401k Plan data: SERVICE MANAGEMENT GROUP HEALTH & WELFARE BENEFITS plan

SERVICE MANAGEMENT GROUP HEALTH & WELFARE BENEFITS 401k Plan overview

Plan Name	SERVICE MANAGEMENT GROUP HEALTH & WELFARE BENEFITS
Plan identification number	501

SERVICE MANAGEMENT GROUP HEALTH & WELFARE BENEFITS 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

SERVICE MANAGEMENT GROUP, LLC has sponsored the creation of one or more 401k plans.

Company Name: SERVICE MANAGEMENT GROUP, LLC

Employer identification number (EIN): 431910102

NAIC Classification: 541800

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SERVICE MANAGEMENT GROUP HEALTH & WELFARE BENEFITS

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-01-01
501 2021-01-01
501 2020-01-01
501 2019-01-01
501 2018-01-01
501 2017-01-01 MARY WIDMER
501 2016-01-01 MARY WIDMER
501 2015-01-01 MARY WIDMER
501 2014-01-01 MARY WIDMER
501 2013-01-01 MARY WIDMER
501 2012-01-01 MARY WIDMER
501 2011-01-01 MARY WIDMER
501 2009-01-01 MARY WIDMER

Plan Statistics for SERVICE MANAGEMENT GROUP HEALTH & WELFARE BENEFITS

401k plan membership statisitcs for SERVICE MANAGEMENT GROUP HEALTH & WELFARE BENEFITS

Measure Date Value
2022: SERVICE MANAGEMENT GROUP HEALTH & WELFARE BENEFITS 2022 401k membership
Total participants, beginning-of-year 2022-01-01 281
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 300
Number of retired or separated participants receiving benefits 2022-01-01 6
Number of other retired or separated participants entitled to future benefits 2022-01-01 0
Total of all active and inactive participants 2022-01-01 306
2021: SERVICE MANAGEMENT GROUP HEALTH & WELFARE BENEFITS 2021 401k membership
Total participants, beginning-of-year 2021-01-01 289
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 277
Number of retired or separated participants receiving benefits 2021-01-01 4
Number of other retired or separated participants entitled to future benefits 2021-01-01 0
Total of all active and inactive participants 2021-01-01 281
2020: SERVICE MANAGEMENT GROUP HEALTH & WELFARE BENEFITS 2020 401k membership
Total participants, beginning-of-year 2020-01-01 329
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 282
Number of retired or separated participants receiving benefits 2020-01-01 7
Number of other retired or separated participants entitled to future benefits 2020-01-01 0
Total of all active and inactive participants 2020-01-01 289
2019: SERVICE MANAGEMENT GROUP HEALTH & WELFARE BENEFITS 2019 401k membership
Total participants, beginning-of-year 2019-01-01 313
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 328
Number of retired or separated participants receiving benefits 2019-01-01 1
Number of other retired or separated participants entitled to future benefits 2019-01-01 0
Total of all active and inactive participants 2019-01-01 329
2018: SERVICE MANAGEMENT GROUP HEALTH & WELFARE BENEFITS 2018 401k membership
Total participants, beginning-of-year 2018-01-01 326
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 310
Number of retired or separated participants receiving benefits 2018-01-01 3
Number of other retired or separated participants entitled to future benefits 2018-01-01 0
Total of all active and inactive participants 2018-01-01 313
2017: SERVICE MANAGEMENT GROUP HEALTH & WELFARE BENEFITS 2017 401k membership
Total participants, beginning-of-year 2017-01-01 281
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 321
Number of retired or separated participants receiving benefits 2017-01-01 5
Number of other retired or separated participants entitled to future benefits 2017-01-01 0
Total of all active and inactive participants 2017-01-01 326
2016: SERVICE MANAGEMENT GROUP HEALTH & WELFARE BENEFITS 2016 401k membership
Total participants, beginning-of-year 2016-01-01 261
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 281
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 281
2015: SERVICE MANAGEMENT GROUP HEALTH & WELFARE BENEFITS 2015 401k membership
Total participants, beginning-of-year 2015-01-01 236
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 261
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 261
2014: SERVICE MANAGEMENT GROUP HEALTH & WELFARE BENEFITS 2014 401k membership
Total participants, beginning-of-year 2014-01-01 197
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 236
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 236
2013: SERVICE MANAGEMENT GROUP HEALTH & WELFARE BENEFITS 2013 401k membership
Total participants, beginning-of-year 2013-01-01 179
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 197
Total of all active and inactive participants 2013-01-01 197
2012: SERVICE MANAGEMENT GROUP HEALTH & WELFARE BENEFITS 2012 401k membership
Total participants, beginning-of-year 2012-01-01 146
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 179
Total of all active and inactive participants 2012-01-01 179
2011: SERVICE MANAGEMENT GROUP HEALTH & WELFARE BENEFITS 2011 401k membership
Total participants, beginning-of-year 2011-01-01 161
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 146
Total of all active and inactive participants 2011-01-01 146
2009: SERVICE MANAGEMENT GROUP HEALTH & WELFARE BENEFITS 2009 401k membership
Total participants, beginning-of-year 2009-01-01 149
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 151
Total of all active and inactive participants 2009-01-01 151

