GT SALES & MANUFACTURING, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan GT MIDWEST EMPLOYEE BENEFIT PLAN
Measure | Date | Value |
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2022: GT MIDWEST EMPLOYEE BENEFIT PLAN 2022 401k membership |
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Total participants, beginning-of-year | 2022-06-01 | 155 |
Total number of active participants reported on line 7a of the Form 5500 | 2022-06-01 | 103 |
Number of retired or separated participants receiving benefits | 2022-06-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2022-06-01 | 0 |
Total of all active and inactive participants | 2022-06-01 | 103 |
Number of employers contributing to the scheme | 2022-06-01 | 0 |
2021: GT MIDWEST EMPLOYEE BENEFIT PLAN 2021 401k membership |
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Total participants, beginning-of-year | 2021-06-01 | 141 |
Total number of active participants reported on line 7a of the Form 5500 | 2021-06-01 | 155 |
Number of retired or separated participants receiving benefits | 2021-06-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2021-06-01 | 0 |
Total of all active and inactive participants | 2021-06-01 | 155 |
Number of employers contributing to the scheme | 2021-06-01 | 0 |
2020: GT MIDWEST EMPLOYEE BENEFIT PLAN 2020 401k membership |
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Total participants, beginning-of-year | 2020-06-01 | 161 |
Total number of active participants reported on line 7a of the Form 5500 | 2020-06-01 | 141 |
Number of retired or separated participants receiving benefits | 2020-06-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2020-06-01 | 0 |
Total of all active and inactive participants | 2020-06-01 | 141 |
Number of employers contributing to the scheme | 2020-06-01 | 0 |
2019: GT MIDWEST EMPLOYEE BENEFIT PLAN 2019 401k membership |
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Total participants, beginning-of-year | 2019-06-01 | 144 |
Total number of active participants reported on line 7a of the Form 5500 | 2019-06-01 | 161 |
Number of retired or separated participants receiving benefits | 2019-06-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2019-06-01 | 0 |
Total of all active and inactive participants | 2019-06-01 | 161 |
Number of employers contributing to the scheme | 2019-06-01 | 0 |
2018: GT MIDWEST EMPLOYEE BENEFIT PLAN 2018 401k membership |
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Total participants, beginning-of-year | 2018-06-01 | 154 |
Total number of active participants reported on line 7a of the Form 5500 | 2018-06-01 | 144 |
Number of retired or separated participants receiving benefits | 2018-06-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2018-06-01 | 0 |
Total of all active and inactive participants | 2018-06-01 | 144 |
Number of employers contributing to the scheme | 2018-06-01 | 0 |
2017: GT MIDWEST EMPLOYEE BENEFIT PLAN 2017 401k membership |
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Total participants, beginning-of-year | 2017-06-01 | 144 |
Total number of active participants reported on line 7a of the Form 5500 | 2017-06-01 | 154 |
Number of retired or separated participants receiving benefits | 2017-06-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2017-06-01 | 0 |
Total of all active and inactive participants | 2017-06-01 | 154 |
Number of employers contributing to the scheme | 2017-06-01 | 0 |
2016: GT MIDWEST EMPLOYEE BENEFIT PLAN 2016 401k membership |
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Total participants, beginning-of-year | 2016-06-01 | 139 |
Total number of active participants reported on line 7a of the Form 5500 | 2016-06-01 | 144 |
Number of retired or separated participants receiving benefits | 2016-06-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2016-06-01 | 0 |
Total of all active and inactive participants | 2016-06-01 | 144 |
2015: GT MIDWEST EMPLOYEE BENEFIT PLAN 2015 401k membership |
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Total participants, beginning-of-year | 2015-06-01 | 140 |
Total number of active participants reported on line 7a of the Form 5500 | 2015-06-01 | 144 |
Total of all active and inactive participants | 2015-06-01 | 144 |
2014: GT MIDWEST EMPLOYEE BENEFIT PLAN 2014 401k membership |
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Total participants, beginning-of-year | 2014-06-01 | 136 |
Total number of active participants reported on line 7a of the Form 5500 | 2014-06-01 | 140 |
Total of all active and inactive participants | 2014-06-01 | 140 |
2013: GT MIDWEST EMPLOYEE BENEFIT PLAN 2013 401k membership |
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Total participants, beginning-of-year | 2013-06-01 | 139 |
Total number of active participants reported on line 7a of the Form 5500 | 2013-06-01 | 136 |
Total of all active and inactive participants | 2013-06-01 | 136 |
2012: GT MIDWEST EMPLOYEE BENEFIT PLAN 2012 401k membership |
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Total participants, beginning-of-year | 2012-06-01 | 140 |
Total number of active participants reported on line 7a of the Form 5500 | 2012-06-01 | 139 |
