401k Plan data: ANDY MOHR AUTOMOTIVE GROUP, INC. WELFARE BENEFIT PLAN plan

ANDY MOHR AUTOMOTIVE GROUP, INC. WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	ANDY MOHR AUTOMOTIVE GROUP, INC. WELFARE BENEFIT PLAN
Plan identification number	501

ANDY MOHR AUTOMOTIVE GROUP, INC. WELFARE BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Long-term disability cover Death benefits (include travel accident but not life insurance) Other welfare benefit cover

401k Sponsoring company profile

ANDY MOHR AUTOMOTIVE GROUP, INC. has sponsored the creation of one or more 401k plans.

Company Name: ANDY MOHR AUTOMOTIVE GROUP, INC.

Employer identification number (EIN): 208324241

NAIC Classification: 441110
NAIC Description: New Car Dealers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ANDY MOHR AUTOMOTIVE GROUP, INC. WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-01-01 CAROL TRAVELSTEAD 2023-03-31
501 2021-01-01 CAROL TRAVELSTEAD 2022-04-05
501 2020-01-01
501 2019-01-01
501 2018-01-01 CAROL TRAVELSTEAD CAROL TRAVELSTEAD 2019-06-05
501 2017-01-01 CAROL TRAVELSTEAD CAROL TRAVELSTEAD 2018-06-06
501 2016-01-01 CAROL TRAVELSTEAD CAROL TRAVELSTEAD 2017-06-14
501 2015-01-01 MCCOY WAGERS MCCOY WAGERS 2016-04-26
501 2014-01-01 MCCOY WAGERS MCCOY WAGERS 2015-09-28
501 2013-01-01 MCCOY WAGERS MCCOY WAGERS 2015-09-28
501 2012-01-01 MCCOY WAGERS MCCOY WAGERS 2015-09-28
501 2011-01-01 MCCOY WAGERS MCCOY WAGERS 2015-09-28
501 2010-01-01 MCCOY WAGERS MCCOY WAGERS 2015-09-28
501 2009-01-01 MCCOY WAGERS MCCOY WAGERS 2015-09-28

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2022-01-01	CAROL TRAVELSTEAD	2023-03-31
501	2021-01-01	CAROL TRAVELSTEAD	2022-04-05
501	2020-01-01
501	2019-01-01
501	2018-01-01	CAROL TRAVELSTEAD		CAROL TRAVELSTEAD	2019-06-05
501	2017-01-01	CAROL TRAVELSTEAD		CAROL TRAVELSTEAD	2018-06-06
501	2016-01-01	CAROL TRAVELSTEAD		CAROL TRAVELSTEAD	2017-06-14
501	2015-01-01	MCCOY WAGERS		MCCOY WAGERS	2016-04-26
501	2014-01-01	MCCOY WAGERS		MCCOY WAGERS	2015-09-28
501	2013-01-01	MCCOY WAGERS		MCCOY WAGERS	2015-09-28
501	2012-01-01	MCCOY WAGERS		MCCOY WAGERS	2015-09-28
501	2011-01-01	MCCOY WAGERS		MCCOY WAGERS	2015-09-28
501	2010-01-01	MCCOY WAGERS		MCCOY WAGERS	2015-09-28
501	2009-01-01	MCCOY WAGERS		MCCOY WAGERS	2015-09-28

Plan Statistics for ANDY MOHR AUTOMOTIVE GROUP, INC. WELFARE BENEFIT PLAN

401k plan membership statisitcs for ANDY MOHR AUTOMOTIVE GROUP, INC. WELFARE BENEFIT PLAN

Measure Date Value
2022: ANDY MOHR AUTOMOTIVE GROUP, INC. WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 796
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 887
Number of retired or separated participants receiving benefits 2022-01-01 0
Number of other retired or separated participants entitled to future benefits 2022-01-01 0
Total of all active and inactive participants 2022-01-01 887
Number of employers contributing to the scheme 2022-01-01 0
2021: ANDY MOHR AUTOMOTIVE GROUP, INC. WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 841
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 796
Number of retired or separated participants receiving benefits 2021-01-01 0
Number of other retired or separated participants entitled to future benefits 2021-01-01 0
Total of all active and inactive participants 2021-01-01 796
Number of employers contributing to the scheme 2021-01-01 0
2020: ANDY MOHR AUTOMOTIVE GROUP, INC. WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 921
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 837
Number of retired or separated participants receiving benefits 2020-01-01 4
Number of other retired or separated participants entitled to future benefits 2020-01-01 0
Total of all active and inactive participants 2020-01-01 841
2019: ANDY MOHR AUTOMOTIVE GROUP, INC. WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 876
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 919
Number of retired or separated participants receiving benefits 2019-01-01 2
Number of other retired or separated participants entitled to future benefits 2019-01-01 0
Total of all active and inactive participants 2019-01-01 921
2018: ANDY MOHR AUTOMOTIVE GROUP, INC. WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 819
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 874
Number of retired or separated participants receiving benefits 2018-01-01 2
Number of other retired or separated participants entitled to future benefits 2018-01-01 0
Total of all active and inactive participants 2018-01-01 876
2017: ANDY MOHR AUTOMOTIVE GROUP, INC. WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 770
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 816
Number of retired or separated participants receiving benefits 2017-01-01 3
Number of other retired or separated participants entitled to future benefits 2017-01-01 0
Total of all active and inactive participants 2017-01-01 819
2016: ANDY MOHR AUTOMOTIVE GROUP, INC. WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 609
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 769
Number of retired or separated participants receiving benefits 2016-01-01 1
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 770
2015: ANDY MOHR AUTOMOTIVE GROUP, INC. WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 582
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 607
Number of retired or separated participants receiving benefits 2015-01-01 2
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 609
2014: ANDY MOHR AUTOMOTIVE GROUP, INC. WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 375
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 582
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 582
2013: ANDY MOHR AUTOMOTIVE GROUP, INC. WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 329
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 375
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 0
Total of all active and inactive participants 2013-01-01 375
2012: ANDY MOHR AUTOMOTIVE GROUP, INC. WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 259
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 329
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 0
Total of all active and inactive participants 2012-01-01 329
2011: ANDY MOHR AUTOMOTIVE GROUP, INC. WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 254
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 259
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 0
Total of all active and inactive participants 2011-01-01 259
2010: ANDY MOHR AUTOMOTIVE GROUP, INC. WELFARE BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 100
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 254
Number of retired or separated participants receiving benefits 2010-01-01 0
Number of other retired or separated participants entitled to future benefits 2010-01-01 0
Total of all active and inactive participants 2010-01-01 254
2009: ANDY MOHR AUTOMOTIVE GROUP, INC. WELFARE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 100
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 100
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 0
Total of all active and inactive participants 2009-01-01 100