Measure	Date	Value
2022: SERVICE MANAGEMENT GROUP HEALTH & WELFARE BENEFITS 2022 401k membership
Total participants, beginning-of-year	2022-01-01	281
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	300
Number of retired or separated participants receiving benefits	2022-01-01	6
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	306
2021: SERVICE MANAGEMENT GROUP HEALTH & WELFARE BENEFITS 2021 401k membership
Total participants, beginning-of-year	2021-01-01	289
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	277
Number of retired or separated participants receiving benefits	2021-01-01	4
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	281
2020: SERVICE MANAGEMENT GROUP HEALTH & WELFARE BENEFITS 2020 401k membership
Total participants, beginning-of-year	2020-01-01	329
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	282
Number of retired or separated participants receiving benefits	2020-01-01	7
Number of other retired or separated participants entitled to future benefits	2020-01-01	0
Total of all active and inactive participants	2020-01-01	289
2019: SERVICE MANAGEMENT GROUP HEALTH & WELFARE BENEFITS 2019 401k membership
Total participants, beginning-of-year	2019-01-01	313
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	328
Number of retired or separated participants receiving benefits	2019-01-01	1
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	329
2018: SERVICE MANAGEMENT GROUP HEALTH & WELFARE BENEFITS 2018 401k membership
Total participants, beginning-of-year	2018-01-01	326
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	310
Number of retired or separated participants receiving benefits	2018-01-01	3
Number of other retired or separated participants entitled to future benefits	2018-01-01	0
Total of all active and inactive participants	2018-01-01	313
2017: SERVICE MANAGEMENT GROUP HEALTH & WELFARE BENEFITS 2017 401k membership
Total participants, beginning-of-year	2017-01-01	281
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	321
Number of retired or separated participants receiving benefits	2017-01-01	5
Number of other retired or separated participants entitled to future benefits	2017-01-01	0
Total of all active and inactive participants	2017-01-01	326
2016: SERVICE MANAGEMENT GROUP HEALTH & WELFARE BENEFITS 2016 401k membership
Total participants, beginning-of-year	2016-01-01	261
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	281
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	281
2015: SERVICE MANAGEMENT GROUP HEALTH & WELFARE BENEFITS 2015 401k membership
Total participants, beginning-of-year	2015-01-01	236
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	261
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	261
2014: SERVICE MANAGEMENT GROUP HEALTH & WELFARE BENEFITS 2014 401k membership
Total participants, beginning-of-year	2014-01-01	197
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	236
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	0
Total of all active and inactive participants	2014-01-01	236
2013: SERVICE MANAGEMENT GROUP HEALTH & WELFARE BENEFITS 2013 401k membership
Total participants, beginning-of-year	2013-01-01	179
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	197
Total of all active and inactive participants	2013-01-01	197
2012: SERVICE MANAGEMENT GROUP HEALTH & WELFARE BENEFITS 2012 401k membership
Total participants, beginning-of-year	2012-01-01	146
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	179
Total of all active and inactive participants	2012-01-01	179
2011: SERVICE MANAGEMENT GROUP HEALTH & WELFARE BENEFITS 2011 401k membership
Total participants, beginning-of-year	2011-01-01	161
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	146
Total of all active and inactive participants	2011-01-01	146
2009: SERVICE MANAGEMENT GROUP HEALTH & WELFARE BENEFITS 2009 401k membership
Total participants, beginning-of-year	2009-01-01	149
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	151
Total of all active and inactive participants	2009-01-01	151

