401k Plan data: UNIVERSITY OF NORTHWESTERN OHIO PREMIUM CONVERSION PLAN plan

UNIVERSITY OF NORTHWESTERN OHIO PREMIUM CONVERSION PLAN 401k Plan overview

Plan Name	UNIVERSITY OF NORTHWESTERN OHIO PREMIUM CONVERSION PLAN
Plan identification number	501

UNIVERSITY OF NORTHWESTERN OHIO PREMIUM CONVERSION PLAN Benefits

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

401k Sponsoring company profile

UNIVERSITY OF NORTHWESTERN OHIO has sponsored the creation of one or more 401k plans.

Company Name: UNIVERSITY OF NORTHWESTERN OHIO

Employer identification number (EIN): 341695897

NAIC Classification: 611000

Additional information about UNIVERSITY OF NORTHWESTERN OHIO

Jurisdiction of Incorporation: Ohio Secretary of State Business Services Division

Incorporation Date: 1991-11-01

Company Identification Number: 806466

Legal Registered Office Address: 1441 NORTH CABLE ROAD
-
LIMA
United States of America (USA)
45805

More information about UNIVERSITY OF NORTHWESTERN OHIO

Form 5500 Filing Information

Submission information for form 5500 for 401k plan UNIVERSITY OF NORTHWESTERN OHIO PREMIUM CONVERSION PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-07-01 JAMES BRONDER 2024-03-18
501 2021-07-01 JAMES BRONDER 2022-11-28
501 2020-07-01 JAMES BRONDER 2022-01-05
501 2019-07-01 JAMES BRONDER 2021-03-24
501 2018-07-01 JAMES BRONDER 2020-01-22
501 2017-07-01
501 2016-07-01
501 2015-07-01
501 2014-07-01
501 2013-07-01
501 2012-07-01 JOYCE A. DULWORTH
501 2011-07-01 JOYCE A. DULWORTH

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2022-07-01	JAMES BRONDER	2024-03-18
501	2021-07-01	JAMES BRONDER	2022-11-28
501	2020-07-01	JAMES BRONDER	2022-01-05
501	2019-07-01	JAMES BRONDER	2021-03-24
501	2018-07-01	JAMES BRONDER	2020-01-22
501	2017-07-01
501	2016-07-01
501	2015-07-01
501	2014-07-01
501	2013-07-01
501	2012-07-01	JOYCE A. DULWORTH
501	2011-07-01	JOYCE A. DULWORTH

Plan Statistics for UNIVERSITY OF NORTHWESTERN OHIO PREMIUM CONVERSION PLAN

401k plan membership statisitcs for UNIVERSITY OF NORTHWESTERN OHIO PREMIUM CONVERSION PLAN