Measure	Date	Value
2022: ANDY MOHR AUTOMOTIVE GROUP, INC. WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	796
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	887
Number of retired or separated participants receiving benefits	2022-01-01	0
Number of other retired or separated participants entitled to future benefits	2022-01-01	0
Total of all active and inactive participants	2022-01-01	887
Number of employers contributing to the scheme	2022-01-01	0
2021: ANDY MOHR AUTOMOTIVE GROUP, INC. WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	841
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	796
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	0
Total of all active and inactive participants	2021-01-01	796
Number of employers contributing to the scheme	2021-01-01	0
2020: ANDY MOHR AUTOMOTIVE GROUP, INC. WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	921
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	837
Number of retired or separated participants receiving benefits	2020-01-01	4
Number of other retired or separated participants entitled to future benefits	2020-01-01	0
Total of all active and inactive participants	2020-01-01	841
2019: ANDY MOHR AUTOMOTIVE GROUP, INC. WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	876
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	919
Number of retired or separated participants receiving benefits	2019-01-01	2
Number of other retired or separated participants entitled to future benefits	2019-01-01	0
Total of all active and inactive participants	2019-01-01	921
2018: ANDY MOHR AUTOMOTIVE GROUP, INC. WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	819
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	874
Number of retired or separated participants receiving benefits	2018-01-01	2
Number of other retired or separated participants entitled to future benefits	2018-01-01	0
Total of all active and inactive participants	2018-01-01	876
2017: ANDY MOHR AUTOMOTIVE GROUP, INC. WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	770
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	816
Number of retired or separated participants receiving benefits	2017-01-01	3
Number of other retired or separated participants entitled to future benefits	2017-01-01	0
Total of all active and inactive participants	2017-01-01	819
2016: ANDY MOHR AUTOMOTIVE GROUP, INC. WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	609
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	769
Number of retired or separated participants receiving benefits	2016-01-01	1
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	770
2015: ANDY MOHR AUTOMOTIVE GROUP, INC. WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	582
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	607
Number of retired or separated participants receiving benefits	2015-01-01	2
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	609
2014: ANDY MOHR AUTOMOTIVE GROUP, INC. WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	375
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	582
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	0
Total of all active and inactive participants	2014-01-01	582
2013: ANDY MOHR AUTOMOTIVE GROUP, INC. WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	329
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	375
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	0
Total of all active and inactive participants	2013-01-01	375
2012: ANDY MOHR AUTOMOTIVE GROUP, INC. WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	259
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	329
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	0
Total of all active and inactive participants	2012-01-01	329
2011: ANDY MOHR AUTOMOTIVE GROUP, INC. WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	254
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	259
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	0
Total of all active and inactive participants	2011-01-01	259
2010: ANDY MOHR AUTOMOTIVE GROUP, INC. WELFARE BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	100
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	254
Number of retired or separated participants receiving benefits	2010-01-01	0
Number of other retired or separated participants entitled to future benefits	2010-01-01	0
Total of all active and inactive participants	2010-01-01	254
2009: ANDY MOHR AUTOMOTIVE GROUP, INC. WELFARE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	100
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	100
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	0
Total of all active and inactive participants	2009-01-01	100

Form 5500 Responses for ANDY MOHR AUTOMOTIVE GROUP, INC. WELFARE BENEFIT PLAN

2022: ANDY MOHR AUTOMOTIVE GROUP, INC. WELFARE BENEFIT PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2021: ANDY MOHR AUTOMOTIVE GROUP, INC. WELFARE BENEFIT PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2020: ANDY MOHR AUTOMOTIVE GROUP, INC. WELFARE BENEFIT PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2019: ANDY MOHR AUTOMOTIVE GROUP, INC. WELFARE BENEFIT PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2018: ANDY MOHR AUTOMOTIVE GROUP, INC. WELFARE BENEFIT PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2017: ANDY MOHR AUTOMOTIVE GROUP, INC. WELFARE BENEFIT PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2016: ANDY MOHR AUTOMOTIVE GROUP, INC. WELFARE BENEFIT PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2015: ANDY MOHR AUTOMOTIVE GROUP, INC. WELFARE BENEFIT PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: ANDY MOHR AUTOMOTIVE GROUP, INC. WELFARE BENEFIT PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: ANDY MOHR AUTOMOTIVE GROUP, INC. WELFARE BENEFIT PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: ANDY MOHR AUTOMOTIVE GROUP, INC. WELFARE BENEFIT PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: ANDY MOHR AUTOMOTIVE GROUP, INC. WELFARE BENEFIT PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2010: ANDY MOHR AUTOMOTIVE GROUP, INC. WELFARE BENEFIT PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	No
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	No
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2009: ANDY MOHR AUTOMOTIVE GROUP, INC. WELFARE BENEFIT PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	First time form 5500 has been submitted	Yes
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