Form 5500 Responses for SERVICE MANAGEMENT GROUP HEALTH & WELFARE BENEFITS

2022: SERVICE MANAGEMENT GROUP HEALTH & WELFARE BENEFITS 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2021: SERVICE MANAGEMENT GROUP HEALTH & WELFARE BENEFITS 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2020: SERVICE MANAGEMENT GROUP HEALTH & WELFARE BENEFITS 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2019: SERVICE MANAGEMENT GROUP HEALTH & WELFARE BENEFITS 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2018: SERVICE MANAGEMENT GROUP HEALTH & WELFARE BENEFITS 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2017: SERVICE MANAGEMENT GROUP HEALTH & WELFARE BENEFITS 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2016: SERVICE MANAGEMENT GROUP HEALTH & WELFARE BENEFITS 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: SERVICE MANAGEMENT GROUP HEALTH & WELFARE BENEFITS 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: SERVICE MANAGEMENT GROUP HEALTH & WELFARE BENEFITS 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: SERVICE MANAGEMENT GROUP HEALTH & WELFARE BENEFITS 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: SERVICE MANAGEMENT GROUP HEALTH & WELFARE BENEFITS 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: SERVICE MANAGEMENT GROUP HEALTH & WELFARE BENEFITS 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2009: SERVICE MANAGEMENT GROUP HEALTH & WELFARE BENEFITS 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 )

Policy contract number

4EL-6080-21

Policy instance

Insurance contract or identification number	4EL-6080-21
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $221
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,472
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $221
Insurance broker organization code?	3

NEW DIRECTIONS BEHAVORIAL HEALTH (National Association of Insurance Commissioners NAIC id number: 00369 )

Policy contract number

EAP

Policy instance

Insurance contract or identification number	EAP
Number of Individuals Covered	300
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Other welfare benefits provided	EAP
Welfare Benefit Premiums Paid to Carrier	USD $4,356
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

MULTIPLE

Policy instance

Insurance contract or identification number	MULTIPLE
Number of Individuals Covered	357
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $15,742
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

914160

Policy instance

Insurance contract or identification number	914160
Number of Individuals Covered	67
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of fees paid to insurance company	USD $1,844
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $20,867
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	1043
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

BLUE CROSS AND BLUE SHIELD OF KANSAS CITY (National Association of Insurance Commissioners NAIC id number: 47171 )

Policy contract number

40977000

Policy instance

Insurance contract or identification number	40977000
Number of Individuals Covered	352
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $28,267
Total amount of fees paid to insurance company	USD $42,015
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,093,843
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $28,267
Amount paid for insurance broker fees	42015
Additional information about fees paid to insurance broker	ADMINISTRATIVE SERVICES OTHER NON-MONETARY COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

914159

Policy instance

Insurance contract or identification number	914159
Number of Individuals Covered	225
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of fees paid to insurance company	USD $4,492
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $51,393
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	2570
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

GLUG0AF5F

Policy instance

Insurance contract or identification number	GLUG0AF5F
Number of Individuals Covered	295
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of fees paid to insurance company	USD $2,454
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $54,097
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	2454
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

BLUE CROSS AND BLUE SHIELD OF KANSAS CITY (National Association of Insurance Commissioners NAIC id number: 47171 )

Policy contract number

40977000

Policy instance

Insurance contract or identification number	40977000
Number of Individuals Covered	522
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $31,792
Total amount of fees paid to insurance company	USD $45,459
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,272,928
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $31,792
Amount paid for insurance broker fees	45459
Additional information about fees paid to insurance broker	ADMINISTRATIVE SERVICES
Insurance broker organization code?	3

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

Policy contract number

GLTD0AF5F

Policy instance

Insurance contract or identification number	GLTD0AF5F
Number of Individuals Covered	295
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of fees paid to insurance company	USD $1,845
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $40,328
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	1845
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

GVTL0AF5F

Policy instance

Insurance contract or identification number	GVTL0AF5F
Number of Individuals Covered	94
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of fees paid to insurance company	USD $1,000
Other welfare benefits provided	VOLUNTARY LIFE AND AD&D
Welfare Benefit Premiums Paid to Carrier	USD $22,541
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	1000
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

