134 |
| Number of employers contributing to the scheme | 2006-10-01 | 0 |
| Total participants, beginning-of-year | 2006-05-01 | 138 |
| Total number of active participants reported on line 7a of the Form 5500 | 2006-05-01 | 138 |
| Number of retired or separated participants receiving benefits | 2006-05-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2006-05-01 | 0 |
| Total of all active and inactive participants | 2006-05-01 | 138 |
| Number of employers contributing to the scheme | 2006-05-01 | 0 |
| 2005: ROYAL OAKS COUNTRY CLUB EMPLOYEE LIFE & ADD BENEFIT PLAN 2005 401k membership |
|---|
| Total participants, beginning-of-year | 2005-05-01 | 138 |
| Total number of active participants reported on line 7a of the Form 5500 | 2005-05-01 | 138 |
| Number of retired or separated participants receiving benefits | 2005-05-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2005-05-01 | 0 |
| Total of all active and inactive participants | 2005-05-01 | 138 |
| Number of employers contributing to the scheme | 2005-05-01 | 0 |
| 2004: ROYAL OAKS COUNTRY CLUB EMPLOYEE LIFE & ADD BENEFIT PLAN 2004 401k membership |
|---|
| Total participants, beginning-of-year | 2004-05-01 | 138 |
| Total number of active participants reported on line 7a of the Form 5500 | 2004-05-01 | 138 |
| Number of retired or separated participants receiving benefits | 2004-05-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2004-05-01 | 0 |
| Total of all active and inactive participants | 2004-05-01 | 138 |
| Number of employers contributing to the scheme | 2004-05-01 | 0 |
| 2021: ROYAL OAKS COUNTRY CLUB EMPLOYEE LIFE & ADD BENEFIT PLAN 2021 form 5500 responses |
|---|
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | This submission is the final filing | Yes |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: ROYAL OAKS COUNTRY CLUB EMPLOYEE LIFE & ADD BENEFIT PLAN 2020 form 5500 responses |
|---|
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: ROYAL OAKS COUNTRY CLUB EMPLOYEE LIFE & ADD BENEFIT PLAN 2019 form 5500 responses |
|---|
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: ROYAL OAKS COUNTRY CLUB EMPLOYEE LIFE & ADD BENEFIT PLAN 2018 form 5500 responses |
|---|
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: ROYAL OAKS COUNTRY CLUB EMPLOYEE LIFE & ADD BENEFIT PLAN 2017 form 5500 responses |
|---|
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: ROYAL OAKS COUNTRY CLUB EMPLOYEE LIFE & ADD BENEFIT PLAN 2016 form 5500 responses |
|---|
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: ROYAL OAKS COUNTRY CLUB EMPLOYEE LIFE & ADD BENEFIT PLAN 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: ROYAL OAKS COUNTRY CLUB EMPLOYEE LIFE & ADD BENEFIT PLAN 2014 form 5500 responses |
|---|
| 2014-05-01 | Type of plan entity | Single employer plan |
| 2014-05-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2014-05-01 | Plan funding arrangement – Insurance | Yes |
| 2014-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: ROYAL OAKS COUNTRY CLUB EMPLOYEE LIFE & ADD BENEFIT PLAN 2013 form 5500 responses |
|---|
| 2013-05-01 | Type of plan entity | Single employer plan |
| 2013-05-01 | Plan funding arrangement – Insurance | Yes |
| 2013-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: ROYAL OAKS COUNTRY CLUB EMPLOYEE LIFE & ADD BENEFIT PLAN 2012 form 5500 responses |
|---|
| 2012-05-01 | Type of plan entity | Single employer plan |
| 2012-05-01 | Plan funding arrangement – Insurance | Yes |
| 2012-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: ROYAL OAKS COUNTRY CLUB EMPLOYEE LIFE & ADD BENEFIT PLAN 2011 form 5500 responses |
|---|
| 2011-05-01 | Type of plan entity | Single employer plan |
| 2011-05-01 | Plan funding arrangement – Insurance | Yes |
| 2011-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2010: ROYAL OAKS COUNTRY CLUB EMPLOYEE LIFE & ADD BENEFIT PLAN 2010 form 5500 responses |
|---|
| 2010-10-01 | Type of plan entity | Single employer plan |
| 2010-10-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2010-10-01 | Plan funding arrangement – Insurance | Yes |
| 2010-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: ROYAL OAKS COUNTRY CLUB EMPLOYEE LIFE & ADD BENEFIT PLAN 2009 form 5500 responses |
|---|
| 2009-10-01 | Type of plan entity | Single employer plan |
| 2009-10-01 | Plan funding arrangement – Insurance | Yes |
| 2009-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2008: ROYAL OAKS COUNTRY CLUB EMPLOYEE LIFE & ADD BENEFIT PLAN 2008 form 5500 responses |
|---|
| 2008-10-01 | Type of plan entity | Single employer plan |
| 2008-10-01 | Plan funding arrangement – Insurance | Yes |