Measure Date Value
2022: UNIVERSITY OF NORTHWESTERN OHIO PREMIUM CONVERSION PLAN 2022 401k membership
Total participants, beginning-of-year 2022-07-01 286
Total number of active participants reported on line 7a of the Form 5500 2022-07-01 301
Total of all active and inactive participants 2022-07-01 301
Total participants 2022-07-01 301
2021: UNIVERSITY OF NORTHWESTERN OHIO PREMIUM CONVERSION PLAN 2021 401k membership
Total participants, beginning-of-year 2021-07-01 277
Total number of active participants reported on line 7a of the Form 5500 2021-07-01 286
Total of all active and inactive participants 2021-07-01 286
Total participants 2021-07-01 286
2020: UNIVERSITY OF NORTHWESTERN OHIO PREMIUM CONVERSION PLAN 2020 401k membership
Total participants, beginning-of-year 2020-07-01 281
Total number of active participants reported on line 7a of the Form 5500 2020-07-01 277
Total of all active and inactive participants 2020-07-01 277
Total participants 2020-07-01 277
2019: UNIVERSITY OF NORTHWESTERN OHIO PREMIUM CONVERSION PLAN 2019 401k membership
Total participants, beginning-of-year 2019-07-01 316
Total number of active participants reported on line 7a of the Form 5500 2019-07-01 281
Total of all active and inactive participants 2019-07-01 281
Total participants 2019-07-01 281
2018: UNIVERSITY OF NORTHWESTERN OHIO PREMIUM CONVERSION PLAN 2018 401k membership
Total participants, beginning-of-year 2018-07-01 332
Total number of active participants reported on line 7a of the Form 5500 2018-07-01 316
Total of all active and inactive participants 2018-07-01 316
Total participants 2018-07-01 316
2017: UNIVERSITY OF NORTHWESTERN OHIO PREMIUM CONVERSION PLAN 2017 401k membership
Total participants, beginning-of-year 2017-07-01 334
Total number of active participants reported on line 7a of the Form 5500 2017-07-01 332
Total of all active and inactive participants 2017-07-01 332
Total participants 2017-07-01 332
2016: UNIVERSITY OF NORTHWESTERN OHIO PREMIUM CONVERSION PLAN 2016 401k membership
Total participants, beginning-of-year 2016-07-01 323
Total number of active participants reported on line 7a of the Form 5500 2016-07-01 334
Total of all active and inactive participants 2016-07-01 334
Total participants 2016-07-01 334
2015: UNIVERSITY OF NORTHWESTERN OHIO PREMIUM CONVERSION PLAN 2015 401k membership
Total participants, beginning-of-year 2015-07-01 431
Total number of active participants reported on line 7a of the Form 5500 2015-07-01 323
Total of all active and inactive participants 2015-07-01 323
Total participants 2015-07-01 323
2014: UNIVERSITY OF NORTHWESTERN OHIO PREMIUM CONVERSION PLAN 2014 401k membership
Total participants, beginning-of-year 2014-07-01 456
Total of all active and inactive participants 2014-07-01 0
Total participants 2014-07-01 0
2013: UNIVERSITY OF NORTHWESTERN OHIO PREMIUM CONVERSION PLAN 2013 401k membership
Total participants, beginning-of-year 2013-07-01 437
Total number of active participants reported on line 7a of the Form 5500 2013-07-01 456
Total of all active and inactive participants 2013-07-01 456
Total participants 2013-07-01 456
2012: UNIVERSITY OF NORTHWESTERN OHIO PREMIUM CONVERSION PLAN 2012 401k membership
Total participants, beginning-of-year 2012-07-01 470
Total number of active participants reported on line 7a of the Form 5500 2012-07-01 437
Total of all active and inactive participants 2012-07-01 437
Total participants 2012-07-01 437
2011: UNIVERSITY OF NORTHWESTERN OHIO PREMIUM CONVERSION PLAN 2011 401k membership
Total participants, beginning-of-year 2011-07-01 465
Total number of active participants reported on line 7a of the Form 5500 2011-07-01 470
Total of all active and inactive participants 2011-07-01 470
Total participants 2011-07-01 470

