401k Plan data: THE NUTRITION GROUP HEALTH AND WELFARE PLAN plan

THE NUTRITION GROUP HEALTH AND WELFARE PLAN 401k Plan overview

Plan Name	THE NUTRITION GROUP HEALTH AND WELFARE PLAN
Plan identification number	503

THE NUTRITION GROUP HEALTH AND WELFARE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Long-term disability cover Severance pay Other welfare benefit cover

401k Sponsoring company profile

NUTRITION, INC. 401K PLAN has sponsored the creation of one or more 401k plans.

Company Name: NUTRITION, INC. 401K PLAN

Employer identification number (EIN): 251272788

NAIC Classification: 722300
NAIC Description: Special Food Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan THE NUTRITION GROUP HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2023-01-01 IAN O'BRIEN 2024-07-25
503 2022-01-01 HILLARY MORGAN 2023-03-28
503 2021-01-01 HILLARY MORGAN 2023-03-28
503 2019-01-01 HILLARY MORGAN 2023-03-28

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
503	2023-01-01	IAN O'BRIEN	2024-07-25
503	2022-01-01	HILLARY MORGAN	2023-03-28
503	2021-01-01	HILLARY MORGAN	2023-03-28
503	2019-01-01	HILLARY MORGAN	2023-03-28

Plan Statistics for THE NUTRITION GROUP HEALTH AND WELFARE PLAN

401k plan membership statisitcs for THE NUTRITION GROUP HEALTH AND WELFARE PLAN

Measure Date Value
2023: THE NUTRITION GROUP HEALTH AND WELFARE PLAN 2023 401k membership
Total participants, beginning-of-year 2023-01-01 2,897
Total number of active participants reported on line 7a of the Form 5500 2023-01-01 3,409
Number of retired or separated participants receiving benefits 2023-01-01 2
Total of all active and inactive participants 2023-01-01 3,411
2022: THE NUTRITION GROUP HEALTH AND WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 3,088
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 3,418
Number of retired or separated participants receiving benefits 2022-01-01 34
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 3,452
2021: THE NUTRITION GROUP HEALTH AND WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 2,884
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 3,059
Number of retired or separated participants receiving benefits 2021-01-01 33
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 3,092
2019: THE NUTRITION GROUP HEALTH AND WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 3,236
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 3,285
Number of retired or separated participants receiving benefits 2019-01-01 32
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 3,317

Measure	Date	Value
2023: THE NUTRITION GROUP HEALTH AND WELFARE PLAN 2023 401k membership
Total participants, beginning-of-year	2023-01-01	2,897
Total number of active participants reported on line 7a of the Form 5500	2023-01-01	3,409
Number of retired or separated participants receiving benefits	2023-01-01	2
Total of all active and inactive participants	2023-01-01	3,411
2022: THE NUTRITION GROUP HEALTH AND WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	3,088
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	3,418
Number of retired or separated participants receiving benefits	2022-01-01	34
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	3,452
2021: THE NUTRITION GROUP HEALTH AND WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	2,884
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	3,059
Number of retired or separated participants receiving benefits	2021-01-01	33
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	3,092
2019: THE NUTRITION GROUP HEALTH AND WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	3,236
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	3,285
Number of retired or separated participants receiving benefits	2019-01-01	32
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	3,317

Form 5500 Responses for THE NUTRITION GROUP HEALTH AND WELFARE PLAN

2023: THE NUTRITION GROUP HEALTH AND WELFARE PLAN 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
2023-01-01	Plan is a collectively bargained plan	Yes
2023-01-01	Plan funding arrangement – Insurance	Yes
2023-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2023-01-01	Plan benefit arrangement – Insurance	Yes
2023-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2022: THE NUTRITION GROUP HEALTH AND WELFARE PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Plan is a collectively bargained plan	Yes
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: THE NUTRITION GROUP HEALTH AND WELFARE PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan is a collectively bargained plan	Yes
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
2019: THE NUTRITION GROUP HEALTH AND WELFARE PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Plan is a collectively bargained plan	Yes
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