MULTIPLE

Policy instance

Insurance contract or identification number	MULTIPLE
Number of Individuals Covered	535
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $17,662
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

NEW DIRECTIONS BEHAVORIAL HEALTH (National Association of Insurance Commissioners NAIC id number: 00369 )

Policy contract number

EAP

Policy instance

Insurance contract or identification number	EAP
Number of Individuals Covered	287
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Other welfare benefits provided	EAP
Welfare Benefit Premiums Paid to Carrier	USD $2,405
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )

Policy contract number

GTP 0009155640

Policy instance

Insurance contract or identification number	GTP 0009155640
Number of Individuals Covered	332
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $257
Other welfare benefits provided	BUSINESS TRAVEL ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $1,284
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $257
Insurance broker organization code?	3

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

Policy contract number

GLUG0AF5F

Policy instance

Insurance contract or identification number	GLUG0AF5F
Number of Individuals Covered	282
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of fees paid to insurance company	USD $2,722
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $55,116
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	2722
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

BLUE CROSS AND BLUE SHIELD OF KANSAS CITY (National Association of Insurance Commissioners NAIC id number: 47171 )

Policy contract number

40977000

Policy instance

Insurance contract or identification number	40977000
Number of Individuals Covered	484
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $27,287
Total amount of fees paid to insurance company	USD $37,380
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,868,988
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $27,287
Amount paid for insurance broker fees	37380
Additional information about fees paid to insurance broker	ADMINISTRATIVE SERVICES
Insurance broker organization code?	3

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

Policy contract number

GLTD0AF5F

Policy instance

Insurance contract or identification number	GLTD0AF5F
Number of Individuals Covered	281
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of fees paid to insurance company	USD $2,067
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $41,477
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	2067
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

GVTL0AF5F

Policy instance

Insurance contract or identification number	GVTL0AF5F
Number of Individuals Covered	92
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of fees paid to insurance company	USD $1,142
Other welfare benefits provided	VOLUNTARY LIFE AND AD&D
Welfare Benefit Premiums Paid to Carrier	USD $22,429
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	1142
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

MULTIPLE

Policy instance

Insurance contract or identification number	MULTIPLE
Number of Individuals Covered	521
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $17,732
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

NEW DIRECTIONS BEHAVORIAL HEALTH (National Association of Insurance Commissioners NAIC id number: 00369 )

Policy contract number

EAP

Policy instance

Insurance contract or identification number	EAP
Number of Individuals Covered	320
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Other welfare benefits provided	EAP
Welfare Benefit Premiums Paid to Carrier	USD $2,672
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )

Policy contract number

GTP 0009155640

Policy instance

Insurance contract or identification number	GTP 0009155640
Number of Individuals Covered	335
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $368
Other welfare benefits provided	BUSINESS TRAVEL ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $1,840
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $368
Insurance broker organization code?	3

BLUE CROSS AND BLUE SHIELD OF KANSAS CITY (National Association of Insurance Commissioners NAIC id number: 47171 )

Policy contract number

40977000

Policy instance

Insurance contract or identification number	40977000
Number of Individuals Covered	531
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $23,686
Total amount of fees paid to insurance company	USD $31,763
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,579,070
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $23,686
Amount paid for insurance broker fees	31763
Additional information about fees paid to insurance broker	ADMINISTRATIVE SERVICES NON-MONETARY COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

GLUG0AF5F

Policy instance

Insurance contract or identification number	GLUG0AF5F
Number of Individuals Covered	328
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of fees paid to insurance company	USD $2,418
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $55,575
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	2418
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 )

Policy contract number

19510022

Policy instance

Insurance contract or identification number	19510022
Number of Individuals Covered	515
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $22,224
Total amount of fees paid to insurance company	USD $1,604
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $205,536
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $22,224
Amount paid for insurance broker fees	1604
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

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

Policy contract number

GLTD0AF5F

Policy instance

Insurance contract or identification number	GLTD0AF5F
Number of Individuals Covered	328
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of fees paid to insurance company	USD $1,833
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $42,206
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	1833
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

GVTL0AF5F

Policy instance

Insurance contract or identification number	GVTL0AF5F
Number of Individuals Covered	113
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of fees paid to insurance company	USD $1,042
Other welfare benefits provided	VOLUNTARY LIFE AND AD&D
Welfare Benefit Premiums Paid to Carrier	USD $23,240
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	1042
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

