COMMUNITY MEDICAL CENTER INC has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan COMMUNITY MEDICAL CENTER INC GROUP HEALTH & DENTAL PLAN
401k plan membership statisitcs for COMMUNITY MEDICAL CENTER INC GROUP HEALTH & DENTAL PLAN
| Measure | Date | Value |
|---|
| 2022: COMMUNITY MEDICAL CENTER INC GROUP HEALTH & DENTAL PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-05-01 | 125 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-05-01 | 132 |
| Number of retired or separated participants receiving benefits | 2022-05-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2022-05-01 | 0 |
| Total of all active and inactive participants | 2022-05-01 | 132 |
| 2021: COMMUNITY MEDICAL CENTER INC GROUP HEALTH & DENTAL PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-05-01 | 133 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-05-01 | 125 |
| Number of retired or separated participants receiving benefits | 2021-05-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-05-01 | 0 |
| Total of all active and inactive participants | 2021-05-01 | 125 |
| 2020: COMMUNITY MEDICAL CENTER INC GROUP HEALTH & DENTAL PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-05-01 | 136 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-05-01 | 133 |
| Number of retired or separated participants receiving benefits | 2020-05-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2020-05-01 | 0 |
| Total of all active and inactive participants | 2020-05-01 | 133 |
| 2019: COMMUNITY MEDICAL CENTER INC GROUP HEALTH & DENTAL PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-05-01 | 140 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-05-01 | 136 |
| Number of retired or separated participants receiving benefits | 2019-05-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-05-01 | 0 |
| Total of all active and inactive participants | 2019-05-01 | 136 |
| 2018: COMMUNITY MEDICAL CENTER INC GROUP HEALTH & DENTAL PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-05-01 | 139 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-05-01 | 140 |
| Number of retired or separated participants receiving benefits | 2018-05-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-05-01 | 0 |
| Total of all active and inactive participants | 2018-05-01 | 140 |
| 2017: COMMUNITY MEDICAL CENTER INC GROUP HEALTH & DENTAL PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-05-01 | 139 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-05-01 | 139 |
| Number of retired or separated participants receiving benefits | 2017-05-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-05-01 | 0 |
| Total of all active and inactive participants | 2017-05-01 | 139 |
| 2016: COMMUNITY MEDICAL CENTER INC GROUP HEALTH & DENTAL PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-05-01 | 131 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-05-01 | 139 |
| Number of retired or separated participants receiving benefits | 2016-05-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2016-05-01 | 0 |
| Total of all active and inactive participants | 2016-05-01 | 139 |
| 2015: COMMUNITY MEDICAL CENTER INC GROUP HEALTH & DENTAL PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-05-01 | 128 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-05-01 | 131 |
| Number of retired or separated participants receiving benefits | 2015-05-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2015-05-01 | 0 |
| Total of all active and inactive participants | 2015-05-01 | 131 |
| 2014: COMMUNITY MEDICAL CENTER INC GROUP HEALTH & DENTAL PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-05-01 | 136 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-05-01 | 128 |
| Number of retired or separated participants receiving benefits | 2014-05-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2014-05-01 | 0 |
| Total of all active and inactive participants | 2014-05-01 | 128 |
| 2013: COMMUNITY MEDICAL CENTER INC GROUP HEALTH & DENTAL PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-05-01 | 132 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-05-01 | 136 |
| Total of all active and inactive participants | 2013-05-01 | 136 |
| 2012: COMMUNITY MEDICAL CENTER INC GROUP HEALTH & DENTAL PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-04-30 | 118 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-04-30 | 132 |
| Total of all active and inactive participants | 2012-04-30 | 132 |
| 2011: COMMUNITY MEDICAL CENTER INC GROUP HEALTH & DENTAL PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-05-01 | 117 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-05-01 | 118 |
| Total of all active and inactive participants | 2011-05-01 | 118 |
| 2009: COMMUNITY MEDICAL CENTER INC GROUP HEALTH & DENTAL PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-05-01 | 108 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-05-01 | 110 |
| Total of all active and inactive participants | 2009-05-01 | 110 |
| Total participants | 2009-05-01 | 110 |
| 2022: COMMUNITY MEDICAL CENTER INC GROUP HEALTH & DENTAL PLAN 2022 form 5500 responses |