Measure	Date	Value
2022: UNIVERSITY OF NORTHWESTERN OHIO PREMIUM CONVERSION PLAN 2022 401k membership
Total participants, beginning-of-year	2022-07-01	286
Total number of active participants reported on line 7a of the Form 5500	2022-07-01	301
Total of all active and inactive participants	2022-07-01	301
Total participants	2022-07-01	301
2021: UNIVERSITY OF NORTHWESTERN OHIO PREMIUM CONVERSION PLAN 2021 401k membership
Total participants, beginning-of-year	2021-07-01	277
Total number of active participants reported on line 7a of the Form 5500	2021-07-01	286
Total of all active and inactive participants	2021-07-01	286
Total participants	2021-07-01	286
2020: UNIVERSITY OF NORTHWESTERN OHIO PREMIUM CONVERSION PLAN 2020 401k membership
Total participants, beginning-of-year	2020-07-01	281
Total number of active participants reported on line 7a of the Form 5500	2020-07-01	277
Total of all active and inactive participants	2020-07-01	277
Total participants	2020-07-01	277
2019: UNIVERSITY OF NORTHWESTERN OHIO PREMIUM CONVERSION PLAN 2019 401k membership
Total participants, beginning-of-year	2019-07-01	316
Total number of active participants reported on line 7a of the Form 5500	2019-07-01	281
Total of all active and inactive participants	2019-07-01	281
Total participants	2019-07-01	281
2018: UNIVERSITY OF NORTHWESTERN OHIO PREMIUM CONVERSION PLAN 2018 401k membership
Total participants, beginning-of-year	2018-07-01	332
Total number of active participants reported on line 7a of the Form 5500	2018-07-01	316
Total of all active and inactive participants	2018-07-01	316
Total participants	2018-07-01	316
2017: UNIVERSITY OF NORTHWESTERN OHIO PREMIUM CONVERSION PLAN 2017 401k membership
Total participants, beginning-of-year	2017-07-01	334
Total number of active participants reported on line 7a of the Form 5500	2017-07-01	332
Total of all active and inactive participants	2017-07-01	332
Total participants	2017-07-01	332
2016: UNIVERSITY OF NORTHWESTERN OHIO PREMIUM CONVERSION PLAN 2016 401k membership
Total participants, beginning-of-year	2016-07-01	323
Total number of active participants reported on line 7a of the Form 5500	2016-07-01	334
Total of all active and inactive participants	2016-07-01	334
Total participants	2016-07-01	334
2015: UNIVERSITY OF NORTHWESTERN OHIO PREMIUM CONVERSION PLAN 2015 401k membership
Total participants, beginning-of-year	2015-07-01	431
Total number of active participants reported on line 7a of the Form 5500	2015-07-01	323
Total of all active and inactive participants	2015-07-01	323
Total participants	2015-07-01	323
2014: UNIVERSITY OF NORTHWESTERN OHIO PREMIUM CONVERSION PLAN 2014 401k membership
Total participants, beginning-of-year	2014-07-01	456
Total of all active and inactive participants	2014-07-01	0
Total participants	2014-07-01	0
2013: UNIVERSITY OF NORTHWESTERN OHIO PREMIUM CONVERSION PLAN 2013 401k membership
Total participants, beginning-of-year	2013-07-01	437
Total number of active participants reported on line 7a of the Form 5500	2013-07-01	456
Total of all active and inactive participants	2013-07-01	456
Total participants	2013-07-01	456
2012: UNIVERSITY OF NORTHWESTERN OHIO PREMIUM CONVERSION PLAN 2012 401k membership
Total participants, beginning-of-year	2012-07-01	470
Total number of active participants reported on line 7a of the Form 5500	2012-07-01	437
Total of all active and inactive participants	2012-07-01	437
Total participants	2012-07-01	437
2011: UNIVERSITY OF NORTHWESTERN OHIO PREMIUM CONVERSION PLAN 2011 401k membership
Total participants, beginning-of-year	2011-07-01	465
Total number of active participants reported on line 7a of the Form 5500	2011-07-01	470
Total of all active and inactive participants	2011-07-01	470
Total participants	2011-07-01	470

