401k Plan data: JACKSON RECOVERY CENTERS, INC. WELFARE BENEFITS WRAP PLAN plan

JACKSON RECOVERY CENTERS, INC. WELFARE BENEFITS WRAP PLAN 401k Plan overview

Plan Name	JACKSON RECOVERY CENTERS, INC. WELFARE BENEFITS WRAP PLAN
Plan identification number	502

JACKSON RECOVERY CENTERS, INC. WELFARE BENEFITS WRAP 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) Prepaid legal Long-term disability cover Other welfare benefit cover

401k Sponsoring company profile

JACKSON RECOVERY CENTERS, INC. has sponsored the creation of one or more 401k plans.

Company Name: JACKSON RECOVERY CENTERS, INC.

Employer identification number (EIN): 391900255

NAIC Classification: 621399
NAIC Description: Offices of All Other Miscellaneous Health Practitioners

Additional information about JACKSON RECOVERY CENTERS, INC.

Jurisdiction of Incorporation: Iowa Secretary of State Business Entities

Incorporation Date: 1997-07-01

Company Identification Number: 207737

Legal Registered Office Address: 800 5TH ST STE 200

SIOUX CITY
United States of America (USA)
51101

More information about JACKSON RECOVERY CENTERS, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan JACKSON RECOVERY CENTERS, INC. WELFARE BENEFITS WRAP PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2019-01-01
502 2018-01-01
502 2017-01-01 JULIE ENOCKSON JULIE ENOCKSON 2018-07-30
502 2016-01-01 JULIE ENOCKSON JULIE ENOCKSON 2017-07-27
502 2015-01-01 JULIE ENOCKSON JULIE ENOCKSON 2016-10-14

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
502	2019-01-01
502	2018-01-01
502	2017-01-01	JULIE ENOCKSON	JULIE ENOCKSON	2018-07-30
502	2016-01-01	JULIE ENOCKSON	JULIE ENOCKSON	2017-07-27
502	2015-01-01	JULIE ENOCKSON	JULIE ENOCKSON	2016-10-14

Plan Statistics for JACKSON RECOVERY CENTERS, INC. WELFARE BENEFITS WRAP PLAN

401k plan membership statisitcs for JACKSON RECOVERY CENTERS, INC. WELFARE BENEFITS WRAP PLAN

Measure Date Value
2019: JACKSON RECOVERY CENTERS, INC. WELFARE BENEFITS WRAP PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 233
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 0
Total of all active and inactive participants 2019-01-01 0
2018: JACKSON RECOVERY CENTERS, INC. WELFARE BENEFITS WRAP PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 220
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 233
Total of all active and inactive participants 2018-01-01 233
2017: JACKSON RECOVERY CENTERS, INC. WELFARE BENEFITS WRAP PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 236
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 220
Total of all active and inactive participants 2017-01-01 220
2016: JACKSON RECOVERY CENTERS, INC. WELFARE BENEFITS WRAP PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 225
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 236
Total of all active and inactive participants 2016-01-01 236
2015: JACKSON RECOVERY CENTERS, INC. WELFARE BENEFITS WRAP PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 0
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 225
Total of all active and inactive participants 2015-01-01 225

Measure	Date	Value
2019: JACKSON RECOVERY CENTERS, INC. WELFARE BENEFITS WRAP PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	233
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	0
Total of all active and inactive participants	2019-01-01	0
2018: JACKSON RECOVERY CENTERS, INC. WELFARE BENEFITS WRAP PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	220
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	233
Total of all active and inactive participants	2018-01-01	233
2017: JACKSON RECOVERY CENTERS, INC. WELFARE BENEFITS WRAP PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	236
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	220
Total of all active and inactive participants	2017-01-01	220
2016: JACKSON RECOVERY CENTERS, INC. WELFARE BENEFITS WRAP PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	225
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	236
Total of all active and inactive participants	2016-01-01	236
2015: JACKSON RECOVERY CENTERS, INC. WELFARE BENEFITS WRAP PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	0
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	225
Total of all active and inactive participants	2015-01-01	225

Form 5500 Responses for JACKSON RECOVERY CENTERS, INC. WELFARE BENEFITS WRAP PLAN

2019: JACKSON RECOVERY CENTERS, INC. WELFARE BENEFITS WRAP PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	This submission is the final filing	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
2018: JACKSON RECOVERY CENTERS, INC. WELFARE BENEFITS WRAP PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2018-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2017: JACKSON RECOVERY CENTERS, INC. WELFARE BENEFITS WRAP PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2016: JACKSON RECOVERY CENTERS, INC. WELFARE BENEFITS WRAP PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2015: JACKSON RECOVERY CENTERS, INC. WELFARE BENEFITS WRAP PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	First time form 5500 has been submitted	Yes
2015-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