|---|
| 2022-05-01 | Type of plan entity | Single employer plan |
| 2022-05-01 | Plan funding arrangement – Insurance | Yes |
| 2022-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: COMMUNITY MEDICAL CENTER INC GROUP HEALTH & DENTAL PLAN 2021 form 5500 responses |
|---|
| 2021-05-01 | Type of plan entity | Single employer plan |
| 2021-05-01 | Plan funding arrangement – Insurance | Yes |
| 2021-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: COMMUNITY MEDICAL CENTER INC GROUP HEALTH & DENTAL PLAN 2020 form 5500 responses |
|---|
| 2020-05-01 | Type of plan entity | Single employer plan |
| 2020-05-01 | Plan funding arrangement – Insurance | Yes |
| 2020-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: COMMUNITY MEDICAL CENTER INC GROUP HEALTH & DENTAL PLAN 2019 form 5500 responses |
|---|
| 2019-05-01 | Type of plan entity | Single employer plan |
| 2019-05-01 | Plan funding arrangement – Insurance | Yes |
| 2019-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: COMMUNITY MEDICAL CENTER INC GROUP HEALTH & DENTAL PLAN 2018 form 5500 responses |
|---|
| 2018-05-01 | Type of plan entity | Single employer plan |
| 2018-05-01 | Plan funding arrangement – Insurance | Yes |
| 2018-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: COMMUNITY MEDICAL CENTER INC GROUP HEALTH & DENTAL PLAN 2017 form 5500 responses |
|---|
| 2017-05-01 | Type of plan entity | Single employer plan |
| 2017-05-01 | Plan funding arrangement – Insurance | Yes |
| 2017-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: COMMUNITY MEDICAL CENTER INC GROUP HEALTH & DENTAL PLAN 2016 form 5500 responses |
|---|
| 2016-05-01 | Type of plan entity | Single employer plan |
| 2016-05-01 | Plan funding arrangement – Insurance | Yes |
| 2016-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: COMMUNITY MEDICAL CENTER INC GROUP HEALTH & DENTAL PLAN 2015 form 5500 responses |
|---|
| 2015-05-01 | Type of plan entity | Single employer plan |
| 2015-05-01 | Plan funding arrangement – Insurance | Yes |
| 2015-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: COMMUNITY MEDICAL CENTER INC GROUP HEALTH & DENTAL PLAN 2014 form 5500 responses |
|---|
| 2014-05-01 | Type of plan entity | Single employer plan |
| 2014-05-01 | Plan funding arrangement – Insurance | Yes |
| 2014-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: COMMUNITY MEDICAL CENTER INC GROUP HEALTH & DENTAL PLAN 2013 form 5500 responses |
|---|
| 2013-05-01 | Type of plan entity | Single employer plan |
| 2013-05-01 | Plan funding arrangement – Insurance | Yes |
| 2013-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2012: COMMUNITY MEDICAL CENTER INC GROUP HEALTH & DENTAL PLAN 2012 form 5500 responses |
|---|
| 2012-04-30 | Type of plan entity | Single employer plan |
| 2012-04-30 | Submission has been amended | Yes |
| 2012-04-30 | Plan funding arrangement – Insurance | Yes |
| 2012-04-30 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2012-04-30 | Plan benefit arrangement – Insurance | Yes |
| 2012-04-30 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2011: COMMUNITY MEDICAL CENTER INC GROUP HEALTH & DENTAL PLAN 2011 form 5500 responses |
|---|
| 2011-05-01 | Type of plan entity | Single employer plan |
| 2011-05-01 | Plan funding arrangement – Insurance | Yes |
| 2011-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2011-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2009: COMMUNITY MEDICAL CENTER INC GROUP HEALTH & DENTAL PLAN 2009 form 5500 responses |
|---|
| 2009-05-01 | Type of plan entity | Single employer plan |
| 2009-05-01 | Submission has been amended | No |
| 2009-05-01 | This submission is the final filing | No |
| 2009-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-05-01 | Plan is a collectively bargained plan | No |
| 2009-05-01 | Plan funding arrangement – Insurance | Yes |
| 2009-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2009-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| VISION CARE DIRECT OF KANSAS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 11054 |
| Policy instance | 4 |
| Insurance contract or identification number | 11054 | | Number of Individuals Covered | 49 | | Insurance policy start date | 2022-05-01 | | Insurance policy end date | 2023-04-30 | | Total amount of commissions paid to insurance broker | USD $523 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $7,474 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $523 | | Additional information about fees paid to insurance broker | VISION | | Insurance broker organization code? | 3 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 010-412657 |
| Policy instance | 3 |
| Insurance contract or identification number | 010-412657 | | Number of Individuals Covered | 80 | | Insurance policy start date | 2022-05-01 | | Insurance policy end date | 2023-04-30 | | Total amount of commissions paid to insurance broker | USD $1,396 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $13,897 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,396 | | Additional information about fees paid to insurance broker | VISION | | Insurance broker organization code? | 3 |