Form 5500 Responses for UNIVERSITY OF NORTHWESTERN OHIO PREMIUM CONVERSION PLAN

2022: UNIVERSITY OF NORTHWESTERN OHIO PREMIUM CONVERSION PLAN 2022 form 5500 responses
2022-07-01	Type of plan entity	Single employer plan
2022-07-01	Plan funding arrangement – Insurance	Yes
2022-07-01	Plan benefit arrangement – Insurance	Yes
2021: UNIVERSITY OF NORTHWESTERN OHIO PREMIUM CONVERSION PLAN 2021 form 5500 responses
2021-07-01	Type of plan entity	Single employer plan
2021-07-01	Plan funding arrangement – Insurance	Yes
2021-07-01	Plan benefit arrangement – Insurance	Yes
2020: UNIVERSITY OF NORTHWESTERN OHIO PREMIUM CONVERSION PLAN 2020 form 5500 responses
2020-07-01	Type of plan entity	Single employer plan
2020-07-01	Plan funding arrangement – Insurance	Yes
2020-07-01	Plan benefit arrangement – Insurance	Yes
2019: UNIVERSITY OF NORTHWESTERN OHIO PREMIUM CONVERSION PLAN 2019 form 5500 responses
2019-07-01	Type of plan entity	Single employer plan
2019-07-01	Plan funding arrangement – Insurance	Yes
2019-07-01	Plan benefit arrangement – Insurance	Yes
2018: UNIVERSITY OF NORTHWESTERN OHIO PREMIUM CONVERSION PLAN 2018 form 5500 responses
2018-07-01	Type of plan entity	Single employer plan
2018-07-01	Plan funding arrangement – Insurance	Yes
2018-07-01	Plan benefit arrangement – Insurance	Yes
2017: UNIVERSITY OF NORTHWESTERN OHIO PREMIUM CONVERSION PLAN 2017 form 5500 responses
2017-07-01	Type of plan entity	Single employer plan
2017-07-01	Plan funding arrangement – Insurance	Yes
2017-07-01	Plan benefit arrangement – Insurance	Yes
2016: UNIVERSITY OF NORTHWESTERN OHIO PREMIUM CONVERSION PLAN 2016 form 5500 responses
2016-07-01	Type of plan entity	Single employer plan
2016-07-01	Plan funding arrangement – Insurance	Yes
2016-07-01	Plan benefit arrangement – Insurance	Yes
2015: UNIVERSITY OF NORTHWESTERN OHIO PREMIUM CONVERSION PLAN 2015 form 5500 responses
2015-07-01	Type of plan entity	Single employer plan
2015-07-01	Plan funding arrangement – Insurance	Yes
2015-07-01	Plan benefit arrangement – Insurance	Yes
2014: UNIVERSITY OF NORTHWESTERN OHIO PREMIUM CONVERSION PLAN 2014 form 5500 responses
2014-07-01	Type of plan entity	Single employer plan
2014-07-01	Plan funding arrangement – Insurance	Yes
2014-07-01	Plan benefit arrangement – Insurance	Yes
2013: UNIVERSITY OF NORTHWESTERN OHIO PREMIUM CONVERSION PLAN 2013 form 5500 responses
2013-07-01	Type of plan entity	Single employer plan
2013-07-01	Plan funding arrangement – Insurance	Yes
2013-07-01	Plan benefit arrangement – Insurance	Yes
2012: UNIVERSITY OF NORTHWESTERN OHIO PREMIUM CONVERSION PLAN 2012 form 5500 responses
2012-07-01	Type of plan entity	Single employer plan
2012-07-01	Plan funding arrangement – Insurance	Yes
2012-07-01	Plan benefit arrangement – Insurance	Yes
2011: UNIVERSITY OF NORTHWESTERN OHIO PREMIUM CONVERSION PLAN 2011 form 5500 responses
2011-07-01	Type of plan entity	Single employer plan
2011-07-01	Plan funding arrangement – Insurance	Yes
2011-07-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

MEDICAL MUTUAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 29076 )

Policy contract number

0121073-01

Policy instance

Insurance contract or identification number	0121073-01
Number of Individuals Covered	158
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $45,784
Total amount of fees paid to insurance company	USD $22,829
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $9,460
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $45,784
Amount paid for insurance broker fees	22829
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

FLX967934

Policy instance

Insurance contract or identification number	FLX967934
Number of Individuals Covered	158
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $13,906
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	SL,DL,AD
Welfare Benefit Premiums Paid to Carrier	USD $85,758
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,863
Insurance broker organization code?	3

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

01003414400001

Policy instance

Insurance contract or identification number	01003414400001
Number of Individuals Covered	301
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $1,721
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $25,744
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,721
Insurance broker organization code?	3

DELTA DENTAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 54402 )

