RJ MERIDIAN CARE OF SAN ANTONIO LTD has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan MERIDIAN CARE GROUP EMPLOYEE BENEFIT PLAN
| Measure | Date | Value |
|---|
| 2022: MERIDIAN CARE GROUP EMPLOYEE BENEFIT PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-04-01 | 317 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-04-01 | 390 |
| Total of all active and inactive participants | 2022-04-01 | 390 |
| Total participants | 2022-04-01 | 390 |
| 2021: MERIDIAN CARE GROUP EMPLOYEE BENEFIT PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-04-01 | 394 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-04-01 | 317 |
| Total of all active and inactive participants | 2021-04-01 | 317 |
| Total participants | 2021-04-01 | 317 |
| 2020: MERIDIAN CARE GROUP EMPLOYEE BENEFIT PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-04-01 | 399 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-04-01 | 393 |
| Number of retired or separated participants receiving benefits | 2020-04-01 | 1 |
| Total of all active and inactive participants | 2020-04-01 | 394 |
| Total participants | 2020-04-01 | 394 |
| 2019: MERIDIAN CARE GROUP EMPLOYEE BENEFIT PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-04-01 | 402 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-04-01 | 397 |
| Number of retired or separated participants receiving benefits | 2019-04-01 | 2 |
| Total of all active and inactive participants | 2019-04-01 | 399 |
| Total participants | 2019-04-01 | 399 |
| 2018: MERIDIAN CARE GROUP EMPLOYEE BENEFIT PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-04-01 | 409 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-04-01 | 402 |
| Total of all active and inactive participants | 2018-04-01 | 402 |
| Total participants | 2018-04-01 | 402 |
| 2017: MERIDIAN CARE GROUP EMPLOYEE BENEFIT PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-04-01 | 422 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-04-01 | 408 |
| Number of retired or separated participants receiving benefits | 2017-04-01 | 1 |
| Total of all active and inactive participants | 2017-04-01 | 409 |
| Total participants | 2017-04-01 | 409 |
| 2016: MERIDIAN CARE GROUP EMPLOYEE BENEFIT PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-04-01 | 389 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-04-01 | 422 |
| Total of all active and inactive participants | 2016-04-01 | 422 |
| Total participants | 2016-04-01 | 422 |
| 2015: MERIDIAN CARE GROUP EMPLOYEE BENEFIT PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-04-01 | 294 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-04-01 | 388 |
| Number of retired or separated participants receiving benefits | 2015-04-01 | 1 |
| Total of all active and inactive participants | 2015-04-01 | 389 |
| Total participants | 2015-04-01 | 389 |
| 2014: MERIDIAN CARE GROUP EMPLOYEE BENEFIT PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-04-01 | 302 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-04-01 | 294 |
| Total of all active and inactive participants | 2014-04-01 | 294 |
| Total participants | 2014-04-01 | 294 |
| 2013: MERIDIAN CARE GROUP EMPLOYEE BENEFIT PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-04-01 | 272 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-04-01 | 287 |
| Number of retired or separated participants receiving benefits | 2013-04-01 | 15 |
| Total of all active and inactive participants | 2013-04-01 | 302 |
| Total participants | 2013-04-01 | 302 |
| 2012: MERIDIAN CARE GROUP EMPLOYEE BENEFIT PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-04-01 | 252 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-04-01 | 272 |
| Total of all active and inactive participants | 2012-04-01 | 272 |
| Total participants | 2012-04-01 | 272 |
| 2011: MERIDIAN CARE GROUP EMPLOYEE BENEFIT PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-04-01 | 331 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-04-01 | 237 |
| Number of retired or separated participants receiving benefits | 2011-04-01 | 15 |
| Total of all active and inactive participants | 2011-04-01 | 252 |
| Total participants | 2011-04-01 | 252 |
| 2009: MERIDIAN CARE GROUP EMPLOYEE BENEFIT PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-04-01 | 218 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-04-01 | 201 |
| Number of retired or separated participants receiving benefits | 2009-04-01 | 16 |
| Total of all active and inactive participants | 2009-04-01 | 217 |
| Total participants | 2009-04-01 | 217 |
| 2008: MERIDIAN CARE GROUP EMPLOYEE BENEFIT PLAN 2008 401k membership |
|---|
| Total participants, beginning-of-year | 2008-04-01 | 120 |
| Total number of active participants reported on line 7a of the Form 5500 | 2008-04-01 | 210 |
| Number of retired or separated participants receiving benefits | 2008-04-01 | 8 |
| Total of all active and inactive participants | 2008-04-01 | 218 |
| Total participants | 2008-04-01 | 218 |
| 2007: MERIDIAN CARE GROUP EMPLOYEE BENEFIT PLAN 2007 401k membership |
|---|
| Total participants, beginning-of-year | 2007-04-01 | 120 |
| Total number of active participants reported on line 7a of the Form 5500 | 2007-04-01 | 120 |
| Total of all active and inactive participants | 2007-04-01 | 120 |
| Total participants | 2007-04-01 | 120 |
| 2022: MERIDIAN CARE GROUP EMPLOYEE BENEFIT PLAN 2022 form 5500 responses |
|---|
| 2022-04-01 | Type of plan entity | Single employer plan |
| 2022-04-01 | Plan funding arrangement – Insurance | Yes |
| 2022-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: MERIDIAN CARE GROUP EMPLOYEE BENEFIT PLAN 2021 form 5500 responses |
|---|
| 2021-04-01 | Type of plan entity | Single employer plan |
| 2021-04-01 | Plan funding arrangement – Insurance | Yes |
| 2021-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: MERIDIAN CARE GROUP EMPLOYEE BENEFIT PLAN 2020 form 5500 responses |
|---|
| 2020-04-01 | Type of plan entity | Single employer plan |
| 2020-04-01 | Plan funding arrangement – Insurance | Yes |
| 2020-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: MERIDIAN CARE GROUP EMPLOYEE BENEFIT PLAN 2019 form 5500 responses |
|---|
| 2019-04-01 | Type of plan entity | Single employer plan |