Total of all active and inactive participants | 2012-06-01 | 139 |
2011: GT MIDWEST EMPLOYEE BENEFIT PLAN 2011 401k membership |
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Total participants, beginning-of-year | 2011-06-01 | 134 |
Total number of active participants reported on line 7a of the Form 5500 | 2011-06-01 | 140 |
Total of all active and inactive participants | 2011-06-01 | 140 |
2009: GT MIDWEST EMPLOYEE BENEFIT PLAN 2009 401k membership |
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Total participants, beginning-of-year | 2009-06-01 | 145 |
Total number of active participants reported on line 7a of the Form 5500 | 2009-06-01 | 128 |
Total of all active and inactive participants | 2009-06-01 | 128 |
2022: GT MIDWEST EMPLOYEE BENEFIT PLAN 2022 form 5500 responses |
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2022-06-01 | Type of plan entity | Single employer plan |
2022-06-01 | Plan funding arrangement – Insurance | Yes |
2022-06-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2022-06-01 | Plan benefit arrangement – Insurance | Yes |
2022-06-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2021: GT MIDWEST EMPLOYEE BENEFIT PLAN 2021 form 5500 responses |
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2021-06-01 | Type of plan entity | Single employer plan |
2021-06-01 | Plan funding arrangement – Insurance | Yes |
2021-06-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2021-06-01 | Plan benefit arrangement – Insurance | Yes |
2021-06-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2020: GT MIDWEST EMPLOYEE BENEFIT PLAN 2020 form 5500 responses |
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2020-06-01 | Type of plan entity | Single employer plan |
2020-06-01 | Plan funding arrangement – Insurance | Yes |
2020-06-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2020-06-01 | Plan benefit arrangement – Insurance | Yes |
2020-06-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2019: GT MIDWEST EMPLOYEE BENEFIT PLAN 2019 form 5500 responses |
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2019-06-01 | Type of plan entity | Single employer plan |
2019-06-01 | Plan funding arrangement – Insurance | Yes |
2019-06-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2019-06-01 | Plan benefit arrangement – Insurance | Yes |
2019-06-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2018: GT MIDWEST EMPLOYEE BENEFIT PLAN 2018 form 5500 responses |
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2018-06-01 | Type of plan entity | Single employer plan |
2018-06-01 | Plan funding arrangement – Insurance | Yes |
2018-06-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2018-06-01 | Plan benefit arrangement – Insurance | Yes |
2018-06-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2017: GT MIDWEST EMPLOYEE BENEFIT PLAN 2017 form 5500 responses |
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2017-06-01 | Type of plan entity | Single employer plan |
2017-06-01 | Plan funding arrangement – Insurance | Yes |
2017-06-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2017-06-01 | Plan benefit arrangement – Insurance | Yes |
2017-06-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2016: GT MIDWEST EMPLOYEE BENEFIT PLAN 2016 form 5500 responses |
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2016-06-01 | Type of plan entity | Single employer plan |
2016-06-01 | Submission has been amended | No |
2016-06-01 | This submission is the final filing | No |
2016-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2016-06-01 | Plan is a collectively bargained plan | No |
2016-06-01 | Plan funding arrangement – Insurance | Yes |
2016-06-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2016-06-01 | Plan benefit arrangement – Insurance | Yes |
2016-06-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2015: GT MIDWEST EMPLOYEE BENEFIT PLAN 2015 form 5500 responses |
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2015-06-01 | Type of plan entity | Single employer plan |
2015-06-01 | Submission has been amended | No |
2015-06-01 | This submission is the final filing | No |
2015-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2015-06-01 | Plan is a collectively bargained plan | No |
2015-06-01 | Plan funding arrangement – Insurance | Yes |
2015-06-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2015-06-01 | Plan benefit arrangement – Insurance | Yes |
2015-06-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2014: GT MIDWEST EMPLOYEE BENEFIT PLAN 2014 form 5500 responses |
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2014-06-01 | Type of plan entity | Single employer plan |
2014-06-01 | Plan funding arrangement – Insurance | Yes |
2014-06-01 | Plan benefit arrangement – Insurance | Yes |
2013: GT MIDWEST EMPLOYEE BENEFIT PLAN 2013 form 5500 responses |
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2013-06-01 | Type of plan entity | Single employer plan |
2013-06-01 | Plan funding arrangement – Insurance | Yes |
2013-06-01 | Plan benefit arrangement – Insurance | Yes |
2012: GT MIDWEST EMPLOYEE BENEFIT PLAN 2012 form 5500 responses |
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2012-06-01 | Type of plan entity | Single employer plan |