Policy contract number

0002273

Policy instance

Insurance contract or identification number	0002273
Number of Individuals Covered	303
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $5,064
Dental 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 $5,064
Insurance broker organization code?	3

DELTA DENTAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 54402 )

Policy contract number

0002273

Policy instance

Insurance contract or identification number	0002273
Number of Individuals Covered	320
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $5,178
Dental 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 $5,178
Insurance broker organization code?	3

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

01003414400001

Policy instance

Insurance contract or identification number	01003414400001
Number of Individuals Covered	286
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $1,796
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $27,885
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,796
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

FLX967934

Policy instance

Insurance contract or identification number	FLX967934
Number of Individuals Covered	169
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $18,203
Total amount of fees paid to insurance company	USD $1,286
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	SL,DL,AD
Welfare Benefit Premiums Paid to Carrier	USD $87,473
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,203
Amount paid for insurance broker fees	1286
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker organization code?	3

MEDICAL MUTUAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 29076 )

Policy contract number

0103954-01

Policy instance

Insurance contract or identification number	0103954-01
Number of Individuals Covered	169
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $49,917
Total amount of fees paid to insurance company	USD $22,516
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $10,147
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $49,917
Amount paid for insurance broker fees	22516
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker organization code?	3

DELTA DENTAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 54402 )

Policy contract number

0002273

Policy instance

Insurance contract or identification number	0002273
Number of Individuals Covered	326
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $5,420
Dental 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 $5,420
Insurance broker organization code?	3

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

01003414400001

Policy instance

Insurance contract or identification number	01003414400001
Number of Individuals Covered	277
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $1,789
Total amount of fees paid to insurance company	USD $281
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $27,666
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,789
Amount paid for insurance broker fees	281
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

FLX967934

Policy instance

Insurance contract or identification number	FLX967934
Number of Individuals Covered	177
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $8,287
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	SL,DL,AD
Welfare Benefit Premiums Paid to Carrier	USD $55,604
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,287
Insurance broker organization code?	3

MEDICAL MUTUAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 29076 )

Policy contract number

0093598-01

Policy instance

Insurance contract or identification number	0093598-01
Number of Individuals Covered	177
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $54,330
Total amount of fees paid to insurance company	USD $27,170
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $10,193
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $54,330
Amount paid for insurance broker fees	27170
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker organization code?	3

DELTA DENTAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 54402 )

Policy contract number

0002273

Policy instance

Insurance contract or identification number	0002273
Number of Individuals Covered	346
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $6,268
Total amount of fees paid to insurance company	USD $514
Dental 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 $6,268
Amount paid for insurance broker fees	514
Additional information about fees paid to insurance broker	NEW BUSINESS BONUS
Insurance broker organization code?	3

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

01003414400001

Policy instance

Insurance contract or identification number	01003414400001
Number of Individuals Covered	281
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $1,865
Total amount of fees paid to insurance company	USD $330
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $29,842
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,865
Amount paid for insurance broker fees	330
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

FLX967934

Policy instance

Insurance contract or identification number	FLX967934
Number of Individuals Covered	193
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $14,144
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	SL,DL,AD
Welfare Benefit Premiums Paid to Carrier	USD $94,443
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,144
Insurance broker organization code?	3

MEDICAL MUTUAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 29076 )

Policy contract number

0083325-01

Policy instance

Insurance contract or identification number	0083325-01
Number of Individuals Covered	193
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $61,837
Total amount of fees paid to insurance company	USD $30,948
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $11,589
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $61,837
Amount paid for insurance broker fees	30948
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker organization code?	3

MEDICAL MUTUAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 29076 )

Policy contract number

0077248-01

Policy instance

Insurance contract or identification number	0077248-01
Number of Individuals Covered	199
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $63,843
Total amount of fees paid to insurance company	USD $31,941
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $11,939
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $63,843
Amount paid for insurance broker fees	31941
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