| 2019-04-01 | Plan funding arrangement – Insurance | Yes |
| 2019-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: MERIDIAN CARE GROUP EMPLOYEE BENEFIT PLAN 2018 form 5500 responses |
|---|
| 2018-04-01 | Type of plan entity | Single employer plan |
| 2018-04-01 | Plan funding arrangement – Insurance | Yes |
| 2018-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: MERIDIAN CARE GROUP EMPLOYEE BENEFIT PLAN 2017 form 5500 responses |
|---|
| 2017-04-01 | Type of plan entity | Single employer plan |
| 2017-04-01 | Plan funding arrangement – Insurance | Yes |
| 2017-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: MERIDIAN CARE GROUP EMPLOYEE BENEFIT PLAN 2016 form 5500 responses |
|---|
| 2016-04-01 | Type of plan entity | Single employer plan |
| 2016-04-01 | Plan funding arrangement – Insurance | Yes |
| 2016-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: MERIDIAN CARE GROUP EMPLOYEE BENEFIT PLAN 2015 form 5500 responses |
|---|
| 2015-04-01 | Type of plan entity | Single employer plan |
| 2015-04-01 | Plan funding arrangement – Insurance | Yes |
| 2015-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: MERIDIAN CARE GROUP EMPLOYEE BENEFIT PLAN 2014 form 5500 responses |
|---|
| 2014-04-01 | Type of plan entity | Single employer plan |
| 2014-04-01 | Plan funding arrangement – Insurance | Yes |
| 2014-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: MERIDIAN CARE GROUP EMPLOYEE BENEFIT PLAN 2013 form 5500 responses |
|---|
| 2013-04-01 | Type of plan entity | Single employer plan |
| 2013-04-01 | Plan funding arrangement – Insurance | Yes |
| 2013-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2012: MERIDIAN CARE GROUP EMPLOYEE BENEFIT PLAN 2012 form 5500 responses |
|---|
| 2012-04-01 | Type of plan entity | Single employer plan |
| 2012-04-01 | Submission has been amended | No |
| 2012-04-01 | This submission is the final filing | No |
| 2012-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-04-01 | Plan is a collectively bargained plan | No |
| 2012-04-01 | Plan funding arrangement – Insurance | Yes |
| 2012-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2012-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2011: MERIDIAN CARE GROUP EMPLOYEE BENEFIT PLAN 2011 form 5500 responses |
|---|
| 2011-04-01 | Type of plan entity | Single employer plan |
| 2011-04-01 | Submission has been amended | No |
| 2011-04-01 | This submission is the final filing | No |
| 2011-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-04-01 | Plan is a collectively bargained plan | No |
| 2011-04-01 | Plan funding arrangement – Insurance | Yes |
| 2011-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2011-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2009: MERIDIAN CARE GROUP EMPLOYEE BENEFIT PLAN 2009 form 5500 responses |
|---|
| 2009-04-01 | Type of plan entity | Single employer plan |
| 2009-04-01 | Submission has been amended | No |
| 2009-04-01 | This submission is the final filing | No |
| 2009-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-04-01 | Plan is a collectively bargained plan | No |
| 2009-04-01 | Plan funding arrangement – Insurance | Yes |
| 2009-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2009-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2008: MERIDIAN CARE GROUP EMPLOYEE BENEFIT PLAN 2008 form 5500 responses |
|---|
| 2008-04-01 | Type of plan entity | Single employer plan |
| 2008-04-01 | Plan funding arrangement – Insurance | Yes |
| 2008-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2008-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2008-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2007: MERIDIAN CARE GROUP EMPLOYEE BENEFIT PLAN 2007 form 5500 responses |
|---|
| 2007-04-01 | Type of plan entity | Single employer plan |
| 2007-04-01 | First time form 5500 has been submitted | Yes |
| 2007-04-01 | Submission has been amended | No |
| 2007-04-01 | This submission is the final filing | No |
| 2007-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2007-04-01 | Plan is a collectively bargained plan | No |
| 2007-04-01 | Plan funding arrangement – Insurance | Yes |
| 2007-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2007-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2007-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| THE NORTH RIVER INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 44520 ) |
| Policy contract number | |
| Policy instance | 6 |
| Number of Individuals Covered | 241 | | Insurance policy start date | 2022-04-01 | | Insurance policy end date | 2023-03-31 | | Total amount of commissions paid to insurance broker | USD $634 | | Other welfare benefits provided | ACCIDENT | | Welfare Benefit Premiums Paid to Carrier | USD $5,282 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $634 | | Insurance broker organization code? | 3 |
|
| NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 ) |
| Policy contract number | |
| Policy instance | 5 |
| Number of Individuals Covered | 241 | | Insurance policy start date | 2022-04-01 | | Insurance policy end date | 2023-03-31 | | Welfare Benefit Premiums Paid to Carrier | USD $6,192 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 ) |
| Policy contract number | |
| Policy instance | 4 |
| Number of Individuals Covered | 241 | | Insurance policy start date | 2022-04-01 | | Insurance policy end date | 2023-03-31 | | Total amount of commissions paid to insurance broker | USD $25,705 | | Welfare Benefit Premiums Paid to Carrier | USD $214,206 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $25,705 | | Insurance broker organization code? | 3 |
|
| STARMOUNT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68985 ) |
| Policy contract number | 444279 |
| Policy instance | 3 |
| Insurance contract or identification number | 444279 | | Number of Individuals Covered | 244 | | Insurance policy start date | 2022-04-01 | | Insurance policy end date | 2023-03-31 | | Total amount of commissions paid to insurance broker | USD $10,548 | | Total amount of fees paid to insurance company | USD $2,010 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $100,504 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,548 | | Amount paid for insurance broker fees | 2010 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AP7E |