RQ924

Policy instance

Insurance contract or identification number	RQ924
Number of Individuals Covered	60380
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $5,824
Total amount of fees paid to insurance company	USD $297
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT, CRITICAL ILLNESS, HOSPITAL, CANCER
Welfare Benefit Premiums Paid to Carrier	USD $33,661
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,146
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	FEES

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

447150

Policy instance

Insurance contract or identification number	447150
Number of Individuals Covered	887
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $29,124
Total amount of fees paid to insurance company	USD $13,395
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $586,058
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $29,124
Amount paid for insurance broker fees	13395
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

JWZ90

Policy instance

Insurance contract or identification number	JWZ90
Number of Individuals Covered	13
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $2,333
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT, CRITICAL ILLNESS, HOSPITAL, CANCER
Welfare Benefit Premiums Paid to Carrier	USD $12,523
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $846
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	FEES

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

F3G07

Policy instance

Insurance contract or identification number	F3G07
Number of Individuals Covered	13
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $2,441
Total amount of fees paid to insurance company	USD $178
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT, CRITICAL ILLNESS, HOSPITAL, CANCER
Welfare Benefit Premiums Paid to Carrier	USD $12,932
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	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	FEES

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

JNU00

Policy instance

Insurance contract or identification number	JNU00
Number of Individuals Covered	8
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $1,882
Total amount of fees paid to insurance company	USD $175
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT, CRITICAL ILLNESS, HOSPITAL, CANCER
Welfare Benefit Premiums Paid to Carrier	USD $7,360
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $842
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	FEES

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

G0630

Policy instance

Insurance contract or identification number	G0630
Number of Individuals Covered	26
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $7,582
Total amount of fees paid to insurance company	USD $20
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT, CRITICAL ILLNESS, HOSPITAL, CANCER
Welfare Benefit Premiums Paid to Carrier	USD $32,636
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,672
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	FEES

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

DJB12

Policy instance

Insurance contract or identification number	DJB12
Number of Individuals Covered	14
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $3,115
Total amount of fees paid to insurance company	USD $202
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT, CRITICAL ILLNESS, HOSPITAL, CANCER
Welfare Benefit Premiums Paid to Carrier	USD $14,922
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,342
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	FEES

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

DHA39

Policy instance

Insurance contract or identification number	DHA39
Number of Individuals Covered	29
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $5,470
Total amount of fees paid to insurance company	USD $95
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT, CRITICAL ILLNESS, HOSPITAL, CANCER
Welfare Benefit Premiums Paid to Carrier	USD $33,107
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,882
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	FEES

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

56391

Policy instance

Insurance contract or identification number	56391
Number of Individuals Covered	37
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $6,850
Total amount of fees paid to insurance company	USD $144
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT, CRITICAL ILLNESS, HOSPITAL, CANCER
Welfare Benefit Premiums Paid to Carrier	USD $46,355
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,889
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	FEES

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

OKCK7

Policy instance

Insurance contract or identification number	OKCK7
Number of Individuals Covered	23
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $4,538
Total amount of fees paid to insurance company	USD $242
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT, CRITICAL ILLNESS, HOSPITAL, CANCER
Welfare Benefit Premiums Paid to Carrier	USD $27,679
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,530
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	FEES

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

JWZ90

Policy instance

Insurance contract or identification number	JWZ90
Number of Individuals Covered	10
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $1,097
Total amount of fees paid to insurance company	USD $441
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT, CRITICAL ILLNESS, HOSPITAL, CANCER
Welfare Benefit Premiums Paid to Carrier	USD $10,257
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $266
Amount paid for insurance broker fees	201
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

RQ924

Policy instance

Insurance contract or identification number	RQ924
Number of Individuals Covered	25
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $4,453
Total amount of fees paid to insurance company	USD $931
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT, CRITICAL ILLNESS, HOSPITAL, CANCER
Welfare Benefit Premiums Paid to Carrier	USD $24,083
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,791
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	FEES

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

JNU00

Policy instance

Insurance contract or identification number	JNU00
Number of Individuals Covered	11
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $2,172
Total amount of fees paid to insurance company	USD $186
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT, CRITICAL ILLNESS, HOSPITAL, CANCER
Welfare Benefit Premiums Paid to Carrier	USD $6,693
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $935
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	FEES

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

G0630

Policy instance

Insurance contract or identification number	G0630
Number of Individuals Covered	27
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $4,744
Total amount of fees paid to insurance company	USD $1,438
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT, CRITICAL ILLNESS, HOSPITAL, CANCER
Welfare Benefit Premiums Paid to Carrier	USD $37,956
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $618
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	FEES

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

447150

Policy instance

Insurance contract or identification number	447150
Number of Individuals Covered	796
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $26,268
Total amount of fees paid to insurance company	USD $1,861
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $513,727
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $26,268
Amount paid for insurance broker fees	1861
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

DHA39

Policy instance

Insurance contract or identification number	DHA39
Number of Individuals Covered	29
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $5,419
Total amount of fees paid to insurance company	USD $759
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT, CRITICAL ILLNESS, HOSPITAL, CANCER
Welfare Benefit Premiums Paid to Carrier	USD $33,772
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,781
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	FEES

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

56391

Policy instance

Insurance contract or identification number	56391
Number of Individuals Covered	42
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $7,173
Total amount of fees paid to insurance company	USD $2,289
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT, CRITICAL ILLNESS, HOSPITAL, CANCER
Welfare Benefit Premiums Paid to Carrier	USD $46,487
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,997
Amount paid for insurance broker fees	33
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

OKCK7

Policy instance

Insurance contract or identification number	OKCK7
Number of Individuals Covered	23
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $4,236
Total amount of fees paid to insurance company	USD $626
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT, CRITICAL ILLNESS, HOSPITAL, CANCER
Welfare Benefit Premiums Paid to Carrier	USD $24,391
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,457
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	FEES