| 2008-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2007: ROYAL OAKS COUNTRY CLUB EMPLOYEE LIFE & ADD BENEFIT PLAN 2007 form 5500 responses |
|---|
| 2007-10-01 | Type of plan entity | Single employer plan |
| 2007-10-01 | Plan funding arrangement – Insurance | Yes |
| 2007-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2006: ROYAL OAKS COUNTRY CLUB EMPLOYEE LIFE & ADD BENEFIT PLAN 2006 form 5500 responses |
|---|
| 2006-10-01 | Type of plan entity | Single employer plan |
| 2006-10-01 | Plan funding arrangement – Insurance | Yes |
| 2006-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2006-05-01 | Type of plan entity | Single employer plan |
| 2006-05-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2006-05-01 | Plan funding arrangement – Insurance | Yes |
| 2006-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2005: ROYAL OAKS COUNTRY CLUB EMPLOYEE LIFE & ADD BENEFIT PLAN 2005 form 5500 responses |
|---|
| 2005-05-01 | Type of plan entity | Single employer plan |
| 2005-05-01 | Plan funding arrangement – Insurance | Yes |
| 2005-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2004: ROYAL OAKS COUNTRY CLUB EMPLOYEE LIFE & ADD BENEFIT PLAN 2004 form 5500 responses |
|---|
| 2004-05-01 | Type of plan entity | Single employer plan |
| 2004-05-01 | Plan funding arrangement – Insurance | Yes |
| 2004-05-01 | Plan benefit arrangement – Insurance | Yes |
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG0ALCM |
| Policy instance | 1 |
| Insurance contract or identification number | GLUG0ALCM | | Number of Individuals Covered | 124 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | 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 AND DISMEMBERMENT | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG0ALCM |
| Policy instance | 1 |
| Insurance contract or identification number | GLUG0ALCM | | Number of Individuals Covered | 124 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $2,660 | | Total amount of fees paid to insurance company | USD $796 | | 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 AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $17,737 | | 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 | GLUG0ALCM |
| Policy instance | 1 |
| Insurance contract or identification number | GLUG0ALCM | | Number of Individuals Covered | 141 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $3,344 | | Total amount of fees paid to insurance company | USD $1,157 | | 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 AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $22,293 | | 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 | GLUG0ALCM |
| Policy instance | 1 |
| Insurance contract or identification number | GLUG0ALCM | | Number of Individuals Covered | 114 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $2,962 | | Total amount of fees paid to insurance company | USD $671 | | 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 AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $19,743 | | 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 | GLUG0ALCM |
| Policy instance | 1 |
| Insurance contract or identification number | GLUG0ALCM | | Number of Individuals Covered | 125 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $3,359 | | Total amount of fees paid to insurance company | USD $0 | | 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 AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $22,395 | | 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 | GLUG0ALCM |
| Policy instance | 1 |
| Insurance contract or identification number | GLUG0ALCM | | Number of Individuals Covered | 123 | | Insurance policy start date | 2016-01-01 | | Insurance policy end date | 2016-12-31 | | Total amount of commissions paid to insurance broker | USD $2,708 | | Total amount of fees paid to insurance company | USD $0 | | 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 AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $18,052 | | 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 | GLUG0ALCM |
| Policy instance | 1 |
| Insurance contract or identification number | GLUG0ALCM | | Number of Individuals Covered | 129 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $3,070 | | Total amount of fees paid to insurance company | USD $391 | | 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 AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $20,467 | | 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 | GLUG0ALCM |
| Policy instance | 1 |
