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THREE RIVERS ORTHOPAEDIC SPINE PRODUCTS LIFE AND ACCIDENT INSURANCE 401k Plan overview

Plan NameTHREE RIVERS ORTHOPAEDIC SPINE PRODUCTS LIFE AND ACCIDENT INSURANCE
Plan identification number 501

THREE RIVERS ORTHOPAEDIC SPINE PRODUCTS LIFE AND ACCIDENT INSURANCE Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Life insurance

401k Sponsoring company profile

THREE RIVERS ORTHOPAEDIC & SPINE PRODUCTS, INC. has sponsored the creation of one or more 401k plans.

Company Name:THREE RIVERS ORTHOPAEDIC & SPINE PRODUCTS, INC.
Employer identification number (EIN):208024741
NAIC Classification:621111
NAIC Description:Offices of Physicians (except Mental Health Specialists)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan THREE RIVERS ORTHOPAEDIC SPINE PRODUCTS LIFE AND ACCIDENT INSURANCE

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012020-02-01
5012019-02-01
5012018-02-01CRAIG LIBERATORE
5012017-02-01CRAIG LIBERATORE
5012016-02-01CRAIG LIBERATORE
5012015-02-01CRAIG LIBERATORE
5012014-02-01CRAIG LIBERATORE
5012013-02-01CRAIG LIBERATORE
5012012-02-01CRAIG LIBERATORE
5012011-02-01CRAIG LIBERATORE
5012010-02-01CRAIG LIBERATORE
5012009-02-01CRAIG LIBERATORE
5012009-02-01CRAIG LIBERATORE
5012009-02-01CRAIG LIBERATORE
5012009-02-01CRAIG LIBERATORE
5012009-02-01CRAIG LIBERATORE
5012009-02-01CRAIG LIBERATORE
5012009-02-01CRAIG LIBERATORE

Plan Statistics for THREE RIVERS ORTHOPAEDIC SPINE PRODUCTS LIFE AND ACCIDENT INSURANCE

401k plan membership statisitcs for THREE RIVERS ORTHOPAEDIC SPINE PRODUCTS LIFE AND ACCIDENT INSURANCE

Measure Date Value
2020: THREE RIVERS ORTHOPAEDIC SPINE PRODUCTS LIFE AND ACCIDENT INSURANCE 2020 401k membership
Total participants, beginning-of-year2020-02-01132
Total number of active participants reported on line 7a of the Form 55002020-02-01135
Number of retired or separated participants receiving benefits2020-02-010
Number of other retired or separated participants entitled to future benefits2020-02-010
Total of all active and inactive participants2020-02-01135
2019: THREE RIVERS ORTHOPAEDIC SPINE PRODUCTS LIFE AND ACCIDENT INSURANCE 2019 401k membership
Total participants, beginning-of-year2019-02-01134
Total number of active participants reported on line 7a of the Form 55002019-02-01132
Number of retired or separated participants receiving benefits2019-02-010
Number of other retired or separated participants entitled to future benefits2019-02-010
Total of all active and inactive participants2019-02-01132
2018: THREE RIVERS ORTHOPAEDIC SPINE PRODUCTS LIFE AND ACCIDENT INSURANCE 2018 401k membership
Total participants, beginning-of-year2018-02-01132
Total number of active participants reported on line 7a of the Form 55002018-02-01134
Number of retired or separated participants receiving benefits2018-02-010
Number of other retired or separated participants entitled to future benefits2018-02-010
Total of all active and inactive participants2018-02-01134
2017: THREE RIVERS ORTHOPAEDIC SPINE PRODUCTS LIFE AND ACCIDENT INSURANCE 2017 401k membership
Total participants, beginning-of-year2017-02-01133