MULTIPLE

Policy instance

Insurance contract or identification number	MULTIPLE
Number of Individuals Covered	573
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $16,784
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

NEW DIRECTIONS BEHAVORIAL HEALTH (National Association of Insurance Commissioners NAIC id number: 00369 )

Policy contract number

EAP

Policy instance

Insurance contract or identification number	EAP
Number of Individuals Covered	302
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Other welfare benefits provided	EAP
Welfare Benefit Premiums Paid to Carrier	USD $2,630
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )

Policy contract number

GTP 0009155640

Policy instance

Insurance contract or identification number	GTP 0009155640
Number of Individuals Covered	381
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $368
Other welfare benefits provided	BUSINESS TRAVEL ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $1,840
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $368
Insurance broker organization code?	3

BLUE CROSS AND BLUE SHIELD OF KANSAS CITY (National Association of Insurance Commissioners NAIC id number: 47171 )

Policy contract number

40977000

Policy instance

Insurance contract or identification number	40977000
Number of Individuals Covered	504
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $21,906
Total amount of fees paid to insurance company	USD $31,213
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,552,623
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $21,906
Amount paid for insurance broker fees	31213
Additional information about fees paid to insurance broker	ADMINISTRATIVE SERVICES NON-MONETARY COMPENSATION
Insurance broker organization code?	3

DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 )

Policy contract number

19510022

Policy instance

Insurance contract or identification number	19510022
Number of Individuals Covered	488
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $19,590
Total amount of fees paid to insurance company	USD $1,393
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $197,161
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $19,590
Amount paid for insurance broker fees	1393
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

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

Policy contract number

GLTD0AF5F

Policy instance

Insurance contract or identification number	GLTD0AF5F
Number of Individuals Covered	619
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of fees paid to insurance company	USD $1,778
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $40,739
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	1778
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

GVTL0AF5F

Policy instance

Insurance contract or identification number	GVTL0AF5F
Number of Individuals Covered	103
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of fees paid to insurance company	USD $1,049
Other welfare benefits provided	VOLUNTARY LIFE AND AD&D
Welfare Benefit Premiums Paid to Carrier	USD $23,147
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	1049
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

139411,101491

Policy instance

Insurance contract or identification number	139411,101491
Number of Individuals Covered	513
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $15,256
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

NEW DIRECTIONS BEHAVORIAL HEALTH (National Association of Insurance Commissioners NAIC id number: 00369 )

Policy contract number

EAP

Policy instance

Insurance contract or identification number	EAP
Number of Individuals Covered	302
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Other welfare benefits provided	EAP
Welfare Benefit Premiums Paid to Carrier	USD $2,596
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

GLUG0AF5F

Policy instance

Insurance contract or identification number	GLUG0AF5F
Number of Individuals Covered	310
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of fees paid to insurance company	USD $2,349
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $53,731
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	2349
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 )

Policy contract number

707728

Policy instance

Insurance contract or identification number	707728
Number of Individuals Covered	234
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $21,355
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

GLUG0AF5F

Policy instance

Insurance contract or identification number	GLUG0AF5F
Number of Individuals Covered	321
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of fees paid to insurance company	USD $1,375
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $48,445
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	1375
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )

Policy contract number

707728

Policy instance

Insurance contract or identification number	707728
Number of Individuals Covered	219
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $46,347
Total amount of fees paid to insurance company	USD $1,559
Health Insurance Welfare Benefit	Yes
Other welfare benefits provided	EAP
Welfare Benefit Premiums Paid to Carrier	USD $1,231,775
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $46,347
Amount paid for insurance broker fees	1559
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 )

Policy contract number

19510022

Policy instance

Insurance contract or identification number	19510022
Number of Individuals Covered	455
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $18,254
Total amount of fees paid to insurance company	USD $987
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $184,063
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,254
Amount paid for insurance broker fees	987
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

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

Policy contract number

GLTD0AF5F

Policy instance

Insurance contract or identification number	GLTD0AF5F
Number of Individuals Covered	320
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of fees paid to insurance company	USD $1,041
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $36,663
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	1041
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