Insurance Providers Used on plan

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GVTL0BJ9H

Policy instance

Insurance contract or identification number	GVTL0BJ9H
Number of Individuals Covered	222
Insurance policy start date	2022-10-01
Insurance policy end date	2023-09-30
Total amount of commissions paid to insurance broker	USD $4,003
Total amount of fees paid to insurance company	USD $3,093
Other welfare benefits provided	LIFE & AD&D VOLUNTARY
Welfare Benefit Premiums Paid to Carrier	USD $43,947
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUDH0BJ9H

Policy instance

Insurance contract or identification number	GUDH0BJ9H
Number of Individuals Covered	173
Insurance policy start date	2022-10-01
Insurance policy end date	2023-09-30
Total amount of commissions paid to insurance broker	USD $3,385
Total amount of fees paid to insurance company	USD $1,899
Other welfare benefits provided	ACCIDENT ONLY VOLUNTARY
Welfare Benefit Premiums Paid to Carrier	USD $22,565
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUDE0BJ9H

Policy instance

Insurance contract or identification number	GUDE0BJ9H
Number of Individuals Covered	100
Insurance policy start date	2022-10-01
Insurance policy end date	2023-09-30
Total amount of commissions paid to insurance broker	USD $3,515
Total amount of fees paid to insurance company	USD $2,175
Other welfare benefits provided	CRITICAL ILLNESS VOLUNTARY
Welfare Benefit Premiums Paid to Carrier	USD $23,433
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0BJ9H

Policy instance

Insurance contract or identification number	GLUG0BJ9H
Number of Individuals Covered	2837
Insurance policy start date	2022-10-01
Insurance policy end date	2023-09-30
Total amount of commissions paid to insurance broker	USD $5,237
Total amount of fees paid to insurance company	USD $9,276
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $96,343
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLTD0BJ9H

Policy instance

Insurance contract or identification number	GLTD0BJ9H
Number of Individuals Covered	91
Insurance policy start date	2022-10-01
Insurance policy end date	2023-09-30
Total amount of commissions paid to insurance broker	USD $3,009
Total amount of fees paid to insurance company	USD $2,160
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $22,591
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )

Policy contract number

008067

Policy instance

Insurance contract or identification number	008067
Number of Individuals Covered	551
Insurance policy start date	2022-10-01
Insurance policy end date	2023-09-30
Total amount of commissions paid to insurance broker	USD $6,894
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $167,486
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUVH0BJ9H

Policy instance

Insurance contract or identification number	GUVH0BJ9H
Number of Individuals Covered	163
Insurance policy start date	2022-10-01
Insurance policy end date	2023-09-30
Total amount of commissions paid to insurance broker	USD $5,136
Total amount of fees paid to insurance company	USD $1,626
Other welfare benefits provided	HOSPITAL INDEMNITY
Welfare Benefit Premiums Paid to Carrier	USD $25,682
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )

Policy contract number

008067

Policy instance

Insurance contract or identification number	008067
Number of Individuals Covered	494
Insurance policy start date	2021-10-01
Insurance policy end date	2022-09-30
Total amount of commissions paid to insurance broker	USD $6,031
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $205,168
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,031
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GVTL0BJ9H

Policy instance

Insurance contract or identification number	GVTL0BJ9H
Number of Individuals Covered	164
Insurance policy start date	2021-10-01
Insurance policy end date	2022-09-30
Total amount of commissions paid to insurance broker	USD $3,131
Total amount of fees paid to insurance company	USD $2,059
Other welfare benefits provided	LIFE & AD&D VOLUNTARY
Welfare Benefit Premiums Paid to Carrier	USD $31,313
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,131
Amount paid for insurance broker fees	1235
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLTD0BJ9H