2012-06-01 | Plan funding arrangement – Insurance | Yes |
2012-06-01 | Plan benefit arrangement – Insurance | Yes |
2011: GT MIDWEST EMPLOYEE BENEFIT PLAN 2011 form 5500 responses |
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2011-06-01 | Type of plan entity | Single employer plan |
2011-06-01 | Plan funding arrangement – Insurance | Yes |
2011-06-01 | Plan benefit arrangement – Insurance | Yes |
2009: GT MIDWEST EMPLOYEE BENEFIT PLAN 2009 form 5500 responses |
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2009-06-01 | Type of plan entity | Single employer plan |
2009-06-01 | This submission is the final filing | No |
2009-06-01 | Plan funding arrangement – Insurance | Yes |
2009-06-01 | Plan benefit arrangement – Insurance | Yes |
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 30058013 |
Policy instance | 2 |
Insurance contract or identification number | 30058013 | Number of Individuals Covered | 83 | Insurance policy start date | 2022-06-01 | Insurance policy end date | 2023-05-31 | Total amount of commissions paid to insurance broker | USD $936 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $15,082 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $936 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 ) |
Policy contract number | 2305 |
Policy instance | 1 |
Insurance contract or identification number | 2305 | Number of Individuals Covered | 103 | Insurance policy start date | 2022-06-01 | Insurance policy end date | 2023-05-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $70,519 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | SGD607918 |
Policy instance | 3 |
Insurance contract or identification number | SGD607918 | Number of Individuals Covered | 103 | Insurance policy start date | 2022-06-01 | Insurance policy end date | 2023-05-31 | Total amount of commissions paid to insurance broker | USD $12,611 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $91,600 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $12,611 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | SGD607918 |
Policy instance | 3 |
Insurance contract or identification number | SGD607918 | Number of Individuals Covered | 155 | Insurance policy start date | 2021-06-01 | Insurance policy end date | 2022-05-31 | Total amount of commissions paid to insurance broker | USD $12,892 | Total amount of fees paid to insurance company | USD $1,698 | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $85,949 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $12,892 | Amount paid for insurance broker fees | 1698 | Additional information about fees paid to insurance broker | OVERRIDE | Insurance broker organization code? | 3 |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 30058013 |
Policy instance | 2 |
Insurance contract or identification number | 30058013 | Number of Individuals Covered | 90 | Insurance policy start date | 2021-06-01 | Insurance policy end date | 2022-05-31 | Total amount of commissions paid to insurance broker | USD $803 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $15,628 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $803 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
|
DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 ) |
Policy contract number | 230500000001 |
Policy instance | 1 |
Insurance contract or identification number | 230500000001 | Number of Individuals Covered | 107 | Insurance policy start date | 2021-06-01 | Insurance policy end date | 2022-05-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $69,532 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 ) |
Policy contract number | 230500000001 |
Policy instance | 2 |
Insurance contract or identification number | 230500000001 | Number of Individuals Covered | 95 | Insurance policy start date | 2020-06-01 | Insurance policy end date | 2021-05-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $68,902 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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BLUE CROSS BLUE SHIELD OF KANSAS (National Association of Insurance Commissioners NAIC id number: 70729 ) |
Policy contract number | 9128 |
Policy instance | 1 |
Insurance contract or identification number | 9128 | Number of Individuals Covered | 157 | Insurance policy start date | 2020-06-01 | Insurance policy end date | 2021-05-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 30058013 |
Policy instance | 3 |
Insurance contract or identification number | 30058013 | Number of Individuals Covered | 83 | Insurance policy start date | 2020-06-01 | Insurance policy end date | 2021-05-31 | Total amount of commissions paid to insurance broker | USD $890 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $13,926 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $890 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
|
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | SGD607918 |
Policy instance | 4 |