| Policy instance | 2 |
| Insurance contract or identification number | G000AP7E | | Number of Individuals Covered | 106 | | Insurance policy start date | 2022-04-01 | | Insurance policy end date | 2023-03-31 | | Total amount of commissions paid to insurance broker | USD $10,281 | | Total amount of fees paid to insurance company | USD $4,236 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $51,405 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,281 | | Amount paid for insurance broker fees | 4236 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AP7E |
| Policy instance | 1 |
| Insurance contract or identification number | G000AP7E | | Number of Individuals Covered | 113 | | Insurance policy start date | 2022-04-01 | | Insurance policy end date | 2023-03-31 | | Total amount of commissions paid to insurance broker | USD $14,302 | | Total amount of fees paid to insurance company | USD $5,503 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $71,468 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $14,302 | | Amount paid for insurance broker fees | 5503 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AP7E |
| Policy instance | 1 |
| Insurance contract or identification number | G000AP7E | | Number of Individuals Covered | 131 | | Insurance policy start date | 2021-04-01 | | Insurance policy end date | 2022-03-31 | | Total amount of commissions paid to insurance broker | USD $15,521 | | Total amount of fees paid to insurance company | USD $5,410 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $77,604 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $15,521 | | Amount paid for insurance broker fees | 5410 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AP7E |
| Policy instance | 2 |
| Insurance contract or identification number | G000AP7E | | Number of Individuals Covered | 154 | | Insurance policy start date | 2021-04-01 | | Insurance policy end date | 2022-03-31 | | Total amount of commissions paid to insurance broker | USD $14,042 | | Total amount of fees paid to insurance company | USD $4,533 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $70,210 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $14,042 | | Amount paid for insurance broker fees | 4533 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| PAN-AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67539 ) |
| Policy contract number | SE098 |
| Policy instance | 3 |
| Insurance contract or identification number | SE098 | | Number of Individuals Covered | 173 | | Insurance policy start date | 2021-04-01 | | Insurance policy end date | 2022-03-31 | | Total amount of commissions paid to insurance broker | USD $39,667 | | Health Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $330,556 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $39,667 | | Insurance broker organization code? | 3 |
|
| STARMOUNT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68985 ) |
| Policy contract number | SMMC314 |
| Policy instance | 4 |
| Insurance contract or identification number | SMMC314 | | Number of Individuals Covered | 238 | | Insurance policy start date | 2021-04-01 | | Insurance policy end date | 2022-03-31 | | Total amount of commissions paid to insurance broker | USD $9,775 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $97,748 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,775 | | Insurance broker organization code? | 3 |
|
| STARMOUNT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68985 ) |
| Policy contract number | SMMC314 |
| Policy instance | 5 |
| Insurance contract or identification number | SMMC314 | | Number of Individuals Covered | 236 | | Insurance policy start date | 2021-04-01 | | Insurance policy end date | 2022-03-31 | | Total amount of commissions paid to insurance broker | USD $4,362 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $36,347 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,362 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AP7E |
| Policy instance | 1 |
| Insurance contract or identification number | G000AP7E | | Number of Individuals Covered | 143 | | Insurance policy start date | 2020-04-01 | | Insurance policy end date | 2021-03-31 | | Total amount of commissions paid to insurance broker | USD $15,383 | | Total amount of fees paid to insurance company | USD $4,533 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $76,914 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $15,383 | | Amount paid for insurance broker fees | 4533 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AP7E |
| Policy instance | 2 |
| Insurance contract or identification number | G000AP7E | | Number of Individuals Covered | 136 | | Insurance policy start date | 2020-04-01 | | Insurance policy end date | 2021-03-31 | | Total amount of commissions paid to insurance broker | USD $9,939 | | Total amount of fees paid to insurance company | USD $3,187 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $49,693 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,939 | | Amount paid for insurance broker fees | 3187 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| PAN-AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67539 ) |
| Policy contract number | SE098 |
| Policy instance | 3 |
| Insurance contract or identification number | SE098 | | Number of Individuals Covered | 218 | | Insurance policy start date | 2020-04-01 | | Insurance policy end date | 2021-03-31 | | Total amount of commissions paid to insurance broker | USD $44,076 | | Health Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $367,302 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $44,076 | | Insurance broker organization code? | 3 |
|
| STARMOUNT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68985 ) |
| Policy contract number | SMMC314 |
| Policy instance | 4 |
| Insurance contract or identification number | SMMC314 | | Number of Individuals Covered | 250 | | Insurance policy start date | 2020-04-01 | | Insurance policy end date | 2021-03-31 | | Total amount of commissions paid to insurance broker | USD $10,117 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $101,166 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,117 | | Insurance broker organization code? | 3 |