| Insurance contract or identification number | GLUG0ALCM | | Number of Individuals Covered | 98 | | Insurance policy start date | 2014-05-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $1,392 | | Total amount of fees paid to insurance company | USD $0 | | 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 AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $9,281 | | 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 | GLUG0ALCM |
| Policy instance | 1 |
| Insurance contract or identification number | GLUG0ALCM | | Number of Individuals Covered | 100 | | Insurance policy start date | 2013-05-01 | | Insurance policy end date | 2014-04-30 | | Total amount of commissions paid to insurance broker | USD $1,862 | | Total amount of fees paid to insurance company | USD $0 | | 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 AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $12,416 | | 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 | 854524G |
| Policy instance | 1 |
| Insurance contract or identification number | 854524G | | Number of Individuals Covered | 167 | | Insurance policy start date | 2012-05-01 | | Insurance policy end date | 2013-04-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $74 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $0 | | 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 | 854524G |
| Policy instance | 1 |
| Insurance contract or identification number | 854524G | | Number of Individuals Covered | 134 | | Insurance policy start date | 2011-05-01 | | Insurance policy end date | 2012-04-30 | | Total amount of commissions paid to insurance broker | USD $1,853 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $12,355 | | 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 | 854524G |
| Policy instance | 1 |
| Insurance contract or identification number | 854524G | | Number of Individuals Covered | 134 | | Insurance policy start date | 2010-10-01 | | Insurance policy end date | 2011-04-30 | | Total amount of commissions paid to insurance broker | USD $1,081 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $7,207 | | 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 | 854524G |
| Policy instance | 1 |
| Insurance contract or identification number | 854524G | | Number of Individuals Covered | 134 | | Insurance policy start date | 2009-10-01 | | Insurance policy end date | 2010-09-30 | | Total amount of commissions paid to insurance broker | USD $1,853 | | Total amount of fees paid to insurance company | USD $93 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $12,355 | | 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 | 854524G |
| Policy instance | 1 |
| Insurance contract or identification number | 854524G | | Number of Individuals Covered | 134 | | Insurance policy start date | 2008-10-01 | | Insurance policy end date | 2009-09-30 | | Total amount of commissions paid to insurance broker | USD $1,699 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $12,355 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 854524G |
| Policy instance | 1 |
| Insurance contract or identification number | 854524G | | Number of Individuals Covered | 134 | | Insurance policy start date | 2007-10-01 | | Insurance policy end date | 2008-09-30 | | Total amount of commissions paid to insurance broker | USD $1,597 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $9,614 | | 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 | 854524G |
| Policy instance | 1 |
| Insurance contract or identification number | 854524G | | Number of Individuals Covered | 134 | | Insurance policy start date | 2006-10-01 | | Insurance policy end date | 2007-09-30 | | Total amount of commissions paid to insurance broker | USD $1,442 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $9,612 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
| Policy contract number | G202,308 |
| Policy instance | 1 |
| Insurance contract or identification number | G202,308 | | Number of Individuals Covered | 138 | | Insurance policy start date | 2006-05-01 | | Insurance policy end date | 2006-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
| Policy contract number | G202,308 |
| Policy instance | 1 |
| Insurance contract or identification number | G202,308 | | Number of Individuals Covered | 138 | | Insurance policy start date | 2005-05-01 | | Insurance policy end date | 2006-04-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
| Policy contract number | G202,308 |
| Policy instance | 1 |
| Insurance contract or identification number | G202,308 | | Number of Individuals Covered | 138 | | Insurance policy start date | 2004-05-01 | | Insurance policy end date | 2005-04-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
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