|
| BLUE CROSS BLUE SHIELD OF NEBRASKA (National Association of Insurance Commissioners NAIC id number: 77780 ) |
| Policy contract number | 04690 |
| Policy instance | 2 |
| Insurance contract or identification number | 04690 | | Number of Individuals Covered | 225 | | Insurance policy start date | 2022-05-01 | | Insurance policy end date | 2023-04-30 | | Total amount of commissions paid to insurance broker | USD $54,125 | | Total amount of fees paid to insurance company | USD $49 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $54,125 | | Amount paid for insurance broker fees | 49 | | Additional information about fees paid to insurance broker | HEALTH PLAN | | Insurance broker organization code? | 3 |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010-301342 |
| Policy instance | 1 |
| Insurance contract or identification number | 010-301342 | | Number of Individuals Covered | 132 | | Insurance policy start date | 2022-05-01 | | Insurance policy end date | 2023-04-30 | | Total amount of commissions paid to insurance broker | USD $3,692 | | Total amount of fees paid to insurance company | USD $58 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $11,872 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,692 | | Amount paid for insurance broker fees | 58 | | Additional information about fees paid to insurance broker | DENTAL PLAN | | Insurance broker organization code? | 3 |
|
| VISION CARE DIRECT OF KANSAS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 11054 |
| Policy instance | 4 |
| Insurance contract or identification number | 11054 | | Number of Individuals Covered | 45 | | Insurance policy start date | 2021-05-01 | | Insurance policy end date | 2022-04-30 | | Total amount of commissions paid to insurance broker | USD $432 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,169 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $432 | | Additional information about fees paid to insurance broker | VISION | | Insurance broker organization code? | 3 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 010-412657 |
| Policy instance | 3 |
| Insurance contract or identification number | 010-412657 | | Number of Individuals Covered | 84 | | Insurance policy start date | 2021-05-01 | | Insurance policy end date | 2022-04-30 | | Total amount of commissions paid to insurance broker | USD $1,395 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $13,975 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,395 | | Additional information about fees paid to insurance broker | VISION | | Insurance broker organization code? | 3 |
|
| BLUE CROSS BLUE SHIELD OF NEBRASKA (National Association of Insurance Commissioners NAIC id number: 77780 ) |
| Policy contract number | 04690 |
| Policy instance | 2 |
| Insurance contract or identification number | 04690 | | Number of Individuals Covered | 230 | | Insurance policy start date | 2021-05-01 | | Insurance policy end date | 2022-04-30 | | Total amount of commissions paid to insurance broker | USD $56,947 | | Total amount of fees paid to insurance company | USD $2,699 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $56,947 | | Amount paid for insurance broker fees | 2699 | | Additional information about fees paid to insurance broker | HEALTH PLAN | | Insurance broker organization code? | 3 |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010-301342 |
| Policy instance | 1 |
| Insurance contract or identification number | 010-301342 | | Number of Individuals Covered | 125 | | Insurance policy start date | 2021-05-01 | | Insurance policy end date | 2022-04-30 | | Total amount of commissions paid to insurance broker | USD $3,659 | | Total amount of fees paid to insurance company | USD $364 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $11,765 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,659 | | Amount paid for insurance broker fees | 188 | | Additional information about fees paid to insurance broker | DENTAL PLAN | | Insurance broker organization code? | 3 |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010-301342 |
| Policy instance | 1 |
| Insurance contract or identification number | 010-301342 | | Number of Individuals Covered | 133 | | Insurance policy start date | 2020-05-01 | | Insurance policy end date | 2021-04-30 | | Total amount of commissions paid to insurance broker | USD $4,780 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $12,238 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,780 | | Additional information about fees paid to insurance broker | DENTAL PLAN | | Insurance broker organization code? | 3 |
|
| BLUE CROSS BLUE SHIELD OF NEBRASKA (National Association of Insurance Commissioners NAIC id number: 77780 ) |
| Policy contract number | 04690 |
| Policy instance | 2 |