|
| STARMOUNT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68985 ) |
| Policy contract number | SMMC314 |
| Policy instance | 5 |
| Insurance contract or identification number | SMMC314 | | Number of Individuals Covered | 275 | | Insurance policy start date | 2020-04-01 | | Insurance policy end date | 2021-03-31 | | Total amount of commissions paid to insurance broker | USD $3,713 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $30,940 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,713 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AP7E |
| Policy instance | 1 |
| Insurance contract or identification number | G000AP7E | | Number of Individuals Covered | 155 | | Insurance policy start date | 2019-04-01 | | Insurance policy end date | 2020-03-31 | | Total amount of commissions paid to insurance broker | USD $14,425 | | Total amount of fees paid to insurance company | USD $5,314 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $72,124 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $14,425 | | Amount paid for insurance broker fees | 5314 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AP7E |
| Policy instance | 2 |
| Insurance contract or identification number | G000AP7E | | Number of Individuals Covered | 190 | | Insurance policy start date | 2019-04-01 | | Insurance policy end date | 2020-03-31 | | Total amount of commissions paid to insurance broker | USD $12,418 | | Total amount of fees paid to insurance company | USD $4,614 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $62,089 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $12,418 | | Amount paid for insurance broker fees | 4614 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| PAN-AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67539 ) |
| Policy contract number | SE098 |
| Policy instance | 3 |
| Insurance contract or identification number | SE098 | | Number of Individuals Covered | 228 | | Insurance policy start date | 2019-04-01 | | Insurance policy end date | 2020-03-31 | | Total amount of commissions paid to insurance broker | USD $38,402 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $320,016 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $38,402 | | Insurance broker organization code? | 3 |
|
| STARMOUNT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68985 ) |
| Policy contract number | SMMC314 |
| Policy instance | 4 |
| Insurance contract or identification number | SMMC314 | | Number of Individuals Covered | 251 | | Insurance policy start date | 2019-04-01 | | Insurance policy end date | 2020-03-31 | | Total amount of commissions paid to insurance broker | USD $11,310 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $113,101 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,310 | | Insurance broker organization code? | 3 |
|
| STARMOUNT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68985 ) |
| Policy contract number | SMMC314 |
| Policy instance | 5 |
| Insurance contract or identification number | SMMC314 | | Number of Individuals Covered | 251 | | Insurance policy start date | 2019-04-01 | | Insurance policy end date | 2020-03-31 | | Total amount of commissions paid to insurance broker | USD $3,946 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $32,885 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,946 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AP7E |
| Policy instance | 1 |
| Insurance contract or identification number | G000AP7E | | Number of Individuals Covered | 314 | | Insurance policy start date | 2018-04-01 | | Insurance policy end date | 2019-03-31 | | Total amount of commissions paid to insurance broker | USD $16,528 | | Total amount of fees paid to insurance company | USD $5,675 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $82,639 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $16,528 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 5675 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AP7E |
| Policy instance | 2 |
| Insurance contract or identification number | G000AP7E | | Number of Individuals Covered | 444 | | Insurance policy start date | 2018-04-01 | | Insurance policy end date | 2019-03-31 | | Total amount of commissions paid to insurance broker | USD $14,694 | | Total amount of fees paid to insurance company | USD $14,694 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $73,472 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $14,694 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 14694 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION |
|
| PAN-AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67539 ) |
| Policy contract number | SE098 |
| Policy instance | 3 |
| Insurance contract or identification number | SE098 | | Number of Individuals Covered | 247 | | Insurance policy start date | 2018-04-01 | | Insurance policy end date | 2019-03-31 | | Total amount of commissions paid to insurance broker | USD $48,373 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $403,112 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $48,373 | | Insurance broker organization code? | 3 |
|
| STARMOUNT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68985 ) |
| Policy contract number | SMMC314 |
| Policy instance | 4 |
| Insurance contract or identification number | SMMC314 | | Number of Individuals Covered | 239 | | Insurance policy start date | 2018-04-01 | | Insurance policy end date | 2019-03-31 | | Total amount of commissions paid to insurance broker | USD $10,958 | | Dental 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 | | Commission paid to Insurance Broker | USD $10,958 | | Insurance broker organization code? | 3 |
|
| STARMOUNT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68985 ) |
| Policy contract number | SMMC314 |
| Policy instance | 5 |
| Insurance contract or identification number | SMMC314 | | Number of Individuals Covered | 250 | | Insurance policy start date | 2018-04-01 | | Insurance policy end date | 2019-03-31 | | Total amount of commissions paid to insurance broker | USD $4,144 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $34,536 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,144 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AP7E |