Insurance contract or identification number | SGD607918 | Number of Individuals Covered | 141 | Insurance policy start date | 2020-06-01 | Insurance policy end date | 2021-05-31 | Total amount of commissions paid to insurance broker | USD $12,706 | Total amount of fees paid to insurance company | USD $757 | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $84,709 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $12,706 | Amount paid for insurance broker fees | 757 | Additional information about fees paid to insurance broker | OVERRIDE | Insurance broker organization code? | 3 |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 30058013 |
Policy instance | 3 |
Insurance contract or identification number | 30058013 | Number of Individuals Covered | 88 | Insurance policy start date | 2019-06-01 | Insurance policy end date | 2020-05-31 | Total amount of commissions paid to insurance broker | USD $916 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $14,675 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $873 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
Policy contract number | 2324 |
Policy instance | 4 |
Insurance contract or identification number | 2324 | Number of Individuals Covered | 53 | Insurance policy start date | 2019-06-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $1,615 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | CANCER | Welfare Benefit Premiums Paid to Carrier | USD $10,034 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,055 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 ) |
Policy contract number | 2305 |
Policy instance | 2 |
Insurance contract or identification number | 2305 | Number of Individuals Covered | 102 | Insurance policy start date | 2019-06-01 | Insurance policy end date | 2020-05-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $70,209 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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BLUE CROSS BLUE SHIELD OF KANSAS (National Association of Insurance Commissioners NAIC id number: 70729 ) |
Policy contract number | 9128 |
Policy instance | 1 |
Insurance contract or identification number | 9128 | Number of Individuals Covered | 161 | Insurance policy start date | 2019-06-01 | Insurance policy end date | 2020-05-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $0 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | SGD0607918 |
Policy instance | 5 |
Insurance contract or identification number | SGD0607918 | Number of Individuals Covered | 161 | Insurance policy start date | 2019-06-01 | Insurance policy end date | 2020-05-31 | Total amount of commissions paid to insurance broker | USD $12,584 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $83,894 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $12,584 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
|
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | SGD0607918 |
Policy instance | 5 |
Insurance contract or identification number | SGD0607918 | Number of Individuals Covered | 144 | Insurance policy start date | 2018-06-01 | Insurance policy end date | 2019-05-31 | Total amount of commissions paid to insurance broker | USD $12,028 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $80,185 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $12,028 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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BLUE CROSS BLUE SHIELD OF KANSAS (National Association of Insurance Commissioners NAIC id number: 70729 ) |
Policy contract number | 9410 |
Policy instance | 1 |
Insurance contract or identification number | 9410 | Number of Individuals Covered | 174 | Insurance policy start date | 2018-06-01 | Insurance policy end date | 2019-05-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $850,427 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 ) |
Policy contract number | 2305 |
Policy instance | 2 |
Insurance contract or identification number | 2305 | Number of Individuals Covered | 95 | Insurance policy start date | 2018-06-01 | Insurance policy end date | 2019-05-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $67,640 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
Policy contract number | 2324 |
Policy instance | 4 |
Insurance contract or identification number | 2324 | Number of Individuals Covered | 48 | Insurance policy start date | 2018-06-01 | Insurance policy end date | 2019-05-31 | Total amount of commissions paid to insurance broker | USD $2,211 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | CANCER | Welfare Benefit Premiums Paid to Carrier | USD $14,680 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $964 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 30058013 |
Policy instance | 3 |
Insurance contract or identification number | 30058013 | Number of Individuals Covered | 82 | Insurance policy start date | 2018-06-01 | Insurance policy end date | 2019-05-31 | Total amount of commissions paid to insurance broker | USD $866 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $13,257 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $866 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | SGD0607918 |
Policy instance | 5 |