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

F3G07

Policy instance

Insurance contract or identification number	F3G07
Number of Individuals Covered	12
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $2,270
Total amount of fees paid to insurance company	USD $377
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT, CRITICAL ILLNESS, HOSPITAL, CANCER
Welfare Benefit Premiums Paid to Carrier	USD $11,122
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $910
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	FEES

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

DJB12

Policy instance

Insurance contract or identification number	DJB12
Number of Individuals Covered	14
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $3,114
Total amount of fees paid to insurance company	USD $314
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT, CRITICAL ILLNESS, HOSPITAL, CANCER
Welfare Benefit Premiums Paid to Carrier	USD $12,927
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,321
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	FEES

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00447150

Policy instance

Insurance contract or identification number	00447150
Number of Individuals Covered	837
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $26,687
Total amount of fees paid to insurance company	USD $6,800
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $548,244
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $26,687
Amount paid for insurance broker fees	6800
Additional information about fees paid to insurance broker	TOTAL FEES PAID
Insurance broker organization code?	3

CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )

Policy contract number

0000023870

Policy instance

Insurance contract or identification number	0000023870
Number of Individuals Covered	488
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $35,592
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $159,155
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $17,869
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

JNU00

Policy instance

Insurance contract or identification number	JNU00
Number of Individuals Covered	6
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $30
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $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 $8
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

F3G07

Policy instance

Insurance contract or identification number	F3G07
Number of Individuals Covered	10
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $343
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $3,081
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $66
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

DJB12

Policy instance

Insurance contract or identification number	DJB12
Number of Individuals Covered	16
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $594
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $5,659
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $96
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

G0630

Policy instance

Insurance contract or identification number	G0630
Number of Individuals Covered	42
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $1,331
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $12,869
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $249
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	`

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00447150

Policy instance

Insurance contract or identification number	00447150
Number of Individuals Covered	919
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $25,596
Total amount of fees paid to insurance company	USD $5,462
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $538,198
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $25,596
Amount paid for insurance broker fees	5462
Additional information about fees paid to insurance broker	TOTAL FEES PAID
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

56391

Policy instance

Insurance contract or identification number	56391
Number of Individuals Covered	51
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $650
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $6,248
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $103
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

0KCK7

Policy instance

Insurance contract or identification number	0KCK7
Number of Individuals Covered	27
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $984
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $8,524
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $155
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

DHA39

Policy instance

Insurance contract or identification number	DHA39
Number of Individuals Covered	38
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $1,334
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $11,566
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $262
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

RQ924

Policy instance

Insurance contract or identification number	RQ924
Number of Individuals Covered	24
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $222
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $2,192
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
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

D0097

Policy instance

Insurance contract or identification number	D0097
Number of Individuals Covered	65
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $1,230
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $10,864
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $192
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

JWZ90

Policy instance

Insurance contract or identification number	JWZ90
Number of Individuals Covered	20
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $241
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $1,751
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $60
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

DJB12

Policy instance

Insurance contract or identification number	DJB12
Number of Individuals Covered	6
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $653
Total amount of fees paid to insurance company	USD $14
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $6,233
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $97
Insurance broker organization code?	3
Amount paid for insurance broker fees	5
Additional information about fees paid to insurance broker	FEES PAID

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

F3G07

Policy instance

Insurance contract or identification number	F3G07
Number of Individuals Covered	3
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $643
Total amount of fees paid to insurance company	USD $56
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $4,362
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $215
Amount paid for insurance broker fees	20
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

JNU00

Policy instance

Insurance contract or identification number	JNU00
Number of Individuals Covered	1
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $106
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $843
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
Insurance broker organization code?	3

CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )

Policy contract number

23870

Policy instance

Insurance contract or identification number	23870
Number of Individuals Covered	468
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $101,226
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $192,269
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $49,972
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

JWZ83

Policy instance

Insurance contract or identification number	JWZ83
Number of Individuals Covered	0
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $6
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $64
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
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

JWZ90

Policy instance

Insurance contract or identification number	JWZ90
Number of Individuals Covered	6
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $443
Total amount of fees paid to insurance company	USD $42
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $3,076
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $115
Amount paid for insurance broker fees	6
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

G0630

Policy instance

Insurance contract or identification number	G0630
Number of Individuals Covered	22
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $2,124
Total amount of fees paid to insurance company	USD $35
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $19,528
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $342
Insurance broker organization code?	3
Amount paid for insurance broker fees	20
Additional information about fees paid to insurance broker	FEES PAID

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

J7P07

Policy instance

Insurance contract or identification number	J7P07
Number of Individuals Covered	0
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $77
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $502
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $20
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

D0097

Policy instance

Insurance contract or identification number	D0097
Number of Individuals Covered	20
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $1,894
Total amount of fees paid to insurance company	USD $48
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $16,821
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $364
Amount paid for insurance broker fees	17
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

RQ924

Policy instance

Insurance contract or identification number	RQ924
Number of Individuals Covered	7
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $690
Total amount of fees paid to insurance company	USD $57
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $5,007
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $136
Insurance broker organization code?	3
Amount paid for insurance broker fees	13
Additional information about fees paid to insurance broker	FEES PAID

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

DHA39

Policy instance

Insurance contract or identification number	DHA39
Number of Individuals Covered	19
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $1,236
Total amount of fees paid to insurance company	USD $76
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $10,797
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $246
Amount paid for insurance broker fees	35
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

0KCK7

Policy instance

Insurance contract or identification number	0KCK7
Number of Individuals Covered	15
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $1,140
Total amount of fees paid to insurance company	USD $87
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $9,687
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $165
Insurance broker organization code?	3
Amount paid for insurance broker fees	15
Additional information about fees paid to insurance broker	FEES PAID

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

56391

Policy instance

Insurance contract or identification number	56391
Number of Individuals Covered	10
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $1,249
Total amount of fees paid to insurance company	USD $28
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $11,161
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $210
Insurance broker organization code?	3
Amount paid for insurance broker fees	10
Additional information about fees paid to insurance broker	FEES PAID