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

Policy contract number

GVTL0AF5F

Policy instance

Insurance contract or identification number	GVTL0AF5F
Number of Individuals Covered	104
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of fees paid to insurance company	USD $615
Other welfare benefits provided	VOLUNTARY LIFE AND AD&D
Welfare Benefit Premiums Paid to Carrier	USD $21,746
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	615
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

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

Policy contract number

GLUG0AF5F

Policy instance

Insurance contract or identification number	GLUG0AF5F
Number of Individuals Covered	261
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $37,418
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 )

Policy contract number

1951-1022&2022

Policy instance

Insurance contract or identification number	1951-1022&2022
Number of Individuals Covered	422
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $12,735
Total amount of fees paid to insurance company	USD $742
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $139,044
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,735
Amount paid for insurance broker fees	742
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

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

Policy contract number

GLTD0AF5F

Policy instance

Insurance contract or identification number	GLTD0AF5F
Number of Individuals Covered	261
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $28,142
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

GVTL0AF5F

Policy instance

Insurance contract or identification number	GVTL0AF5F
Number of Individuals Covered	91
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Other welfare benefits provided	VOLUNTARY LIFE AND AD&D
Welfare Benefit Premiums Paid to Carrier	USD $13,960
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 )

Policy contract number

707728

Policy instance

Insurance contract or identification number	707728
Number of Individuals Covered	192
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of fees paid to insurance company	USD $110
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $18,912
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	110
Additional information about fees paid to insurance broker	BROKER BONUS NON-MONETARY COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )

Policy contract number

707728

Policy instance

Insurance contract or identification number	707728
Number of Individuals Covered	186
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $49,972
Total amount of fees paid to insurance company	USD $1,411
Health Insurance Welfare Benefit	Yes
Other welfare benefits provided	EAP
Welfare Benefit Premiums Paid to Carrier	USD $1,426,949
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $49,972
Amount paid for insurance broker fees	1411
Additional information about fees paid to insurance broker	ADMINISTRATIVE FEES NON-MONETARY COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

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

Policy contract number

GLUG0AF5F

Policy instance

Insurance contract or identification number	GLUG0AF5F
Number of Individuals Covered	236
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of fees paid to insurance company	USD $1,158
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $32,609
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	1158
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )

Policy contract number

707728

Policy instance

Insurance contract or identification number	707728
Number of Individuals Covered	173
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $57,793
Total amount of fees paid to insurance company	USD $6,662
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Other welfare benefits provided	EAP, HSA
Welfare Benefit Premiums Paid to Carrier	USD $1,445,624
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $57,793
Amount paid for insurance broker fees	6662
Additional information about fees paid to insurance broker	ADMINISTRATIVE FEES
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 )

Policy contract number

1951-1022&2022

Policy instance

Insurance contract or identification number	1951-1022&2022
Number of Individuals Covered	379
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $13,311
Total amount of fees paid to insurance company	USD $574
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $133,552
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,311
Amount paid for insurance broker fees	574
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

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

Policy contract number

GLTD0AF5F

Policy instance

Insurance contract or identification number	GLTD0AF5F
Number of Individuals Covered	236
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of fees paid to insurance company	USD $873
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $24,577
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	873
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

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

Policy contract number

GVTL0AF5F

Policy instance

Insurance contract or identification number	GVTL0AF5F
Number of Individuals Covered	77
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of fees paid to insurance company	USD $340
Other welfare benefits provided	VOLUNTARY LIFE AND AD&D
Welfare Benefit Premiums Paid to Carrier	USD $10,720
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	340
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

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

Policy contract number

GLTD0AF5F

Policy instance

Insurance contract or identification number	GLTD0AF5F
Number of Individuals Covered	197
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of fees paid to insurance company	USD $1,038
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $21,296
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	1038
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

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

Policy contract number

GVTL0AF5F

Policy instance

Insurance contract or identification number	GVTL0AF5F
Number of Individuals Covered	52
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of fees paid to insurance company	USD $439
Other welfare benefits provided	VOLUNTARY LIFE AND AD&D
Welfare Benefit Premiums Paid to Carrier	USD $8,232
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	439
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )

Policy contract number

707728

Policy instance

Insurance contract or identification number	707728
Number of Individuals Covered	145
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $60,193
Total amount of fees paid to insurance company	USD $5,614
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Other welfare benefits provided	EAP
Welfare Benefit Premiums Paid to Carrier	USD $1,292,600
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $60,193
Amount paid for insurance broker fees	5614
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