60790-1680

Policy instance

Insurance contract or identification number	60790-1680
Number of Individuals Covered	147
Insurance policy start date	2019-01-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $1,103
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,338
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $578
Insurance broker organization code?	5

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

60790-1006

Policy instance

Insurance contract or identification number	60790-1006
Number of Individuals Covered	58
Insurance policy start date	2019-01-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $406
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Other welfare benefits provided	VISION CARE AND HEARING
Welfare Benefit Premiums Paid to Carrier	USD $1,962
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $213
Insurance broker organization code?	5

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

Policy contract number

875268G

Policy instance

Insurance contract or identification number	875268G
Number of Individuals Covered	0
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $2,384
Total amount of fees paid to insurance company	USD $700
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $23,838
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,384
Insurance broker organization code?	3
Amount paid for insurance broker fees	700
Additional information about fees paid to insurance broker	BONUS

WELLMARK BLUE CROSS BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 88848 )

Policy contract number

00038128

Policy instance

Insurance contract or identification number	00038128
Number of Individuals Covered	0
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
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
Welfare Benefit Premiums Paid to Carrier	USD $1,606,034
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

29479

Policy instance

Insurance contract or identification number	29479
Number of Individuals Covered	128
Insurance policy start date	2019-10-01
Insurance policy end date	2019-09-30
Total amount of commissions paid to insurance broker	USD $4,704
Total amount of fees paid to insurance company	USD $103
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $26,319
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,704
Insurance broker organization code?	3
Amount paid for insurance broker fees	103
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION

WELLMARK HEALTH PLAN OF IOWA (National Association of Insurance Commissioners NAIC id number: 95531 )

Policy contract number

00038128

Policy instance

Insurance contract or identification number	00038128
Number of Individuals Covered	0
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
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
Welfare Benefit Premiums Paid to Carrier	USD $192,111
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EMPLOYEE & FAMILY RESOURCES, INC. (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

Policy instance

Number of Individuals Covered	0
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $567
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $11,347
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $567
Insurance broker organization code?	3

HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

8210010

Policy instance

Insurance contract or identification number	8210010
Number of Individuals Covered	10
Insurance policy start date	2019-01-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	PREPAID LEGAL
Welfare Benefit Premiums Paid to Carrier	USD $1,086
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

WELLMARK BLUE CROSS BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 88848 )

Policy contract number

00038128

Policy instance

Insurance contract or identification number	00038128
Number of Individuals Covered	0
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $81,452
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

875268G

Policy instance

Insurance contract or identification number	875268G
Number of Individuals Covered	211
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $4,666
Total amount of fees paid to insurance company	USD $777
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $46,655
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,666
Insurance broker organization code?	3
Amount paid for insurance broker fees	777
Additional information about fees paid to insurance broker	BONUS

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

60790-1680

Policy instance

Insurance contract or identification number	60790-1680
Number of Individuals Covered	147
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $2,371
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $12,201
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,242
Insurance broker organization code?	3

WELLMARK BLUE CROSS BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 88848 )

Policy contract number

00038128

Policy instance

Insurance contract or identification number	00038128
Number of Individuals Covered	135
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $2,799
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $81,098
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,799
Insurance broker organization code?	3

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

60790-1006

Policy instance

Insurance contract or identification number	60790-1006
Number of Individuals Covered	51
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $997
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Other welfare benefits provided	VISION CARE AND HEARING
Welfare Benefit Premiums Paid to Carrier	USD $5,096
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $522
Insurance broker organization code?	3

HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

8210010

Policy instance

Insurance contract or identification number	8210010
Number of Individuals Covered	11
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $360
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	PREPAID LEGAL
Welfare Benefit Premiums Paid to Carrier	USD $3,552
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
Insurance broker organization code?	3

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

29479

Policy instance

Insurance contract or identification number	29479
Number of Individuals Covered	135
Insurance policy start date	2017-10-01
Insurance policy end date	2018-09-30
Total amount of commissions paid to insurance broker	USD $6,383
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $27,277
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,383
Insurance broker organization code?	3

WELLMARK HEALTH PLAN OF IOWA (National Association of Insurance Commissioners NAIC id number: 95531 )

Policy contract number

00038128

Policy instance

Insurance contract or identification number	00038128
Number of Individuals Covered	9
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
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
Welfare Benefit Premiums Paid to Carrier	USD $95,798
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

WELLMARK BLUE CROSS BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 88848 )

Policy contract number

00038128

Policy instance

Insurance contract or identification number	00038128
Number of Individuals Covered	121
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
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
Welfare Benefit Premiums Paid to Carrier	USD $1,768,174
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EMPLOYEE & FAMILY RESOURCES, INC. (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

Policy instance

Number of Individuals Covered	218
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
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
Welfare Benefit Premiums Paid to Carrier	USD $10,307
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

WELLMARK BLUE CROSS BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 88848 )

Policy contract number

00038128

Policy instance

Insurance contract or identification number	00038128
Number of Individuals Covered	131
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $-30
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,920,507
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $-30
Insurance broker organization code?	3
Insurance broker name	GALLAGHER BENEFIT SERVICES INC.