FLX967934

Policy instance

Insurance contract or identification number	FLX967934
Number of Individuals Covered	199
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $15,320
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	SL,DL,AD&D
Welfare Benefit Premiums Paid to Carrier	USD $102,133
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $15,320
Insurance broker organization code?	3

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

01003414400001

Policy instance

Insurance contract or identification number	01003414400001
Number of Individuals Covered	316
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $1,842
Total amount of fees paid to insurance company	USD $155
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $29,205
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,842
Amount paid for insurance broker fees	155
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker organization code?	3

DELTA DENTAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 54402 )

Policy contract number

0002273

Policy instance

Insurance contract or identification number	0002273
Number of Individuals Covered	372
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $5,607
Total amount of fees paid to insurance company	USD $393
Dental 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 $5,607
Amount paid for insurance broker fees	393
Additional information about fees paid to insurance broker	NEW BUSINESS BONUS
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

FLX967934

Policy instance

Insurance contract or identification number	FLX967934
Number of Individuals Covered	298
Insurance policy start date	2017-07-01
Insurance policy end date	2018-07-01
Total amount of commissions paid to insurance broker	USD $12,191
Total amount of fees paid to insurance company	USD $2,875
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	SL,DL,AD&D
Welfare Benefit Premiums Paid to Carrier	USD $81,273
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,191
Amount paid for insurance broker fees	2875
Additional information about fees paid to insurance broker	SALES & SERVICE
Insurance broker organization code?	3
Insurance broker name	HYLANT GROUP INC.

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

01003414400001

Policy instance

Insurance contract or identification number	01003414400001
Number of Individuals Covered	332
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $1,873
Total amount of fees paid to insurance company	USD $168
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $30,080
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,873
Amount paid for insurance broker fees	168
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker organization code?	3
Insurance broker name	HYLANT GROUP INC

COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 )

Policy contract number

246676

Policy instance

Insurance contract or identification number	246676
Number of Individuals Covered	429
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $53,162
Health Insurance Welfare Benefit	Yes
Dental 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 $53,162
Insurance broker organization code?	3
Insurance broker name	HYLANT GROUP INC

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

871423G

Policy instance

Insurance contract or identification number	871423G
Number of Individuals Covered	298
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $-1
Total amount of fees paid to insurance company	USD $635
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 $-7
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
Amount paid for insurance broker fees	635
Additional information about fees paid to insurance broker	BONUSES PAID
Insurance broker organization code?	3
Insurance broker name	HYLANT GROUP INC

COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 )

Policy contract number

00170848

Policy instance

Insurance contract or identification number	00170848
Number of Individuals Covered	403
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Total amount of commissions paid to insurance broker	USD $51,246
Total amount of fees paid to insurance company	USD $2,303
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,050,407
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $51,246
Amount paid for insurance broker fees	2303
Insurance broker organization code?	3
Insurance broker name	HYLANT GROUP INC

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

01003414400001

Policy instance

Insurance contract or identification number	01003414400001
Number of Individuals Covered	323
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Total amount of commissions paid to insurance broker	USD $1,844
Total amount of fees paid to insurance company	USD $147
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $29,258
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,844
Amount paid for insurance broker fees	147
Insurance broker organization code?	3
Insurance broker name	HYLANT GROUP INC

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

871423G

Policy instance

Insurance contract or identification number	871423G
Number of Individuals Covered	301
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Total amount of commissions paid to insurance broker	USD $14,743
Total amount of fees paid to insurance company	USD $1,606
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 $107,236
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,743
Amount paid for insurance broker fees	1606
Additional information about fees paid to insurance broker	BONUSES PAID
Insurance broker organization code?	3
Insurance broker name	HYLANT GROUP INC

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

Policy contract number

135775

Policy instance

Insurance contract or identification number	135775
Number of Individuals Covered	271
Insurance policy start date	2010-07-01
Insurance policy end date	2011-07-01
Total amount of commissions paid to insurance broker	USD $6,614
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 $62,955
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,794
Insurance broker organization code?	3
Insurance broker name	HYLANT GROUP INC