| Policy instance | 1 |
| Insurance contract or identification number | G000AP7E | | Number of Individuals Covered | 160 | | Insurance policy start date | 2017-04-01 | | Insurance policy end date | 2018-03-31 | | Total amount of commissions paid to insurance broker | USD $15,342 | | Total amount of fees paid to insurance company | USD $4,864 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $76,713 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $15,342 | | Amount paid for insurance broker fees | 4864 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | HUB INTERNATIONAL TEXAS INC. |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AP7E |
| Policy instance | 2 |
| Insurance contract or identification number | G000AP7E | | Number of Individuals Covered | 153 | | Insurance policy start date | 2017-04-01 | | Insurance policy end date | 2018-03-31 | | Total amount of commissions paid to insurance broker | USD $9,290 | | Total amount of fees paid to insurance company | USD $3,186 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $46,453 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,290 | | Amount paid for insurance broker fees | 3186 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | HUB INTERNATIONAL TEXAS INC. |
|
| PAN-AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67539 ) |
| Policy contract number | SE098 |
| Policy instance | 3 |
| Insurance contract or identification number | SE098 | | Number of Individuals Covered | 295 | | Insurance policy start date | 2017-04-01 | | Insurance policy end date | 2018-03-31 | | Total amount of commissions paid to insurance broker | USD $48,518 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $405,158 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $48,518 | | Insurance broker organization code? | 3 | | Insurance broker name | HUB INTERNATIONAL TEXAS INC. |
|
| STARMOUNT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68985 ) |
| Policy contract number | SMMC314 |
| Policy instance | 4 |
| Insurance contract or identification number | SMMC314 | | Number of Individuals Covered | 272 | | Insurance policy start date | 2017-04-01 | | Insurance policy end date | 2018-03-31 | | Total amount of commissions paid to insurance broker | USD $10,602 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $106,047 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,602 | | Insurance broker organization code? | 3 | | Insurance broker name | HUB INTERNATIONAL TEXAS, INC. |
|
| STARMOUNT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68985 ) |
| Policy contract number | SMMC314 |
| Policy instance | 5 |
| Insurance contract or identification number | SMMC314 | | Number of Individuals Covered | 276 | | Insurance policy start date | 2017-04-01 | | Insurance policy end date | 2018-03-31 | | Total amount of commissions paid to insurance broker | USD $4,031 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $33,595 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,031 | | Insurance broker organization code? | 3 | | Insurance broker name | HUB INTERNATIONAL TEXAS, INC. |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AP7E |
| Policy instance | 2 |
| Insurance contract or identification number | G000AP7E | | Number of Individuals Covered | 211 | | Insurance policy start date | 2015-04-01 | | Insurance policy end date | 2016-03-31 | | Total amount of commissions paid to insurance broker | USD $11,596 | | Total amount of fees paid to insurance company | USD $4,064 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $57,980 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,596 | | Amount paid for insurance broker fees | 4064 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | HUB INTERNATIONAL TEXAS INC. |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AP7E |
| Policy instance | 1 |
| Insurance contract or identification number | G000AP7E | | Number of Individuals Covered | 150 | | Insurance policy start date | 2015-04-01 | | Insurance policy end date | 2016-03-31 | | Total amount of commissions paid to insurance broker | USD $13,886 | | Total amount of fees paid to insurance company | USD $2,224 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $69,432 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,886 | | Amount paid for insurance broker fees | 2224 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | HUB INTERNATIONAL TEXAS INC. |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AP7E |
| Policy instance | 3 |
| Insurance contract or identification number | G000AP7E | | Number of Individuals Covered | 51 | | Insurance policy start date | 2015-04-01 | | Insurance policy end date | 2016-03-31 | | Total amount of fees paid to insurance company | USD $560 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $11,887 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 560 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | HUB INTERNATIONAL TEXAS INC. |
|
| PAN-AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67539 ) |
| Policy contract number | SE098 |
| Policy instance | 4 |
| Insurance contract or identification number | SE098 | | Number of Individuals Covered | 257 | | Insurance policy start date | 2015-04-01 | | Insurance policy end date | 2016-03-31 | | Total amount of commissions paid to insurance broker | USD $45,941 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $392,343 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $45,941 | | Insurance broker organization code? | 3 | | Insurance broker name | HUB INTERNATIONAL TEXAS INC. |
|
| STARMOUNT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68985 ) |
| Policy contract number | SMMC314 |
| Policy instance | 5 |
| Insurance contract or identification number | SMMC314 | | Number of Individuals Covered | 241 | | Insurance policy start date | 2015-04-01 | | Insurance policy end date | 2016-03-31 | | Total amount of commissions paid to insurance broker | USD $10,157 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $101,568 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,157 | | Insurance broker organization code? | 3 | | Insurance broker name | HUB INTERNATIONAL TEXAS, INC. |
|
| STARMOUNT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68985 ) |