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00447150

Policy instance

Insurance contract or identification number	00447150
Number of Individuals Covered	874
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $24,902
Total amount of fees paid to insurance company	USD $9,857
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $540,569
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $24,902
Amount paid for insurance broker fees	9857
Additional information about fees paid to insurance broker	TOTAL FEES PAID
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

G0630

Policy instance

Insurance contract or identification number	G0630
Number of Individuals Covered	44
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $5,588
Total amount of fees paid to insurance company	USD $75
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $37,739
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,387
Amount paid for insurance broker fees	29
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker organization code?	3
Insurance broker name	MICHAEL HALL

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

DJB12

Policy instance

Insurance contract or identification number	DJB12
Number of Individuals Covered	8
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $1,409
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $10,479
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $238
Insurance broker organization code?	3
Insurance broker name	LLOYD HAWKINS JR

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

F3G07

Policy instance

Insurance contract or identification number	F3G07
Number of Individuals Covered	5
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $2,003
Total amount of fees paid to insurance company	USD $92
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $6,655
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $561
Amount paid for insurance broker fees	33
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker organization code?	3
Insurance broker name	CAROLYN RICHARDS

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

JNU00

Policy instance

Insurance contract or identification number	JNU00
Number of Individuals Covered	2
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $328
Total amount of fees paid to insurance company	USD $33
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $1,237
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $99
Amount paid for insurance broker fees	21
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker organization code?	3
Insurance broker name	PETER EMMERT

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

JWZ83

Policy instance

Insurance contract or identification number	JWZ83
Number of Individuals Covered	1
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $251
Total amount of fees paid to insurance company	USD $30
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $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 $69
Insurance broker organization code?	3
Amount paid for insurance broker fees	11
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker name	MATTHEW SMITH

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

JWZ90

Policy instance

Insurance contract or identification number	JWZ90
Number of Individuals Covered	12
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $2,504
Total amount of fees paid to insurance company	USD $260
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $8,172
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $440
Amount paid for insurance broker fees	37
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker organization code?	3
Insurance broker name	MATTHEW SMITH

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

J7P07

Policy instance

Insurance contract or identification number	J7P07
Number of Individuals Covered	5
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $1,358
Total amount of fees paid to insurance company	USD $84
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $4,437
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $392
Amount paid for insurance broker fees	43
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker organization code?	3
Insurance broker name	JOHN CLANCY

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

ZA853

Policy instance

Insurance contract or identification number	ZA853
Number of Individuals Covered	0
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $57
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $454
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $20
Insurance broker organization code?	3
Insurance broker name	ROBERT BURGETT

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00447150

Policy instance

Insurance contract or identification number	00447150
Number of Individuals Covered	816
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $22,617
Total amount of fees paid to insurance company	USD $9,367
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $494,034
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $22,617
Amount paid for insurance broker fees	9367
Additional information about fees paid to insurance broker	TOTAL FEES PAID
Insurance broker organization code?	3
Insurance broker name	MJ INSURANCE INC.

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

56391

Policy instance

Insurance contract or identification number	56391
Number of Individuals Covered	30
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $4,121
Total amount of fees paid to insurance company	USD $163
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $28,849
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $794
Insurance broker organization code?	3
Amount paid for insurance broker fees	67
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker name	RETTENMUND INSURANCE LLC

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

0KCK7

Policy instance

Insurance contract or identification number	0KCK7
Number of Individuals Covered	20
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $3,398
Total amount of fees paid to insurance company	USD $230
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $21,841
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $646
Insurance broker organization code?	3
Amount paid for insurance broker fees	145
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker name	BRIANNA ROWE

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

DHA39

Policy instance

Insurance contract or identification number	DHA39
Number of Individuals Covered	28
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $3,728
Total amount of fees paid to insurance company	USD $148
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $24,543
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $988
Amount paid for insurance broker fees	53
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker organization code?	3
Insurance broker name	PETER EMMERT

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

RQ924

Policy instance

Insurance contract or identification number	RQ924
Number of Individuals Covered	18
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $3,239
Total amount of fees paid to insurance company	USD $64
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $12,488
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $850
Insurance broker organization code?	3
Amount paid for insurance broker fees	23
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker name	PETER EMMERT

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

D0097

Policy instance

Insurance contract or identification number	D0097
Number of Individuals Covered	34
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $4,901
Total amount of fees paid to insurance company	USD $215
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $34,360
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $984
Amount paid for insurance broker fees	101
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker organization code?	3
Insurance broker name	AMY GEHLHAUSEN

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

F3G07

Policy instance

Insurance contract or identification number	F3G07
Number of Individuals Covered	3
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $808
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $2,241
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $193
Insurance broker organization code?	3
Insurance broker name	MATTHEW D SMITH

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

G0630

Policy instance

Insurance contract or identification number	G0630
Number of Individuals Covered	49
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $5,514
Total amount of fees paid to insurance company	USD $264
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $35,621
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,069
Amount paid for insurance broker fees	63
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker organization code?	3
Insurance broker name	HARROLD HUGHES INSURANCE

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

DJB12

Policy instance

Insurance contract or identification number	DJB12
Number of Individuals Covered	17
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $2,104
Total amount of fees paid to insurance company	USD $295
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $12,770
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $352
Insurance broker organization code?	3
Amount paid for insurance broker fees	59
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker name	LLOYD W HUGHES

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

ZA853

Policy instance

Insurance contract or identification number	ZA853
Number of Individuals Covered	2
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $329
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $1,099
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $76
Insurance broker organization code?	3
Insurance broker name	STEPHEN W PHILLIPS

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00447150

Policy instance

Insurance contract or identification number	00447150
Number of Individuals Covered	607
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $18,184
Total amount of fees paid to insurance company	USD $7,787
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $411,985
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $17,482
Amount paid for insurance broker fees	7787
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker organization code?	3
Insurance broker name	ASSUREX AGENCY INC