Total number of active participants reported on line 7a of the Form 55002017-02-01132
Number of retired or separated participants receiving benefits2017-02-010
Number of other retired or separated participants entitled to future benefits2017-02-010
Total of all active and inactive participants2017-02-01132
2016: THREE RIVERS ORTHOPAEDIC SPINE PRODUCTS LIFE AND ACCIDENT INSURANCE 2016 401k membership
Total participants, beginning-of-year2016-02-01134
Total number of active participants reported on line 7a of the Form 55002016-02-01133
Number of retired or separated participants receiving benefits2016-02-010
Number of other retired or separated participants entitled to future benefits2016-02-010
Total of all active and inactive participants2016-02-01133
2015: THREE RIVERS ORTHOPAEDIC SPINE PRODUCTS LIFE AND ACCIDENT INSURANCE 2015 401k membership
Total participants, beginning-of-year2015-02-01135
Total number of active participants reported on line 7a of the Form 55002015-02-01134
Number of retired or separated participants receiving benefits2015-02-010
Number of other retired or separated participants entitled to future benefits2015-02-010
Total of all active and inactive participants2015-02-01134
2014: THREE RIVERS ORTHOPAEDIC SPINE PRODUCTS LIFE AND ACCIDENT INSURANCE 2014 401k membership
Total participants, beginning-of-year2014-02-01138
Total number of active participants reported on line 7a of the Form 55002014-02-01135
Number of retired or separated participants receiving benefits2014-02-010
Number of other retired or separated participants entitled to future benefits2014-02-010
Total of all active and inactive participants2014-02-01135
2013: THREE RIVERS ORTHOPAEDIC SPINE PRODUCTS LIFE AND ACCIDENT INSURANCE 2013 401k membership
Total participants, beginning-of-year2013-02-01140
Total number of active participants reported on line 7a of the Form 55002013-02-01138
Total of all active and inactive participants2013-02-01138
2012: THREE RIVERS ORTHOPAEDIC SPINE PRODUCTS LIFE AND ACCIDENT INSURANCE 2012 401k membership
Total participants, beginning-of-year2012-02-01144
Total number of active participants reported on line 7a of the Form 55002012-02-01140
Total of all active and inactive participants2012-02-01140
2011: THREE RIVERS ORTHOPAEDIC SPINE PRODUCTS LIFE AND ACCIDENT INSURANCE 2011 401k membership
Total participants, beginning-of-year2011-02-01134
Total number of active participants reported on line 7a of the Form 55002011-02-01144
Total of all active and inactive participants2011-02-01144
2010: THREE RIVERS ORTHOPAEDIC SPINE PRODUCTS LIFE AND ACCIDENT INSURANCE 2010 401k membership
Total participants, beginning-of-year2010-02-01129
Total number of active participants reported on line 7a of the Form 55002010-02-01134
Total of all active and inactive participants2010-02-01134
2009: THREE RIVERS ORTHOPAEDIC SPINE PRODUCTS LIFE AND ACCIDENT INSURANCE 2009 401k membership
Total participants, beginning-of-year2009-02-01118
Total number of active participants reported on line 7a of the Form 55002009-02-01129
Total of all active and inactive participants2009-02-01129