| Policy contract number | SMMC314 |
| Policy instance | 6 |
| Insurance contract or identification number | SMMC314 | | Number of Individuals Covered | 223 | | Insurance policy start date | 2015-04-01 | | Insurance policy end date | 2016-03-31 | | Total amount of commissions paid to insurance broker | USD $3,511 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $29,261 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,511 | | Insurance broker organization code? | 3 | | Insurance broker name | HUB INTERNATIONAL TEXAS, INC. |
|
| STARMOUNT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68985 ) |
| Policy contract number | SMMC314 |
| Policy instance | 6 |
| Insurance contract or identification number | SMMC314 | | Number of Individuals Covered | 217 | | Insurance policy start date | 2014-04-01 | | Insurance policy end date | 2015-03-31 | | Total amount of commissions paid to insurance broker | USD $9,683 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $96,831 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,683 | | Insurance broker organization code? | 3 | | Insurance broker name | HUB INTERNATIONAL TEXAS, INC. |
|
| KANAWHA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65110 ) |
| Policy contract number | 7211684000 |
| Policy instance | 4 |
| Insurance contract or identification number | 7211684000 | | Number of Individuals Covered | 43 | | Insurance policy start date | 2014-04-01 | | Insurance policy end date | 2015-03-31 | | Total amount of commissions paid to insurance broker | USD $2,870 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $9,005 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,870 | | Insurance broker organization code? | 3 | | Insurance broker name | HUB INTERNATIONAL TEXAS INC. |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AP7E |
| Policy instance | 3 |
| Insurance contract or identification number | G000AP7E | | Number of Individuals Covered | 60 | | Insurance policy start date | 2014-04-01 | | Insurance policy end date | 2015-03-31 | | Total amount of fees paid to insurance company | USD $467 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $15,411 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 467 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | HUB INTERNATIONAL TEXAS INC. |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AP7E |
| Policy instance | 2 |
| Insurance contract or identification number | G000AP7E | | Number of Individuals Covered | 224 | | Insurance policy start date | 2014-04-01 | | Insurance policy end date | 2015-03-31 | | Total amount of commissions paid to insurance broker | USD $12,395 | | Total amount of fees paid to insurance company | USD $2,022 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $61,976 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $12,395 | | Amount paid for insurance broker fees | 2022 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | HUB INTERNATIONAL TEXAS INC. |
|
| PAN-AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67539 ) |
| Policy contract number | SE098 |
| Policy instance | 5 |
| Insurance contract or identification number | SE098 | | Number of Individuals Covered | 294 | | Insurance policy start date | 2014-04-01 | | Insurance policy end date | 2015-03-31 | | Total amount of commissions paid to insurance broker | USD $46,423 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $398,710 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $46,423 | | Insurance broker organization code? | 3 | | Insurance broker name | HUB INTERNATIONAL TEXAS INC. |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AP7E |
| Policy instance | 1 |
| Insurance contract or identification number | G000AP7E | | Number of Individuals Covered | 156 | | Insurance policy start date | 2014-04-01 | | Insurance policy end date | 2015-03-31 | | Total amount of commissions paid to insurance broker | USD $13,785 | | Total amount of fees paid to insurance company | USD $2,185 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $68,927 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,785 | | Amount paid for insurance broker fees | 2185 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | HUB INTERNATIONAL TEXAS INC. |
|
| STARMOUNT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68985 ) |
| Policy contract number | SMMC314 |
| Policy instance | 7 |
| Insurance contract or identification number | SMMC314 | | Number of Individuals Covered | 201 | | Insurance policy start date | 2014-04-01 | | Insurance policy end date | 2015-03-31 | | Total amount of commissions paid to insurance broker | USD $3,233 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $26,938 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,233 | | Insurance broker organization code? | 3 | | Insurance broker name | HUB INTERNATIONAL TEXAS, INC. |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG0AP7E |
| Policy instance | 5 |
| Insurance contract or identification number | GLUG0AP7E | | Number of Individuals Covered | 230 | | Insurance policy start date | 2013-04-01 | | Insurance policy end date | 2014-04-01 | | Total amount of commissions paid to insurance broker | USD $1,486 | | Total amount of fees paid to insurance company | USD $2,014 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $9,906 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,486 | | Amount paid for insurance broker fees | 2014 | | Additional information about fees paid to insurance broker | OTHER SERVICES | | Insurance broker organization code? | 3 | | Insurance broker name | HUB INTERNATIONAL TEXAS INC. |
|
| KANAWHA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65110 ) |
| Policy contract number | 7211089000 |
| Policy instance | 9 |
| Insurance contract or identification number | 7211089000 | | Number of Individuals Covered | 17 | | Insurance policy start date | 2013-04-01 | | Insurance policy end date | 2014-03-31 | | Total amount of commissions paid to insurance broker | USD $1,062 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,418 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,062 | | Insurance broker organization code? | 3 | | Insurance broker name | HUB INTERNATIONAL TEXAS INC. |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GVTL0AP7E |