| Insurance contract or identification number | 04690 | | Number of Individuals Covered | 250 | | Insurance policy start date | 2020-05-01 | | Insurance policy end date | 2021-04-30 | | Total amount of commissions paid to insurance broker | USD $53,745 | | Total amount of fees paid to insurance company | USD $4,186 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $53,745 | | Amount paid for insurance broker fees | 4186 | | Additional information about fees paid to insurance broker | HEALTH PLAN | | Insurance broker organization code? | 3 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 010-412657 |
| Policy instance | 3 |
| Insurance contract or identification number | 010-412657 | | Number of Individuals Covered | 86 | | Insurance policy start date | 2020-05-01 | | Insurance policy end date | 2021-04-30 | | Total amount of commissions paid to insurance broker | USD $1,571 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $15,714 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,571 | | Additional information about fees paid to insurance broker | VISION | | Insurance broker organization code? | 3 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 010-412657 |
| Policy instance | 3 |
| Insurance contract or identification number | 010-412657 | | Number of Individuals Covered | 103 | | Insurance policy start date | 2019-05-01 | | Insurance policy end date | 2020-04-30 | | Total amount of commissions paid to insurance broker | USD $1,960 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $17,448 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,960 | | Additional information about fees paid to insurance broker | VISION | | Insurance broker organization code? | 3 |
|
| BLUE CROSS BLUE SHIELD OF NEBRASKA (National Association of Insurance Commissioners NAIC id number: 77780 ) |
| Policy contract number | 04690 |
| Policy instance | 2 |
| Insurance contract or identification number | 04690 | | Number of Individuals Covered | 264 | | Insurance policy start date | 2019-05-01 | | Insurance policy end date | 2020-04-30 | | Total amount of commissions paid to insurance broker | USD $45,947 | | Total amount of fees paid to insurance company | USD $3,841 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $45,947 | | Amount paid for insurance broker fees | 3841 | | Additional information about fees paid to insurance broker | HEALTH PLAN | | Insurance broker organization code? | 3 |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010-301342 |
| Policy instance | 1 |
| Insurance contract or identification number | 010-301342 | | Number of Individuals Covered | 136 | | Insurance policy start date | 2019-05-01 | | Insurance policy end date | 2020-04-30 | | Total amount of commissions paid to insurance broker | USD $2,979 | | Total amount of fees paid to insurance company | USD $81 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $12,710 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,979 | | Amount paid for insurance broker fees | 81 | | Additional information about fees paid to insurance broker | DENTAL PLAN | | Insurance broker organization code? | 3 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 010-412657 |
| Policy instance | 3 |
| Insurance contract or identification number | 010-412657 | | Number of Individuals Covered | 103 | | Insurance policy start date | 2018-05-01 | | Insurance policy end date | 2019-04-30 | | Total amount of commissions paid to insurance broker | USD $2,250 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $17,310 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,250 | | Additional information about fees paid to insurance broker | VISION | | Insurance broker organization code? | 3 |
|
| BLUE CROSS BLUE SHIELD OF NEBRASKA (National Association of Insurance Commissioners NAIC id number: 77780 ) |
| Policy contract number | 04690 |
| Policy instance | 2 |
| Insurance contract or identification number | 04690 | | Number of Individuals Covered | 267 | | Insurance policy start date | 2018-05-01 | | Insurance policy end date | 2019-04-30 | | Total amount of commissions paid to insurance broker | USD $32,728 | | Total amount of fees paid to insurance company | USD $50 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $32,728 | | Amount paid for insurance broker fees | 50 | | Additional information about fees paid to insurance broker | HEALTH PLAN | | Insurance broker organization code? | 3 |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010-301342 |
| Policy instance | 1 |
| Insurance contract or identification number | 010-301342 | | Number of Individuals Covered | 140 | | Insurance policy start date | 2018-05-01 | | Insurance policy end date | 2019-04-30 | | Total amount of commissions paid to insurance broker | USD $3,962 | | Total amount of fees paid to insurance company | USD $273 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $12,741 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,962 | | Amount paid for insurance broker fees | 273 | | Additional information about fees paid to insurance broker | DENTAL PLAN | | Insurance broker organization code? | 3 |
|
| BLUE CROSS BLUE SHIELD OF NEBRASKA (National Association of Insurance Commissioners NAIC id number: 77780 ) |
| Policy contract number | 04690 |
| Policy instance | 2 |