Financial Data on THREE RIVERS ORTHOPAEDIC SPINE PRODUCTS LIFE AND ACCIDENT INSURANCE

Measure Date Value
2021 : THREE RIVERS ORTHOPAEDIC SPINE PRODUCTS LIFE AND ACCIDENT INSURANCE 2021 401k financial data
Total income from all sources2021-01-31$0
Total plan assets at end of year2021-01-31$0
Total plan assets at beginning of year2021-01-31$0
Net plan assets at end of year (total assets less liabilities)2021-01-31$0
Net plan assets at beginning of year (total assets less liabilities)2021-01-31$0
2020 : THREE RIVERS ORTHOPAEDIC SPINE PRODUCTS LIFE AND ACCIDENT INSURANCE 2020 401k financial data
Total income from all sources2020-01-31$0
Total plan assets at end of year2020-01-31$0
Total plan assets at beginning of year2020-01-31$0
Net plan assets at end of year (total assets less liabilities)2020-01-31$0
Net plan assets at beginning of year (total assets less liabilities)2020-01-31$0
2019 : THREE RIVERS ORTHOPAEDIC SPINE PRODUCTS LIFE AND ACCIDENT INSURANCE 2019 401k financial data
Total income from all sources2019-01-31$0
Total plan assets at end of year2019-01-31$0
Total plan assets at beginning of year2019-01-31$0
Net plan assets at end of year (total assets less liabilities)2019-01-31$0
Net plan assets at beginning of year (total assets less liabilities)2019-01-31$0
2018 : THREE RIVERS ORTHOPAEDIC SPINE PRODUCTS LIFE AND ACCIDENT INSURANCE 2018 401k financial data
Total income from all sources2018-01-31$0
Total plan assets at end of year2018-01-31$0
Total plan assets at beginning of year2018-01-31$0
Net plan assets at end of year (total assets less liabilities)2018-01-31$0
Net plan assets at beginning of year (total assets less liabilities)2018-01-31$0
2017 : THREE RIVERS ORTHOPAEDIC SPINE PRODUCTS LIFE AND ACCIDENT INSURANCE 2017 401k financial data
Total income from all sources2017-01-31$0
Total plan assets at end of year2017-01-31$0
Total plan assets at beginning of year2017-01-31$0
Net plan assets at end of year (total assets less liabilities)2017-01-31$0
Net plan assets at beginning of year (total assets less liabilities)2017-01-31$0
2016 : THREE RIVERS ORTHOPAEDIC SPINE PRODUCTS LIFE AND ACCIDENT INSURANCE 2016 401k financial data
Total income from all sources2016-01-31$0
Total plan assets at end of year2016-01-31$0
Total plan assets at beginning of year2016-01-31$0
Net plan assets at end of year (total assets less liabilities)2016-01-31$0
Net plan assets at beginning of year (total assets less liabilities)2016-01-31$0
2015 : THREE RIVERS ORTHOPAEDIC SPINE PRODUCTS LIFE AND ACCIDENT INSURANCE 2015 401k financial data
Total income from all sources2015-01-31$0
Total plan assets at end of year2015-01-31$0
Total plan assets at beginning of year2015-01-31$0
Net plan assets at end of year (total assets less liabilities)2015-01-31$0
Net plan assets at beginning of year (total assets less liabilities)2015-01-31$0
2014 : THREE RIVERS ORTHOPAEDIC SPINE PRODUCTS LIFE AND ACCIDENT INSURANCE 2014 401k financial data
Total income from all sources2014-01-31$0
Total plan assets at end of year2014-01-31$0
Total plan assets at beginning of year2014-01-31$0
Net plan assets at end of year (total assets less liabilities)2014-01-31$0
Net plan assets at beginning of year (total assets less liabilities)2014-01-31$0
2013 : THREE RIVERS ORTHOPAEDIC SPINE PRODUCTS LIFE AND ACCIDENT INSURANCE 2013 401k financial data
Total income from all sources2013-01-31$0
Total plan assets at end of year2013-01-31$0
Total plan assets at beginning of year2013-01-31$0
Net plan assets at end of year (total assets less liabilities)2013-01-31$0
Net plan assets at beginning of year (total assets less liabilities)2013-01-31$0
2012 : THREE RIVERS ORTHOPAEDIC SPINE PRODUCTS LIFE AND ACCIDENT INSURANCE 2012 401k financial data
Total income from all sources2012-01-31$0
Total plan assets at end of year2012-01-31$0
Total plan assets at beginning of year2012-01-31$0
Net plan assets at end of year (total assets less liabilities)2012-01-31$0
Net plan assets at beginning of year (total assets less liabilities)2012-01-31$0
2011 : THREE RIVERS ORTHOPAEDIC SPINE PRODUCTS LIFE AND ACCIDENT INSURANCE 2011 401k financial data
Total plan assets at end of year2011-01-31$0
Net plan assets at end of year (total assets less liabilities)2011-01-31$0
Net plan assets at beginning of year (total assets less liabilities)2011-01-31$0