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

56391

Policy instance

Insurance contract or identification number	56391
Number of Individuals Covered	33
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $5,451
Total amount of fees paid to insurance company	USD $343
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $26,475
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,230
Insurance broker organization code?	3
Amount paid for insurance broker fees	53
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker name	ANN T MURREY

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

0KCK7

Policy instance

Insurance contract or identification number	0KCK7
Number of Individuals Covered	24
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $2,840
Total amount of fees paid to insurance company	USD $298
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $16,368
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $473
Insurance broker organization code?	3
Amount paid for insurance broker fees	78
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker name	FRED L AUBREY JR

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

DHA39

Policy instance

Insurance contract or identification number	DHA39
Number of Individuals Covered	24
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $3,656
Total amount of fees paid to insurance company	USD $230
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $18,375
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $902
Amount paid for insurance broker fees	79
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker organization code?	3
Insurance broker name	PEGGY S BAUMANN

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

RQ924

Policy instance

Insurance contract or identification number	RQ924
Number of Individuals Covered	15
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $1,639
Total amount of fees paid to insurance company	USD $47
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $7,559
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $363
Insurance broker organization code?	3
Amount paid for insurance broker fees	6
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker name	BRIAN LEE WYNDHAM

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

D0097

Policy instance

Insurance contract or identification number	D0097
Number of Individuals Covered	46
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $7,513
Total amount of fees paid to insurance company	USD $412
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $36,937
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,624
Insurance broker organization code?	3
Amount paid for insurance broker fees	108
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker name	INEZ E LEWIS

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

DHA39

Policy instance

Insurance contract or identification number	DHA39
Number of Individuals Covered	29
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $4,984
Total amount of fees paid to insurance company	USD $486
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $23,185
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,146
Amount paid for insurance broker fees	118
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker organization code?	3
Insurance broker name	REMECS INC

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

F3G07

Policy instance

Insurance contract or identification number	F3G07
Number of Individuals Covered	1
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $245
Total amount of fees paid to insurance company	USD $55
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $1,034
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $56
Amount paid for insurance broker fees	17
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker organization code?	3
Insurance broker name	WARREN REID HAVENOR

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

RQ924

Policy instance

Insurance contract or identification number	RQ924
Number of Individuals Covered	13
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $688
Total amount of fees paid to insurance company	USD $152
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $5,280
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $97
Amount paid for insurance broker fees	43
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker organization code?	3
Insurance broker name	MARCELLUS MARTIN JR

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

DJB12

Policy instance

Insurance contract or identification number	DJB12
Number of Individuals Covered	20
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $3,642
Total amount of fees paid to insurance company	USD $139
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $13,445
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $747
Insurance broker organization code?	3
Amount paid for insurance broker fees	56
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker name	NAVILLE & ASSOCIATES

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

G0630

Policy instance

Insurance contract or identification number	G0630
Number of Individuals Covered	48
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $5,941
Total amount of fees paid to insurance company	USD $679
Other welfare benefits provided	VOLUTNARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $34,814
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $971
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker name	HAROLD HUGHES INSURANCE

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

ZA853

Policy instance

Insurance contract or identification number	ZA853
Number of Individuals Covered	1
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $54
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $457
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
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	RANDAL R YURCZYK

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00447150

Policy instance

Insurance contract or identification number	00447150
Number of Individuals Covered	582
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $10,382
Total amount of fees paid to insurance company	USD $9,175
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $280,589
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,244
Amount paid for insurance broker fees	9175
Additional information about fees paid to insurance broker	OTHER FEES
Insurance broker organization code?	3
Insurance broker name	ASSUREX AGENCY INC

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

56391

Policy instance

Insurance contract or identification number	56391
Number of Individuals Covered	24
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $4,690
Total amount of fees paid to insurance company	USD $432
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $20,529
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $901
Insurance broker organization code?	3
Amount paid for insurance broker fees	127
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker name	G DIANE THOMPSON

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

0KCK7

Policy instance

Insurance contract or identification number	0KCK7
Number of Individuals Covered	24
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $4,286
Total amount of fees paid to insurance company	USD $114
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $18,968
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $800
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker name	MICHAEL K HALL

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

D0097

Policy instance

Insurance contract or identification number	D0097
Number of Individuals Covered	47
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $6,632
Total amount of fees paid to insurance company	USD $794
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $33,124
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,198
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker name	LLOYD W HUGHES

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

F3G07

Policy instance

Insurance contract or identification number	F3G07
Number of Individuals Covered	3
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $1,207
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $2,182
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $360
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	ROBERT W BURGETT

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

56391

Policy instance

Insurance contract or identification number	56391
Number of Individuals Covered	28
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $5,777
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $21,562
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,378
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	G DIANE THOMPSON

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

G0630

Policy instance

Insurance contract or identification number	G0630
Number of Individuals Covered	55
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $10,021
Total amount of fees paid to insurance company	USD $8
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $41,002
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,593
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker name	JOHN TYLER & ASSOCIATES

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

DJB12

Policy instance

Insurance contract or identification number	DJB12
Number of Individuals Covered	24
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $3,557
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $14,888
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,052
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	J THEIS & ASSOCIATES INC

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

DHA39

Policy instance

Insurance contract or identification number	DHA39
Number of Individuals Covered	33
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $5,871
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $17,305
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,589
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	JL BASS & ASSOCIATES

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00447150

Policy instance

Insurance contract or identification number	00447150
Number of Individuals Covered	375
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $7,620
Total amount of fees paid to insurance company	USD $2,580
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $254,016
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,620
Amount paid for insurance broker fees	2580
Additional information about fees paid to insurance broker	OTHER FEES
Insurance broker organization code?	3
Insurance broker name	MJ INSURANCE INC.