| Insurance contract or identification number | 04690 | | Number of Individuals Covered | 269 | | Insurance policy start date | 2017-05-01 | | Insurance policy end date | 2018-04-30 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Additional information about fees paid to insurance broker | HEALTH PLAN | | Insurance broker organization code? | 3 | | Insurance broker name | MARCOTTE INSURANCE AGENCY INC |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010-027601 |
| Policy instance | 1 |
| Insurance contract or identification number | 010-027601 | | Number of Individuals Covered | 139 | | Insurance policy start date | 2017-05-01 | | Insurance policy end date | 2018-04-30 | | Total amount of commissions paid to insurance broker | USD $3,989 | | Total amount of fees paid to insurance company | USD $190 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $12,824 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,989 | | Amount paid for insurance broker fees | 190 | | Additional information about fees paid to insurance broker | DENTAL PLAN | | Insurance broker organization code? | 3 | | Insurance broker name | MARCOTTE INSURANCE AGENCY INC |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010-027601 |
| Policy instance | 1 |
| Insurance contract or identification number | 010-027601 | | Number of Individuals Covered | 218 | | Insurance policy start date | 2015-05-01 | | Insurance policy end date | 2016-04-30 | | Total amount of commissions paid to insurance broker | USD $3,673 | | Total amount of fees paid to insurance company | USD $161 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $11,811 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,673 | | Amount paid for insurance broker fees | 161 | | Additional information about fees paid to insurance broker | DENTAL PLAN | | Insurance broker organization code? | 3 | | Insurance broker name | TIM OLSON INC |
|
| BLUE CROSS BLUE SHIELD OF NEBRASKA (National Association of Insurance Commissioners NAIC id number: 77780 ) |
| Policy contract number | 04690 |
| Policy instance | 2 |
| Insurance contract or identification number | 04690 | | Number of Individuals Covered | 241 | | Insurance policy start date | 2015-05-01 | | Insurance policy end date | 2016-04-30 | | Total amount of commissions paid to insurance broker | USD $31,701 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $31,701 | | Additional information about fees paid to insurance broker | BONUS & PERSISTENCY COMMISSIONS | | Insurance broker organization code? | 3 | | Insurance broker name | STEVE KOTTICH |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010-027601 |
| Policy instance | 1 |
| Insurance contract or identification number | 010-027601 | | Number of Individuals Covered | 218 | | Insurance policy start date | 2014-05-01 | | Insurance policy end date | 2015-04-30 | | Total amount of commissions paid to insurance broker | USD $3,410 | | Total amount of fees paid to insurance company | USD $174 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,965 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,410 | | Amount paid for insurance broker fees | 174 | | Additional information about fees paid to insurance broker | DENTAL PLAN | | Insurance broker organization code? | 3 | | Insurance broker name | TIM OLSON INC |
|
| BLUE CROSS BLUE SHIELD OF NEBRASKA (National Association of Insurance Commissioners NAIC id number: 77780 ) |
| Policy contract number | 04690 |
| Policy instance | 2 |
| Insurance contract or identification number | 04690 | | Number of Individuals Covered | 218 | | Insurance policy start date | 2014-05-01 | | Insurance policy end date | 2015-04-30 | | Total amount of commissions paid to insurance broker | USD $32,064 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $32,064 | | Additional information about fees paid to insurance broker | BONUS & PERSISTENCY COMMISSIONS | | Insurance broker organization code? | 3 | | Insurance broker name | STEVE KOTTICH |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010-027601 |
| Policy instance | 1 |
| Insurance contract or identification number | 010-027601 | | Number of Individuals Covered | 230 | | Insurance policy start date | 2013-05-01 | | Insurance policy end date | 2014-04-30 | | Total amount of commissions paid to insurance broker | USD $4,086 | | Total amount of fees paid to insurance company | USD $264 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $13,137 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,086 | | Amount paid for insurance broker fees | 264 | | Additional information about fees paid to insurance broker | 3 | | Insurance broker name | TIM OLSON INC |
|
| BLUE CROSS BLUE SHIELD OF NEBRASKA (National Association of Insurance Commissioners NAIC id number: 77780 ) |
| Policy contract number | 04690 |
| Policy instance | 2 |
| Insurance contract or identification number | 04690 | | Number of Individuals Covered | 230 | | Insurance policy start date | 2013-05-01 | | Insurance policy end date | 2014-04-30 | | Total amount of commissions paid to insurance broker | USD $63,028 | | Total amount of fees paid to insurance company | USD $7 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $63,028 | | Amount paid for insurance broker fees | 7 | | Additional information about fees paid to insurance broker | BONUS & PERSISTENCY COMMISSIONS 3 | | Insurance broker name | STEVE KOTTICH |