Insurance contract or identification number | SGD0607918 | Number of Individuals Covered | 154 | Insurance policy start date | 2017-06-01 | Insurance policy end date | 2018-05-31 | Total amount of commissions paid to insurance broker | USD $11,023 | Total amount of fees paid to insurance company | USD $3,363 | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $73,484 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $11,023 | Amount paid for insurance broker fees | 3363 | Additional information about fees paid to insurance broker | OVERRIDE | Insurance broker organization code? | 3 | Insurance broker name | THE HAYS GROUP OF KANSAS CITY, LLC |
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AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
Policy contract number | 2324 |
Policy instance | 4 |
Insurance contract or identification number | 2324 | Number of Individuals Covered | 47 | Insurance policy start date | 2017-06-01 | Insurance policy end date | 2018-05-31 | Total amount of commissions paid to insurance broker | USD $1,031 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | CANCER | Welfare Benefit Premiums Paid to Carrier | USD $13,630 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $507 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Insurance broker name | USI INSURANCE SERVICES LLC |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 30058013 |
Policy instance | 3 |
Insurance contract or identification number | 30058013 | Number of Individuals Covered | 90 | Insurance policy start date | 2017-06-01 | Insurance policy end date | 2018-05-31 | Total amount of commissions paid to insurance broker | USD $878 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $13,595 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $837 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Insurance broker name | USI INSURANCE SERVICES LLC |
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DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 ) |
Policy contract number | 2305 |
Policy instance | 2 |
Insurance contract or identification number | 2305 | Number of Individuals Covered | 107 | Insurance policy start date | 2017-06-01 | Insurance policy end date | 2018-05-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $73,166 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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BLUE CROSS BLUE SHIELD OF KANSAS (National Association of Insurance Commissioners NAIC id number: 70729 ) |
Policy contract number | 9410 |
Policy instance | 1 |
Insurance contract or identification number | 9410 | Number of Individuals Covered | 208 | Insurance policy start date | 2017-06-01 | Insurance policy end date | 2018-05-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $823,058 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 ) |
Policy contract number | 02305-000-00001 |
Policy instance | 1 |
Insurance contract or identification number | 02305-000-00001 | Number of Individuals Covered | 98 | Insurance policy start date | 2015-06-01 | Insurance policy end date | 2016-05-31 | Total amount of commissions paid to insurance broker | USD $1,875 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $72,600 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,875 | Insurance broker organization code? | 3 | Insurance broker name | RIDGE CONSULTING GROUP, INC. |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GLUG0APTR |
Policy instance | 2 |
Insurance contract or identification number | GLUG0APTR | Number of Individuals Covered | 144 | Insurance policy start date | 2015-06-01 | Insurance policy end date | 2016-05-31 | Total amount of commissions paid to insurance broker | USD $1,300 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $12,998 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,088 | Insurance broker organization code? | 3 | Insurance broker name | THE HAYS GROUP OF KANSAS CITY LLC |
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HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
Policy contract number | 872752G |
Policy instance | 3 |
Insurance contract or identification number | 872752G | Number of Individuals Covered | 69 | Insurance policy start date | 2015-06-01 | Insurance policy end date | 2016-05-31 | Total amount of commissions paid to insurance broker | USD $3,648 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $24,317 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,128 | Insurance broker organization code? | 3 | Insurance broker name | THE HAYS GROUP OF KANSAS CITY |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 30058013 |
Policy instance | 4 |
Insurance contract or identification number | 30058013 | Number of Individuals Covered | 63 | Insurance policy start date | 2015-06-01 | Insurance policy end date | 2016-05-31 | Total amount of commissions paid to insurance broker | USD $794 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $11,248 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $713 | Insurance broker organization code? | 3 | Insurance broker name | THE HAYS GROUP OF KANSAS CITY LLC |
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BLUE CROSS BLUE SHIELD OF KANSAS (National Association of Insurance Commissioners NAIC id number: 70729 ) |
Policy contract number | 09410 |
Policy instance | 5 |