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

ZA853

Policy instance

Insurance contract or identification number	ZA853
Number of Individuals Covered	3
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $391
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $2,700
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $61
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	KEVIN M VERST

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

RQ924

Policy instance

Insurance contract or identification number	RQ924
Number of Individuals Covered	16
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $1,997
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $9,125
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $423
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	BRIAN LEE WYNDHAM

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

0KCK7

Policy instance

Insurance contract or identification number	0KCK7
Number of Individuals Covered	27
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $3,607
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $18,470
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $534
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	RICHARD L PITMAN

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

56391

Policy instance

Insurance contract or identification number	56391
Number of Individuals Covered	31
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $2,906
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $18,490
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $351
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	JAMES R HARROLD

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

ZA853

Policy instance

Insurance contract or identification number	ZA853
Number of Individuals Covered	8
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $872
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	VOLUNTARY WORKPLACE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $4,219
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $121
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	GREGORY AND APEL INC

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00447150

Policy instance

Insurance contract or identification number	00447150
Number of Individuals Covered	329
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $23,975
Total amount of fees paid to insurance company	USD $7,020
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $238,507
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $17,696
Amount paid for insurance broker fees	7020
Additional information about fees paid to insurance broker	OTHER FEES
Insurance broker organization code?	3
Insurance broker name	MJ INSURANCE INC.

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

RQ924

Policy instance

Insurance contract or identification number	RQ924
Number of Individuals Covered	18
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $1,049
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $8,305
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $245
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	ROBERT J MENGE

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

0730623

Policy instance

Insurance contract or identification number	0730623
Number of Individuals Covered	78
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $84,603
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,461,267
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $84,174
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	MJ INSURANCE INC.

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

OKCK7

Policy instance

Insurance contract or identification number	OKCK7
Number of Individuals Covered	25
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $3,609
Total amount of fees paid to insurance company	USD $14
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $18,170
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $581
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker name	LLOYD W HUGHES

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

D0097

Policy instance

Insurance contract or identification number	D0097
Number of Individuals Covered	62
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $5,018
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $27,609
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $836
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	LLOYD W HUGHES

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

DJB12

Policy instance

Insurance contract or identification number	DJB12
Number of Individuals Covered	21
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $2,770
Total amount of fees paid to insurance company	USD $85
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $15,190
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $557
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker name	WARREN REID HAVENOR

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

G0630

Policy instance

Insurance contract or identification number	G0630
Number of Individuals Covered	56
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $4,608
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $33,379
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,168
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	REMECS INC

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

DHA39

Policy instance

Insurance contract or identification number	DHA39
Number of Individuals Covered	26
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $2,851
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $11,186
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $805
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	NATHAN L HARRISON

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

RQ924

Policy instance

Insurance contract or identification number	RQ924
Number of Individuals Covered	19
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $2,515
Total amount of fees paid to insurance company	USD $169
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $10,734
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

0730623

Policy instance

Insurance contract or identification number	0730623
Number of Individuals Covered	77
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $99,677
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,406,177
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

G0630

Policy instance

Insurance contract or identification number	G0630
Number of Individuals Covered	48
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $6,239
Total amount of fees paid to insurance company	USD $509
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $40,256
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

00447150

Policy instance

Insurance contract or identification number	00447150
Number of Individuals Covered	259
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $16,080
Total amount of fees paid to insurance company	USD $529
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $231,259
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

0KCK7

Policy instance

Insurance contract or identification number	0KCK7
Number of Individuals Covered	33
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $3,695
Total amount of fees paid to insurance company	USD $173
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $23,158
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

DHA39

Policy instance

Insurance contract or identification number	DHA39
Number of Individuals Covered	12
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $3,112
Total amount of fees paid to insurance company	USD $237
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $11,530
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

56391

Policy instance

Insurance contract or identification number	56391
Number of Individuals Covered	34
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $5,227
Total amount of fees paid to insurance company	USD $464
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $24,394
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

DJB12

Policy instance

Insurance contract or identification number	DJB12
Number of Individuals Covered	16
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $2,870
Total amount of fees paid to insurance company	USD $87
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $14,983
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

ZA853

Policy instance

Insurance contract or identification number	ZA853
Number of Individuals Covered	6
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $500
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $1,933
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

D0097

Policy instance

Insurance contract or identification number	D0097
Number of Individuals Covered	40
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $3,106
Total amount of fees paid to insurance company	USD $155
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $23,322
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

D0097

Policy instance

Insurance contract or identification number	D0097
Number of Individuals Covered	31
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $4,756
Total amount of fees paid to insurance company	USD $173
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $25,270
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,298
Amount paid for insurance broker fees	43
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker organization code?	3
Insurance broker name	MARSHA HUGHES

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

0KCK7

Policy instance

Insurance contract or identification number	0KCK7
Number of Individuals Covered	30
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $5,905
Total amount of fees paid to insurance company	USD $286
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $26,405
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,420
Amount paid for insurance broker fees	89
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker organization code?	3
Insurance broker name	JAMES BURRESS

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

G0630

Policy instance

Insurance contract or identification number	G0630
Number of Individuals Covered	56
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $8,154
Total amount of fees paid to insurance company	USD $162
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $41,787
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,408
Amount paid for insurance broker fees	51
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker organization code?	3
Insurance broker name	MARSHA HUGHES

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

DHA39

Policy instance

Insurance contract or identification number	DHA39
Number of Individuals Covered	15
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $1,425
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $5,126
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $357
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	SHEPHERD INS LLC

ANTHEM INSURANCE COMPANIES, INC (National Association of Insurance Commissioners NAIC id number: 28207 )

Policy contract number

000007531

Policy instance

Insurance contract or identification number	000007531
Number of Individuals Covered	524
Insurance policy start date	2009-11-01
Insurance policy end date	2010-10-31
Total amount of commissions paid to insurance broker	USD $70,602
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $70,602
Insurance broker organization code?	3
Insurance broker name	STONER INSURANCE INC.