|
| BLUE CROSS BLUE SHIELD OF NEBRASKA (National Association of Insurance Commissioners NAIC id number: 77780 ) |
| Policy contract number | 04690 |
| Policy instance | 2 |
| Insurance contract or identification number | 04690 | | Number of Individuals Covered | 229 | | Insurance policy start date | 2012-05-01 | | Insurance policy end date | 2013-04-30 | | Total amount of commissions paid to insurance broker | USD $58,485 | | Total amount of fees paid to insurance company | USD $6 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010-027601 |
| Policy instance | 1 |
| Insurance contract or identification number | 010-027601 | | Number of Individuals Covered | 260 | | Insurance policy start date | 2012-05-01 | | Insurance policy end date | 2013-04-30 | | Total amount of commissions paid to insurance broker | USD $3,571 | | Total amount of fees paid to insurance company | USD $116 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $11,483 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010-027601 |
| Policy instance | 1 |
| Insurance contract or identification number | 010-027601 | | Number of Individuals Covered | 260 | | Insurance policy start date | 2012-04-30 | | Insurance policy end date | 2013-04-30 | | Total amount of commissions paid to insurance broker | USD $3,571 | | Total amount of fees paid to insurance company | USD $116 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $11,483 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,571 | | Amount paid for insurance broker fees | 116 | | Additional information about fees paid to insurance broker | 3 | | Insurance broker name | TIM OLSON INC |
|
| BLUE CROSS BLUE SHIELD OF NEBRASKA (National Association of Insurance Commissioners NAIC id number: 77780 ) |
| Policy contract number | 04690 |
| Policy instance | 2 |
| Insurance contract or identification number | 04690 | | Number of Individuals Covered | 229 | | Insurance policy start date | 2012-04-30 | | Insurance policy end date | 2013-04-30 | | Total amount of commissions paid to insurance broker | USD $58,485 | | Total amount of fees paid to insurance company | USD $6 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $58,485 | | Amount paid for insurance broker fees | 6 | | Additional information about fees paid to insurance broker | BONUS & PERSISTENCY COMMISSIONS 3 | | Insurance broker name | STEVE KOTTICH |
|
| BLUE CROSS BLUE SHIELD OF NEBRASKA (National Association of Insurance Commissioners NAIC id number: 77780 ) |
| Policy contract number | 04690 |
| Policy instance | 2 |
| Insurance contract or identification number | 04690 | | Number of Individuals Covered | 221 | | Insurance policy start date | 2011-05-01 | | Insurance policy end date | 2012-04-30 | | Total amount of commissions paid to insurance broker | USD $38,085 | | Total amount of fees paid to insurance company | USD $2,556 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010-027601 |
| Policy instance | 1 |
| Insurance contract or identification number | 010-027601 | | Number of Individuals Covered | 259 | | Insurance policy start date | 2011-05-01 | | Insurance policy end date | 2012-04-30 | | Total amount of commissions paid to insurance broker | USD $3,318 | | Total amount of fees paid to insurance company | USD $1,350 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $66,358 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF NEBRASKA (National Association of Insurance Commissioners NAIC id number: 77780 ) |
| Policy contract number | 04690 |
| Policy instance | 2 |
| Insurance contract or identification number | 04690 | | Number of Individuals Covered | 196 | | Insurance policy start date | 2010-05-01 | | Insurance policy end date | 2011-04-30 | | Total amount of commissions paid to insurance broker | USD $38,469 | | Total amount of fees paid to insurance company | USD $5,314 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $38,469 | | Amount paid for insurance broker fees | 5314 | | Additional information about fees paid to insurance broker | BONUS PERSISTENCY COMMISSIONS | | Insurance broker organization code? | 3 | | Insurance broker name | STEVE KOTTICH |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010-027601 |
| Policy instance | 1 |
| Insurance contract or identification number | 010-027601 | | Number of Individuals Covered | 257 | | Insurance policy start date | 2010-05-01 | | Insurance policy end date | 2011-04-30 | | Total amount of commissions paid to insurance broker | USD $3,221 | | Total amount of fees paid to insurance company | USD $1,295 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $64,417 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,221 | | Amount paid for insurance broker fees | 1295 | | Insurance broker organization code? | 3 | | Insurance broker name | TIM OLSON INC |
|