| Policy instance | 8 |
| Insurance contract or identification number | GVTL0AP7E | | Number of Individuals Covered | 124 | | Insurance policy start date | 2013-04-01 | | Insurance policy end date | 2014-04-01 | | Total amount of commissions paid to insurance broker | USD $7,305 | | Total amount of fees paid to insurance company | USD $6,157 | | Other welfare benefits provided | VOLUNTARY LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $36,522 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,653 | | Amount paid for insurance broker fees | 6157 | | Additional information about fees paid to insurance broker | OTHER SERVICES | | Insurance broker organization code? | 3 | | Insurance broker name | TROY WAYNE DAVIS |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUC 0AP7E |
| Policy instance | 7 |
| Insurance contract or identification number | GUC 0AP7E | | Number of Individuals Covered | 77 | | Insurance policy start date | 2013-04-01 | | Insurance policy end date | 2014-04-01 | | Total amount of commissions paid to insurance broker | USD $7,015 | | Total amount of fees paid to insurance company | USD $9,098 | | Other welfare benefits provided | VOLUNTARY STD | | Welfare Benefit Premiums Paid to Carrier | USD $35,072 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,426 | | Amount paid for insurance broker fees | 9098 | | Additional information about fees paid to insurance broker | OTHER SERVICES | | Insurance broker organization code? | 3 | | Insurance broker name | TROY WAYNE DAVIS |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLTD0AP7E |
| Policy instance | 6 |
| Insurance contract or identification number | GLTD0AP7E | | Number of Individuals Covered | 80 | | Insurance policy start date | 2013-04-01 | | Insurance policy end date | 2014-04-01 | | Total amount of commissions paid to insurance broker | USD $986 | | Total amount of fees paid to insurance company | USD $2,841 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $9,864 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $986 | | Amount paid for insurance broker fees | 2841 | | Additional information about fees paid to insurance broker | OTHER SERVICES | | Insurance broker organization code? | 3 | | Insurance broker name | HUB INTERNATIONAL TEXAS INC. |
|
| NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 ) |
| Policy contract number | 2RJMC1107 |
| Policy instance | 1 |
| Insurance contract or identification number | 2RJMC1107 | | Number of Individuals Covered | 170 | | Insurance policy start date | 2013-04-01 | | Insurance policy end date | 2014-03-31 | | Total amount of commissions paid to insurance broker | USD $2,476 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $20,635 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,476 | | Insurance broker organization code? | 3 | | Insurance broker name | HUB INTERNATIONAL TEXAS, INC. |
|
| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
| Policy contract number | 0008103559 |
| Policy instance | 2 |
| Insurance contract or identification number | 0008103559 | | Number of Individuals Covered | 3 | | Insurance policy start date | 2013-04-01 | | Insurance policy end date | 2014-04-01 | | Total amount of commissions paid to insurance broker | USD $4 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $78 | | 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 | | Insurance broker organization code? | 3 | | Insurance broker name | HUB INTERNATIONAL TEXAS INC. |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00431559 |
| Policy instance | 3 |
| Insurance contract or identification number | 00431559 | | Number of Individuals Covered | 188 | | Insurance policy start date | 2013-04-01 | | Insurance policy end date | 2014-03-31 | | Total amount of commissions paid to insurance broker | USD $7,745 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $76,880 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $70 | | Insurance broker organization code? | 3 | | Insurance broker name | HUB INTERNATIONAL TEXAS INC. |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUG 0AP7E |
| Policy instance | 4 |
| Insurance contract or identification number | GUG 0AP7E | | Number of Individuals Covered | 80 | | Insurance policy start date | 2013-04-01 | | Insurance policy end date | 2014-04-01 | | Total amount of commissions paid to insurance broker | USD $1,523 | | Total amount of fees paid to insurance company | USD $2,654 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $15,226 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,523 | | Amount paid for insurance broker fees | 2654 | | Additional information about fees paid to insurance broker | OTHER SERVICES | | Insurance broker organization code? | 3 | | Insurance broker name | HUB INTERNATIONAL TEXAS INC. |
|
| KANAWHA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65110 ) |
| Policy contract number | 7211089001 |
| Policy instance | 10 |
| Insurance contract or identification number | 7211089001 | | Number of Individuals Covered | 17 | | Insurance policy start date | 2013-04-01 | | Insurance policy end date | 2014-03-31 | | Total amount of commissions paid to insurance broker | USD $1,193 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,041 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,193 | | Insurance broker organization code? | 3 | | Insurance broker name | HUB INTERNATIONAL TEXAS INC. |
|
| KANAWHA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65110 ) |
| Policy contract number | 7211089004 |
| Policy instance | 11 |
| Insurance contract or identification number | 7211089004 | | Number of Individuals Covered | 4 | | Insurance policy start date | 2013-04-01 | | Insurance policy end date | 2014-03-31 | | Total amount of commissions paid to insurance broker | USD $396 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,139 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $396 | | Insurance broker organization code? | 3 | | Insurance broker name | HUB INTERNATIONAL TEXAS INC. |
|
| KANAWHA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65110 ) |
| Policy contract number | 7211089002 |
| Policy instance | 12 |