Form 5500 Responses for THREE RIVERS ORTHOPAEDIC SPINE PRODUCTS LIFE AND ACCIDENT INSURANCE

2020: THREE RIVERS ORTHOPAEDIC SPINE PRODUCTS LIFE AND ACCIDENT INSURANCE 2020 form 5500 responses
2020-02-01Type of plan entitySingle employer plan
2020-02-01Plan funding arrangement – InsuranceYes
2020-02-01Plan benefit arrangement – InsuranceYes
2019: THREE RIVERS ORTHOPAEDIC SPINE PRODUCTS LIFE AND ACCIDENT INSURANCE 2019 form 5500 responses
2019-02-01Type of plan entitySingle employer plan
2019-02-01Plan funding arrangement – InsuranceYes
2019-02-01Plan benefit arrangement – InsuranceYes
2018: THREE RIVERS ORTHOPAEDIC SPINE PRODUCTS LIFE AND ACCIDENT INSURANCE 2018 form 5500 responses
2018-02-01Type of plan entitySingle employer plan
2018-02-01Plan funding arrangement – InsuranceYes
2018-02-01Plan benefit arrangement – InsuranceYes
2017: THREE RIVERS ORTHOPAEDIC SPINE PRODUCTS LIFE AND ACCIDENT INSURANCE 2017 form 5500 responses
2017-02-01Type of plan entitySingle employer plan
2017-02-01Plan funding arrangement – InsuranceYes
2017-02-01Plan benefit arrangement – InsuranceYes
2016: THREE RIVERS ORTHOPAEDIC SPINE PRODUCTS LIFE AND ACCIDENT INSURANCE 2016 form 5500 responses
2016-02-01Type of plan entitySingle employer plan
2016-02-01Plan funding arrangement – InsuranceYes
2016-02-01Plan benefit arrangement – InsuranceYes
2015: THREE RIVERS ORTHOPAEDIC SPINE PRODUCTS LIFE AND ACCIDENT INSURANCE 2015 form 5500 responses
2015-02-01Type of plan entitySingle employer plan
2015-02-01Plan funding arrangement – InsuranceYes
2015-02-01Plan benefit arrangement – InsuranceYes
2014: THREE RIVERS ORTHOPAEDIC SPINE PRODUCTS LIFE AND ACCIDENT INSURANCE 2014 form 5500 responses
2014-02-01Type of plan entitySingle employer plan
2014-02-01Plan funding arrangement – InsuranceYes
2014-02-01Plan benefit arrangement – InsuranceYes
2013: THREE RIVERS ORTHOPAEDIC SPINE PRODUCTS LIFE AND ACCIDENT INSURANCE 2013 form 5500 responses
2013-02-01Type of plan entitySingle employer plan
2013-02-01Plan funding arrangement – InsuranceYes
2013-02-01Plan benefit arrangement – InsuranceYes
2012: THREE RIVERS ORTHOPAEDIC SPINE PRODUCTS LIFE AND ACCIDENT INSURANCE 2012 form 5500 responses
2012-02-01Type of plan entitySingle employer plan
2012-02-01Plan funding arrangement – InsuranceYes
2012-02-01Plan benefit arrangement – InsuranceYes
2011: THREE RIVERS ORTHOPAEDIC SPINE PRODUCTS LIFE AND ACCIDENT INSURANCE 2011 form 5500 responses
2011-02-01Type of plan entitySingle employer plan
2011-02-01Plan funding arrangement – InsuranceYes
2011-02-01Plan benefit arrangement – InsuranceYes
2010: THREE RIVERS ORTHOPAEDIC SPINE PRODUCTS LIFE AND ACCIDENT INSURANCE 2010 form 5500 responses
2010-02-01Type of plan entitySingle employer plan
2010-02-01Submission has been amendedYes
2010-02-01Plan funding arrangement – InsuranceYes
2010-02-01Plan benefit arrangement – InsuranceYes
2009: THREE RIVERS ORTHOPAEDIC SPINE PRODUCTS LIFE AND ACCIDENT INSURANCE 2009 form 5500 responses
2009-02-01Type of plan entitySingle employer plan
2009-02-01Submission has been amendedYes
2009-02-01Plan funding arrangement – InsuranceYes
2009-02-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLTD0174F
Policy instance 2
Insurance contract or identification numberGLTD0174F
Number of Individuals Covered132
Insurance policy start date2020-02-01
Insurance policy end date2021-01-31
Total amount of commissions paid to insurance brokerUSD $1,197
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $778
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0174F
Policy instance 1
Insurance contract or identification numberGLUG0174F
Number of Individuals Covered133
Insurance policy start date2020-02-01
Insurance policy end date2021-01-31
Total amount of commissions paid to insurance brokerUSD $372
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $242
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0174F
Policy instance 1
Insurance contract or identification numberGLUG0174F
Number of Individuals Covered133
Insurance policy start date2019-02-01
Insurance policy end date2020-01-31
Total amount of commissions paid to insurance brokerUSD $1,048
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $681
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLTD0174F
Policy instance 2
Insurance contract or identification numberGLTD0174F
Number of Individuals Covered132
Insurance policy start date2019-02-01
Insurance policy end date2020-01-31
Total amount of commissions paid to insurance brokerUSD $3,405
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,213
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLTD0174F
Policy instance 2
Insurance contract or identification numberGLTD0174F
Number of Individuals Covered119
Insurance policy start date2018-02-01
Insurance policy end date2019-01-31
Total amount of commissions paid to insurance brokerUSD $3,613
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,348
Insurance broker organization code?3
AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )
Policy contract numberG00609475
Policy instance 3
Insurance contract or identification numberG00609475
Number of Individuals Covered134
Insurance policy start date2018-02-01
Insurance policy end date2019-01-31
Total amount of commissions paid to insurance brokerUSD $5,603
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,363
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0174F
Policy instance 1
Insurance contract or identification numberGLUG0174F
Number of Individuals Covered121
Insurance policy start date2018-02-01
Insurance policy end date2019-01-31
Total amount of commissions paid to insurance brokerUSD $1,080
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $702
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0174F