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

Policy contract number

875268G

Policy instance

Insurance contract or identification number	875268G
Number of Individuals Covered	210
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $5,179
Total amount of fees paid to insurance company	USD $100
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $51,793
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,179
Insurance broker organization code?	3
Amount paid for insurance broker fees	100
Additional information about fees paid to insurance broker	BONUS
Insurance broker name	GALLAGHER BENEFIT SERVICES INC.

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

60790-1680

Policy instance

Insurance contract or identification number	60790-1680
Number of Individuals Covered	152
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $2,291
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $10,907
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,200
Insurance broker organization code?	3
Insurance broker name	GALLAGHER BENEFITS

WELLMARK BLUE CROSS BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 88848 )

Policy contract number

00038128

Policy instance

Insurance contract or identification number	00038128
Number of Individuals Covered	134
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $79,506
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

60790-1006

Policy instance

Insurance contract or identification number	60790-1006
Number of Individuals Covered	47
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $836
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Other welfare benefits provided	VISION CARE AND HEARING
Welfare Benefit Premiums Paid to Carrier	USD $3,980
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $438
Insurance broker organization code?	3
Insurance broker name	GALLAGHER BENEFITS

HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

8210010

Policy instance

Insurance contract or identification number	8210010
Number of Individuals Covered	16
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $540
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	PREPAID LEGAL
Welfare Benefit Premiums Paid to Carrier	USD $5,424
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $540
Insurance broker organization code?	3
Insurance broker name	GALLAGHER BENEFIT SERVICES INC.

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

29479

Policy instance

Insurance contract or identification number	29479
Number of Individuals Covered	106
Insurance policy start date	2016-10-01
Insurance policy end date	2017-09-30
Total amount of commissions paid to insurance broker	USD $16,407
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $27,756
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16,407
Insurance broker organization code?	3
Insurance broker name	GALLAGHER BENEFIT SERVICES INC.

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

60790-1006

Policy instance

Insurance contract or identification number	60790-1006
Number of Individuals Covered	9
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $164
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Other welfare benefits provided	VISION CARE AND HEARING
Welfare Benefit Premiums Paid to Carrier	USD $874
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $86
Insurance broker organization code?	3
Insurance broker name	GALLAGHER BENEFITS

WELLMARK BLUE CROSS BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 88848 )

Policy contract number

00038128

Policy instance

Insurance contract or identification number	00038128
Number of Individuals Covered	147
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $3,352
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $69,894
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,352
Insurance broker organization code?	3
Insurance broker name	GALLAGHER BENEFIT SERVICES INC.

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

60790-1680

Policy instance

Insurance contract or identification number	60790-1680
Number of Individuals Covered	149
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $2,201
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $10,563
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,153
Insurance broker organization code?	3
Insurance broker name	GALLAGHER BENEFITS

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E3170305

Policy instance

Insurance contract or identification number	E3170305
Number of Individuals Covered	11
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $256
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,132
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $77
Insurance broker organization code?	3
Insurance broker name	GARY L HOLTROP

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

Policy contract number

875268G

Policy instance

Insurance contract or identification number	875268G
Number of Individuals Covered	193
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $2,986
Total amount of fees paid to insurance company	USD $771
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $26,714
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,986
Insurance broker organization code?	3
Amount paid for insurance broker fees	771
Additional information about fees paid to insurance broker	BONUS
Insurance broker name	GALLAGHER BENEFIT SERVICES INC.

WELLMARK BLUE CROSS BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 88848 )

Policy contract number

00038128

Policy instance

Insurance contract or identification number	00038128
Number of Individuals Covered	134
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $22,260
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,533,270
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $22,260
Insurance broker organization code?	3
Insurance broker name	GALLAGHER BENEFIT SERVICES INC.

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Company Name:	JACKSON RECOVERY CENTERS, INC.
Employer identification number (EIN):	391900255
NAIC Classification:	621399
NAIC Description:	Offices of All Other Miscellaneous Health Practitioners

Jurisdiction of Incorporation:	Iowa Secretary of State Business Entities
Incorporation Date:	1997-07-01
Company Identification Number:	207737
Legal Registered Office Address:	800 5TH ST STE 200 SIOUX CITY United States of America (USA) 51101