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

010-034144

Policy instance

Insurance contract or identification number	010-034144
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Insurance broker organization code?	3
Insurance broker name	HYLANT GROUP INC

COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 )

Policy contract number

00170848

Policy instance

Insurance contract or identification number	00170848
Health Insurance Welfare Benefit	Yes
Insurance broker organization code?	3
Insurance broker name	HYLANT GROUP INC

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

Policy contract number

135776

Policy instance

Insurance contract or identification number	135776
Number of Individuals Covered	129
Insurance policy start date	2010-07-01
Insurance policy end date	2011-07-01
Total amount of commissions paid to insurance broker	USD $6,607
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $39,531
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,833
Insurance broker organization code?	3
Insurance broker name	HYLANT GROUP INC

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

871423G

Policy instance

Insurance contract or identification number	871423G
Number of Individuals Covered	296
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $17,934
Total amount of fees paid to insurance company	USD $1,368
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 $119,559
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $17,934
Amount paid for insurance broker fees	1368
Insurance broker organization code?	3
Insurance broker name	HYLANT GROUP INC

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

01003414400001

Policy instance

Insurance contract or identification number	01003414400001
Number of Individuals Covered	345
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $5,315
Total amount of fees paid to insurance company	USD $3,122
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $153,987
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,315
Amount paid for insurance broker fees	3122
Insurance broker organization code?	3
Insurance broker name	HYLANT GROUP INC

COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 )

Policy contract number

00170848

Policy instance

Insurance contract or identification number	00170848
Number of Individuals Covered	456
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $39,616
Total amount of fees paid to insurance company	USD $1,045
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,945,368
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $39,616
Insurance broker organization code?	3
Amount paid for insurance broker fees	1045
Insurance broker name	HYLANT GROUP INC

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

01003414400001

Policy instance

Insurance contract or identification number	01003414400001
Number of Individuals Covered	330
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Total amount of commissions paid to insurance broker	USD $5,230
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 $148,502
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,230
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	HYLANT GROUP INC

COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 )

Policy contract number

00170848

Policy instance

Insurance contract or identification number	00170848
Number of Individuals Covered	437
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Total amount of commissions paid to insurance broker	USD $38,032
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,823,797
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $38,032
Insurance broker organization code?	3
Insurance broker name	HYLANT GROUP INC

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

871423G

Policy instance

Insurance contract or identification number	871423G
Number of Individuals Covered	285
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Total amount of commissions paid to insurance broker	USD $15,505
Total amount of fees paid to insurance company	USD $4,757
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 $103,366
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $15,505
Amount paid for insurance broker fees	4757
Insurance broker organization code?	3
Insurance broker name	HYLANT GROUP INC

COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 )

Policy contract number

00170848

Policy instance

Insurance contract or identification number	00170848
Number of Individuals Covered	470
Insurance policy start date	2010-07-01
Insurance policy end date	2011-06-30
Total amount of commissions paid to insurance broker	USD $39,664
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,611,037
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

01003414400001

Policy instance

Insurance contract or identification number	01003414400001
Number of Individuals Covered	336
Insurance policy start date	2010-07-01
Insurance policy end date	2011-06-30
Total amount of commissions paid to insurance broker	USD $5,553
Total amount of fees paid to insurance company	USD $220
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $132,903
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

135775

Policy instance

Insurance contract or identification number	135775
Number of Individuals Covered	271
Insurance policy start date	2010-07-01
Insurance policy end date	2011-07-01
Total amount of commissions paid to insurance broker	USD $13,221
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 $102,486
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	UNIVERSITY OF NORTHWESTERN OHIO
Employer identification number (EIN):	341695897
NAIC Classification:	611000

Jurisdiction of Incorporation:	Ohio Secretary of State Business Services Division
Incorporation Date:	1991-11-01
Company Identification Number:	806466
Legal Registered Office Address:	1441 NORTH CABLE ROAD - LIMA United States of America (USA) 45805