Policy instance

Insurance contract or identification number	GLTD0BJ9H
Number of Individuals Covered	87
Insurance policy start date	2021-10-01
Insurance policy end date	2022-09-30
Total amount of commissions paid to insurance broker	USD $2,998
Total amount of fees paid to insurance company	USD $1,390
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $21,999
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,998
Amount paid for insurance broker fees	834
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0BJ9H

Policy instance

Insurance contract or identification number	GLUG0BJ9H
Number of Individuals Covered	2455
Insurance policy start date	2021-10-01
Insurance policy end date	2022-09-30
Total amount of commissions paid to insurance broker	USD $5,327
Total amount of fees paid to insurance company	USD $5,283
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $95,255
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,327
Amount paid for insurance broker fees	3170
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUDE0BJ9H

Policy instance

Insurance contract or identification number	GUDE0BJ9H
Number of Individuals Covered	83
Insurance policy start date	2021-10-01
Insurance policy end date	2022-09-30
Total amount of commissions paid to insurance broker	USD $3,310
Total amount of fees paid to insurance company	USD $2,047
Other welfare benefits provided	CRITICAL ILLNESS VOLUNTARY
Welfare Benefit Premiums Paid to Carrier	USD $22,067
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,310
Amount paid for insurance broker fees	1228
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUDH0BJ9H

Policy instance

Insurance contract or identification number	GUDH0BJ9H
Number of Individuals Covered	147
Insurance policy start date	2021-10-01
Insurance policy end date	2022-09-30
Total amount of commissions paid to insurance broker	USD $2,924
Total amount of fees paid to insurance company	USD $1,429
Other welfare benefits provided	ACCIDENT ONLY VOLUNTARY
Welfare Benefit Premiums Paid to Carrier	USD $19,495
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,924
Amount paid for insurance broker fees	857
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

R0652263

Policy instance

Insurance contract or identification number	R0652263
Number of Individuals Covered	186
Insurance policy start date	2021-10-01
Insurance policy end date	2022-09-30
Total amount of commissions paid to insurance broker	USD $4,500
Total amount of fees paid to insurance company	USD $699
Other welfare benefits provided	GCIEE, GRPACCVO, GRPHSPVOEN
Welfare Benefit Premiums Paid to Carrier	USD $25,951
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,250
Amount paid for insurance broker fees	699
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GVTL0BJ9H

Policy instance

Insurance contract or identification number	GVTL0BJ9H
Number of Individuals Covered	157
Insurance policy start date	2020-10-01
Insurance policy end date	2021-09-30
Total amount of commissions paid to insurance broker	USD $2,759
Total amount of fees paid to insurance company	USD $2,252
Other welfare benefits provided	LIFE & AD&D VOLUNTARY
Welfare Benefit Premiums Paid to Carrier	USD $28,093
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,759
Amount paid for insurance broker fees	1501
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

R0652263

Policy instance

Insurance contract or identification number	R0652263
Number of Individuals Covered	121
Insurance policy start date	2020-10-01
Insurance policy end date	2021-09-30
Total amount of commissions paid to insurance broker	USD $3,390
Total amount of fees paid to insurance company	USD $262
Other welfare benefits provided	GCIEE, GRPACCVO, GRPHSPVOEN
Welfare Benefit Premiums Paid to Carrier	USD $17,033
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,695
Amount paid for insurance broker fees	262
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )

Policy contract number

008067

Policy instance

Insurance contract or identification number	008067
Number of Individuals Covered	445
Insurance policy start date	2020-10-01
Insurance policy end date	2021-09-30
Total amount of commissions paid to insurance broker	USD $5,564
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $196,653
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,564
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUDH0BJ9H

Policy instance

Insurance contract or identification number	GUDH0BJ9H
Number of Individuals Covered	134
Insurance policy start date	2020-10-01
Insurance policy end date	2021-09-30
Total amount of commissions paid to insurance broker	USD $2,888
Total amount of fees paid to insurance company	USD $828
Other welfare benefits provided	ACCIDENT ONLY VOLUNTARY
Welfare Benefit Premiums Paid to Carrier	USD $19,254
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,888
Amount paid for insurance broker fees	446
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUDE0BJ9H