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

Policy contract number

GLUG0AF5F

Policy instance

Insurance contract or identification number	GLUG0AF5F
Number of Individuals Covered	197
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of fees paid to insurance company	USD $1,379
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $28,339
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	1379
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 )

Policy contract number

1951-1022&2022

Policy instance

Insurance contract or identification number	1951-1022&2022
Number of Individuals Covered	315
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $10,720
Total amount of fees paid to insurance company	USD $498
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $99,087
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,720
Amount paid for insurance broker fees	498
Additional information about fees paid to insurance broker	DELTA REWARDS
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

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

Policy contract number

GLTD0AF5F

Policy instance

Insurance contract or identification number	GLTD0AF5F
Number of Individuals Covered	179
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of fees paid to insurance company	USD $687
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $17,294
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	687
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 )

Policy contract number

1951-1022&2022

Policy instance

Insurance contract or identification number	1951-1022&2022
Number of Individuals Covered	283
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $9,030
Total amount of fees paid to insurance company	USD $421
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 $9,030
Amount paid for insurance broker fees	421
Additional information about fees paid to insurance broker	DELTA REWARDS
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )

Policy contract number

707728

Policy instance

Insurance contract or identification number	707728
Number of Individuals Covered	130
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $42,327
Total amount of fees paid to insurance company	USD $5,141
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Other welfare benefits provided	EAP
Welfare Benefit Premiums Paid to Carrier	USD $951,783
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $42,327
Insurance broker organization code?	3
Amount paid for insurance broker fees	5141
Additional information about fees paid to insurance broker	ADMINISTRATIVE FEES
Insurance broker name	HUMANA INSURANCE COMPANY

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

Policy contract number

GLUG0AF5F

Policy instance

Insurance contract or identification number	GLUG0AF5F
Number of Individuals Covered	179
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of fees paid to insurance company	USD $903
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $22,985
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	903
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

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

Policy contract number

GVTL0AF5F

Policy instance

Insurance contract or identification number	GVTL0AF5F
Number of Individuals Covered	45
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of fees paid to insurance company	USD $350
Other welfare benefits provided	VOLUNTARY LIFE/AD&D
Welfare Benefit Premiums Paid to Carrier	USD $7,319
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	350
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )

Policy contract number

707728

Policy instance

Insurance contract or identification number	707728
Number of Individuals Covered	111
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $49,655
Total amount of fees paid to insurance company	USD $5,486
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Other welfare benefits provided	EAP
Welfare Benefit Premiums Paid to Carrier	USD $862,347
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

GLUG0AF5F

Policy instance

Insurance contract or identification number	GLUG0AF5F
Number of Individuals Covered	146
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of fees paid to insurance company	USD $670
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $22,205
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 )

Policy contract number

1951-1022

Policy instance

Insurance contract or identification number	1951-1022
Number of Individuals Covered	111
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $8,456
Total amount of fees paid to insurance company	USD $581
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $84,564
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

GLTD0AF5F

Policy instance

Insurance contract or identification number	GLTD0AF5F
Number of Individuals Covered	146
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of fees paid to insurance company	USD $515
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $16,856
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )

Policy contract number

707728

Policy instance

Insurance contract or identification number	707728
Number of Individuals Covered	128
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $39,151
Total amount of fees paid to insurance company	USD $5,445
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Other welfare benefits provided	EAP
Welfare Benefit Premiums Paid to Carrier	USD $700,164
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $39,151
Insurance broker organization code?	3
Amount paid for insurance broker fees	5445
Additional information about fees paid to insurance broker	ADMINISTRATIVE FEES
Insurance broker name	HUMANA HEALTH PLAN, INC.

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

Policy contract number

GLUG0AF5F

Policy instance

Insurance contract or identification number	GLUG0AF5F
Number of Individuals Covered	161
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $20,194
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

GLTD0AF5F

Policy instance

Insurance contract or identification number	GLTD0AF5F
Number of Individuals Covered	161
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $15,466
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 )

Policy contract number

1951-1022

Policy instance

Insurance contract or identification number	1951-1022
Number of Individuals Covered	128
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $8,674
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $82,625
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,674
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

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Company Name:	SERVICE MANAGEMENT GROUP, LLC
Employer identification number (EIN):	431910102
NAIC Classification:	541800