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

0730623

Policy instance

Insurance contract or identification number	0730623
Insurance policy start date	2010-11-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

ZA853

Policy instance

Insurance contract or identification number	ZA853
Number of Individuals Covered	3
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $648
Total amount of fees paid to insurance company	USD $107
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $2,020
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $168
Amount paid for insurance broker fees	31
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker organization code?	3
Insurance broker name	JOHN TYLER & ASSOCIATES

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

DJB12

Policy instance

Insurance contract or identification number	DJB12
Number of Individuals Covered	21
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $2,109
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $11,826
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $285
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	GEORGIA CANNADY

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

56391

Policy instance

Insurance contract or identification number	56391
Number of Individuals Covered	32
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $6,459
Total amount of fees paid to insurance company	USD $133
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $23,218
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,445
Amount paid for insurance broker fees	41
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker organization code?	3
Insurance broker name	BOBBIE BROOKS

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00447150

Policy instance

Insurance contract or identification number	00447150
Number of Individuals Covered	254
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $1,899
Total amount of fees paid to insurance company	USD $584
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $18,222
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,551
Insurance broker organization code?	3
Amount paid for insurance broker fees	584
Additional information about fees paid to insurance broker	OTHER FEES
Insurance broker name	HORIZON PLANNING GROUP

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

RQ924

Policy instance

Insurance contract or identification number	RQ924
Number of Individuals Covered	16
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $2,580
Total amount of fees paid to insurance company	USD $105
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $10,317
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $519
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker name	ROBERT MENGE

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

RQ924

Policy instance

Insurance contract or identification number	RQ924
Number of Individuals Covered	17
Insurance policy start date	2009-01-01
Insurance policy end date	2009-12-31
Total amount of commissions paid to insurance broker	USD $2,923
Total amount of fees paid to insurance company	USD $87
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $10,799
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $583
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker name	HARROLD HUGHES INSURANCE

ANTHEM INSURANCE COMPANIES, INC (National Association of Insurance Commissioners NAIC id number: 28207 )

Policy contract number

000007531

Policy instance

Insurance contract or identification number	000007531
Insurance policy start date	2008-11-01
Insurance policy end date	2009-10-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

ZA853

Policy instance

Insurance contract or identification number	ZA853
Number of Individuals Covered	4
Insurance policy start date	2009-01-01
Insurance policy end date	2009-12-31
Total amount of commissions paid to insurance broker	USD $1,097
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $2,066
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $302
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	JOHN TYLER & ASSOCIATES

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

D0097

Policy instance

Insurance contract or identification number	D0097
Number of Individuals Covered	44
Insurance policy start date	2009-01-01
Insurance policy end date	2009-12-31
Total amount of commissions paid to insurance broker	USD $6,287
Total amount of fees paid to insurance company	USD $418
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $31,740
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,652
Amount paid for insurance broker fees	72
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker organization code?	3
Insurance broker name	INEZ LEWIS

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

56391

Policy instance

Insurance contract or identification number	56391
Number of Individuals Covered	29
Insurance policy start date	2009-01-01
Insurance policy end date	2009-12-31
Total amount of commissions paid to insurance broker	USD $3,724
Total amount of fees paid to insurance company	USD $149
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $18,798
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $950
Amount paid for insurance broker fees	24
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker organization code?	3
Insurance broker name	NORMA DUNCAN

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

0KCK7

Policy instance

Insurance contract or identification number	0KCK7
Number of Individuals Covered	31
Insurance policy start date	2009-01-01
Insurance policy end date	2009-12-31
Total amount of commissions paid to insurance broker	USD $4,833
Total amount of fees paid to insurance company	USD $86
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $23,720
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,108
Amount paid for insurance broker fees	34
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker organization code?	3
Insurance broker name	MINON MARSH-STEPP

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00447150

Policy instance

Insurance contract or identification number	00447150
Number of Individuals Covered	19
Insurance policy start date	2009-05-01
Insurance policy end date	2009-12-31
Total amount of commissions paid to insurance broker	USD $1,253
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $11,686
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
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	SHEPHERD INSURANCE LLC

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

G0630

Policy instance

Insurance contract or identification number	G0630
Number of Individuals Covered	56
Insurance policy start date	2009-01-01
Insurance policy end date	2009-12-31
Total amount of commissions paid to insurance broker	USD $7,245
Total amount of fees paid to insurance company	USD $488
Other welfare benefits provided	VOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $40,941
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,301
Amount paid for insurance broker fees	98
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker organization code?	3
Insurance broker name	JASON NAVILLE

Potentially related plans

ANDY MOHR AUTOMOTIVE 401(K) PLAN [EIN = 841692452]

Was this data useful?

If you found the data here useful, PLEASE HELP US. We are a start-up and believe in making information freely available. By linking to us, posting on twitter, facebook and linkedin about us and generally spreading the word, you'll help us to grow. Our vision is to provide high quality data about the activities of all the companies in the world and where possible make it free to use and view. Finding and integrating data from thousands of data sources is time consuming and needs lots of effort. By simply spreading the word about us, you will help us. Please use the share buttons. It will only take a few seconds of your time. Thanks for helping

Information Disclaimer

The information provided on this website is not advice, endorsement or recommendation
The information published is supplied by third parties so we make no warranty on the accuracy, completeness etc. This information is provided "as-is". The information is subject to change as we obtain updates and corrections from the primary information sources.
You are free to use the information for your own personal research on the understanding to do so is at your own risk.

See full terms and conditions

Company Name:	ANDY MOHR AUTOMOTIVE GROUP, INC.
Employer identification number (EIN):	208324241
NAIC Classification:	441110
NAIC Description:	New Car Dealers