Policy instance 1
Insurance contract or identification numberGLUG0174F
Number of Individuals Covered132
Insurance policy start date2017-02-01
Insurance policy end date2018-01-31
Total amount of commissions paid to insurance brokerUSD $1,087
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $707
Insurance broker organization code?3
Insurance broker nameSTUART D. FOX
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLTD0174F
Policy instance 2
Insurance contract or identification numberGLTD0174F
Number of Individuals Covered130
Insurance policy start date2017-02-01
Insurance policy end date2018-01-31
Total amount of commissions paid to insurance brokerUSD $3,661
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,380
Insurance broker organization code?3
Insurance broker nameSTUART D. FOX
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0174F
Policy instance 1
Insurance contract or identification numberGLUG0174F
Number of Individuals Covered136
Insurance policy start date2015-02-01
Insurance policy end date2016-01-31
Total amount of commissions paid to insurance brokerUSD $1,094
Welfare Benefit Premiums Paid to CarrierUSD $5,467
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $711
Insurance broker organization code?3
Insurance broker nameSTUART D. FOX
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLTD0174F
Policy instance 2
Insurance contract or identification numberGLTD0174F
Number of Individuals Covered134
Insurance policy start date2015-02-01
Insurance policy end date2016-01-31
Total amount of commissions paid to insurance brokerUSD $2,826
Welfare Benefit Premiums Paid to CarrierUSD $14,131
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,837
Insurance broker organization code?3
Insurance broker nameSTUART D. FOX
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0174F
Policy instance 1
Insurance contract or identification numberGLUG0174F
Number of Individuals Covered140
Insurance policy start date2014-02-01
Insurance policy end date2015-01-31
Total amount of commissions paid to insurance brokerUSD $1,147
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $746
Insurance broker organization code?3
Insurance broker nameSTUART D. FOX
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLTD0174F
Policy instance 2
Insurance contract or identification numberGLTD0174F
Number of Individuals Covered139
Insurance policy start date2014-02-01
Insurance policy end date2015-01-31
Total amount of commissions paid to insurance brokerUSD $2,848
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,851
Insurance broker organization code?3
Insurance broker nameSTUART D. FOX
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLTD0174F
Policy instance 2
Insurance contract or identification numberGLTD0174F
Number of Individuals Covered139
Insurance policy start date2013-02-01
Insurance policy end date2014-01-31
Total amount of commissions paid to insurance brokerUSD $2,708
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,760
Insurance broker organization code?3
Insurance broker nameSTUART D. FOX
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0174F
Policy instance 1
Insurance contract or identification numberGLUG0174F
Number of Individuals Covered140
Insurance policy start date2013-02-01
Insurance policy end date2014-01-31
Total amount of commissions paid to insurance brokerUSD $1,149
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $747
Insurance broker organization code?3
Insurance broker nameSTUART D. FOX
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0174F
Policy instance 1
Insurance contract or identification numberGLUG0174F
Number of Individuals Covered140
Insurance policy start date2012-02-01
Insurance policy end date2013-01-31
Total amount of commissions paid to insurance brokerUSD $1,103
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $717
Insurance broker organization code?3
Insurance broker nameSTUART D. FOX
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLTD0174F
Policy instance 2
Insurance contract or identification numberGLTD0174F
Number of Individuals Covered139
Insurance policy start date2012-02-01
Insurance policy end date2013-01-31
Total amount of commissions paid to insurance brokerUSD $2,439
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,585
Insurance broker organization code?3
Insurance broker nameSTUART D. FOX
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLTD0174F
Policy instance 2
Insurance contract or identification numberGLTD0174F
Number of Individuals Covered144
Insurance policy start date2011-02-01
Insurance policy end date2012-01-31
Total amount of commissions paid to insurance brokerUSD $2,488
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 numberGLUG0174F
Policy instance 1
Insurance contract or identification numberGLUG0174F
Number of Individuals Covered144
Insurance policy start date2011-02-01
Insurance policy end date2012-01-31
Total amount of commissions paid to insurance brokerUSD $1,151
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 numberGLUG0174F
Policy instance 2
Insurance contract or identification numberGLUG0174F
Number of Individuals Covered134
Insurance policy start date2010-02-01
Insurance policy end date2011-01-31
Total amount of commissions paid to insurance brokerUSD $1,058
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 numberGLTD0174F
Policy instance 1
Insurance contract or identification numberGLTD0174F
Number of Individuals Covered134
Insurance policy start date2010-02-01
Insurance policy end date2011-01-31
Total amount of commissions paid to insurance brokerUSD $2,237
Contracts With Unallocated Funds Deposit Administration1
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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