Policy instance

Insurance contract or identification number	GUDE0BJ9H
Number of Individuals Covered	139
Insurance policy start date	2020-10-01
Insurance policy end date	2021-09-30
Total amount of commissions paid to insurance broker	USD $4,199
Total amount of fees paid to insurance company	USD $1,337
Other welfare benefits provided	CRITICAL ILLNESS VOLUNTARY
Welfare Benefit Premiums Paid to Carrier	USD $27,995
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,199
Amount paid for insurance broker fees	720
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0BJ9H

Policy instance

Insurance contract or identification number	GLUG0BJ9H
Number of Individuals Covered	1870
Insurance policy start date	2020-10-01
Insurance policy end date	2021-09-30
Total amount of commissions paid to insurance broker	USD $4,552
Total amount of fees paid to insurance company	USD $5,668
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $70,164
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,552
Amount paid for insurance broker fees	3779
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLTD0BJ9H

Policy instance

Insurance contract or identification number	GLTD0BJ9H
Number of Individuals Covered	86
Insurance policy start date	2020-10-01
Insurance policy end date	2021-09-30
Total amount of commissions paid to insurance broker	USD $2,629
Total amount of fees paid to insurance company	USD $1,171
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $18,194
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,629
Amount paid for insurance broker fees	781
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0BJ9H

Policy instance

Insurance contract or identification number	GLUG0BJ9H
Number of Individuals Covered	1870
Insurance policy start date	2019-05-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $3,948
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $48,962
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,948
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GVTL0BJ9H

Policy instance

Insurance contract or identification number	GVTL0BJ9H
Number of Individuals Covered	157
Insurance policy start date	2019-05-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $1,884
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	VOLUNTARY LIFE, AD&D
Welfare Benefit Premiums Paid to Carrier	USD $18,835
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,884
Insurance broker organization code?	3

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

5486235

Policy instance

Insurance contract or identification number	5486235
Number of Individuals Covered	421
Insurance policy start date	2018-10-01
Insurance policy end date	2019-09-30
Total amount of commissions paid to insurance broker	USD $3,958
Total amount of fees paid to insurance company	USD $2,000
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $131,965
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,958
Amount paid for insurance broker fees	2000
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

701187

Policy instance

Insurance contract or identification number	701187
Number of Individuals Covered	1012
Insurance policy start date	2018-10-01
Insurance policy end date	2019-04-30
Total amount of commissions paid to insurance broker	USD $2,740
Total amount of fees paid to insurance company	USD $294
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $39,182
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,740
Amount paid for insurance broker fees	294
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

701195

Policy instance

Insurance contract or identification number	701195
Number of Individuals Covered	146
Insurance policy start date	2018-10-01
Insurance policy end date	2019-04-30
Total amount of commissions paid to insurance broker	USD $2,072
Total amount of fees paid to insurance company	USD $104
Other welfare benefits provided	VOLUNTARY LIFE, AD&D
Welfare Benefit Premiums Paid to Carrier	USD $13,810
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,072
Amount paid for insurance broker fees	104
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )

Policy contract number

008067

Policy instance

Insurance contract or identification number	008067
Number of Individuals Covered	410
Insurance policy start date	2018-10-01
Insurance policy end date	2019-09-30
Total amount of commissions paid to insurance broker	USD $1,163
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $38,925
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,163
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLTD0BJ9H

Policy instance

Insurance contract or identification number	GLTD0BJ9H
Number of Individuals Covered	93
Insurance policy start date	2019-05-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $1,396
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $9,306
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,396
Insurance broker organization code?	3

Potentially related plans

THE NUTRITION COALITION 401(K) PLAN [EIN = 814498321]

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Company Name:	NUTRITION, INC. 401K PLAN
Employer identification number (EIN):	251272788
NAIC Classification:	722300
NAIC Description:	Special Food Services