| Insurance contract or identification number | 7211089002 | | Number of Individuals Covered | 5 | | Insurance policy start date | 2013-04-01 | | Insurance policy end date | 2014-03-31 | | Total amount of commissions paid to insurance broker | USD $349 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $707 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $349 | | Insurance broker organization code? | 3 | | Insurance broker name | HUB INTERNATIONAL TEXAS INC. |
|
| KANAWHA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65110 ) |
| Policy contract number | 7211089003 |
| Policy instance | 13 |
| Insurance contract or identification number | 7211089003 | | Number of Individuals Covered | 13 | | Insurance policy start date | 2013-04-01 | | Insurance policy end date | 2014-03-31 | | Total amount of commissions paid to insurance broker | USD $743 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,113 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $743 | | Insurance broker organization code? | 3 | | Insurance broker name | HUB INTERNATIONAL TEXAS INC. |
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| KANAWHA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65110 ) |
| Policy contract number | 7211089005 |
| Policy instance | 14 |
| Insurance contract or identification number | 7211089005 | | Number of Individuals Covered | 12 | | Insurance policy start date | 2013-04-01 | | Insurance policy end date | 2014-03-31 | | Total amount of commissions paid to insurance broker | USD $528 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,412 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $528 | | Insurance broker organization code? | 3 | | Insurance broker name | HUB INTERNATIONAL TEXAS INC. |
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| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00431559 |
| Policy instance | 3 |
| Insurance contract or identification number | 00431559 | | Number of Individuals Covered | 251 | | Insurance policy start date | 2012-04-01 | | Insurance policy end date | 2013-03-31 | | Total amount of commissions paid to insurance broker | USD $18,298 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $135,194 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $172 | | Insurance broker organization code? | 3 | | Insurance broker name | TROY W DAVIS |
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| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
| Policy contract number | 0008103559 |
| Policy instance | 4 |
| Insurance contract or identification number | 0008103559 | | Number of Individuals Covered | 3 | | Insurance policy start date | 2012-04-01 | | Insurance policy end date | 2013-03-31 | | Total amount of commissions paid to insurance broker | USD $47 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $936 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $47 | | Insurance broker organization code? | 3 | | Insurance broker name | TROY W DAVIS |
|
| NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 ) |
| Policy contract number | 2RJMC1107 |
| Policy instance | 2 |
| Insurance contract or identification number | 2RJMC1107 | | Number of Individuals Covered | 159 | | Insurance policy start date | 2012-04-01 | | Insurance policy end date | 2013-03-31 | | Total amount of commissions paid to insurance broker | USD $2,403 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $20,029 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,403 | | Insurance broker organization code? | 3 | | Insurance broker name | HUB INTERNATIONAL TEXAS, INC. |
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| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00431559 |
| Policy instance | 4 |
| Insurance contract or identification number | 00431559 | | Number of Individuals Covered | 251 | | Insurance policy start date | 2011-04-01 | | Insurance policy end date | 2012-03-31 | | Total amount of commissions paid to insurance broker | USD $20,748 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $149,409 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 ) |
| Policy contract number | 2RJMC1107 |
| Policy instance | 3 |
| Insurance contract or identification number | 2RJMC1107 | | Number of Individuals Covered | 163 | | Insurance policy start date | 2011-04-01 | | Insurance policy end date | 2012-03-31 | | Total amount of commissions paid to insurance broker | USD $2,546 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $21,212 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
| Policy contract number | 0008103559 |
| Policy instance | 1 |
| Insurance contract or identification number | 0008103559 | | Number of Individuals Covered | 4 | | Insurance policy start date | 2011-04-01 | | Insurance policy end date | 2012-03-31 | | Total amount of commissions paid to insurance broker | USD $44 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $881 | | 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 | 00431559 |
| Policy instance | 3 |
| Insurance contract or identification number | 00431559 | | Number of Individuals Covered | 315 | | Insurance policy start date | 2010-04-01 | | Insurance policy end date | 2011-03-31 | | Total amount of commissions paid to insurance broker | USD $19,723 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $140,150 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 ) |
| Policy contract number | 2RJMC1107 |
| Policy instance | 1 |
| Insurance contract or identification number | 2RJMC1107 | | Number of Individuals Covered | 188 | | Insurance policy start date | 2010-04-01 | | Insurance policy end date | 2011-03-31 | | Total amount of commissions paid to insurance broker | USD $1,714 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $14,286 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
| Policy contract number | 0008103559 |
| Policy instance | 4 |
| Insurance contract or identification number | 0008103559 | | Number of Individuals Covered | 5 | | Insurance policy start date | 2010-04-01 | | Insurance policy end date | 2011-03-31 | | Total amount of commissions paid to insurance broker | USD $75 | | Total amount of fees paid to insurance company | USD $0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,498 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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