Insurance contract or identification number | 09410 | Number of Individuals Covered | 206 | Insurance policy start date | 2015-06-01 | Insurance policy end date | 2016-05-31 | Total amount of commissions paid to insurance broker | USD $13,307 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $749,755 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $13,307 | Insurance broker organization code? | 3 | Insurance broker name | ROBERT LANGHOFER - HARRINGTON HEALT |
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AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
Policy contract number | 02324 |
Policy instance | 6 |
Insurance contract or identification number | 02324 | Number of Individuals Covered | 52 | Insurance policy start date | 2015-06-01 | Insurance policy end date | 2016-05-31 | Total amount of commissions paid to insurance broker | USD $2,003 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | CANCER/SPECIFIED DISEASE | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $16,408 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,601 | Insurance broker organization code? | 3 | Insurance broker name | PAUL LIBEL |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GVTL0APTR |
Policy instance | 7 |
Insurance contract or identification number | GVTL0APTR | Number of Individuals Covered | 53 | Insurance policy start date | 2015-06-01 | Insurance policy end date | 2016-05-31 | Total amount of commissions paid to insurance broker | USD $3,644 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D - VOLUNTARY | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $24,292 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,035 | Insurance broker organization code? | 3 | Insurance broker name | THE HAYS GROUP OF KANSAS CITY LLC |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000APTR |
Policy instance | 8 |
Insurance contract or identification number | G000APTR | Number of Individuals Covered | 144 | Insurance policy start date | 2015-06-01 | Insurance policy end date | 2016-05-31 | Total amount of commissions paid to insurance broker | USD $2,540 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $17,898 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,251 | Insurance broker organization code? | 3 | Insurance broker name | THE HAYS GROUP OF KANSAS CITY, LLC |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G00APTR |
Policy instance | 1 |
Insurance contract or identification number | G00APTR | Number of Individuals Covered | 54 | Insurance policy start date | 2014-06-01 | Insurance policy end date | 2014-05-31 | Total amount of commissions paid to insurance broker | USD $3,178 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D-VOLUNTARY | Welfare Benefit Premiums Paid to Carrier | USD $21,185 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,178 | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD | Insurance broker organization code? | 3 | Insurance broker name | RIDGE CONSULTING GROUP INC |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000APTR |
Policy instance | 2 |
Insurance contract or identification number | G000APTR | Number of Individuals Covered | 140 | Insurance policy start date | 2014-06-01 | Insurance policy end date | 2015-05-31 | Total amount of commissions paid to insurance broker | USD $1,161 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $11,606 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,161 | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD | Insurance broker organization code? | 3 | Insurance broker name | RIDGE CONSULTING GROUP INC |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000APTR |
Policy instance | 3 |
Insurance contract or identification number | G000APTR | Number of Individuals Covered | 140 | Insurance policy start date | 2014-06-01 | Insurance policy end date | 2015-05-31 | Total amount of commissions paid to insurance broker | USD $2,304 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $15,544 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,304 | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD | Insurance broker organization code? | 3 | Insurance broker name | RIDGE CONSULTING GROUP INC |
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AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
Policy contract number | 02324 |
Policy instance | 4 |
Insurance contract or identification number | 02324 | Number of Individuals Covered | 54 | Insurance policy start date | 2014-06-01 | Insurance policy end date | 2015-05-31 | Total amount of commissions paid to insurance broker | USD $1,981 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $17,943 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,813 | Insurance broker organization code? | 3 | Insurance broker name | PAUL LIBEL |
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HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
Policy contract number | 872752F |
Policy instance | 5 |
Insurance contract or identification number | 872752F | Number of Individuals Covered | 74 | Insurance policy start date | 2014-06-01 | Insurance policy end date | 2015-05-31 | Total amount of commissions paid to insurance broker | USD $2,616 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Other welfare benefits provided | WD-NST | Welfare Benefit Premiums Paid to Carrier | USD $17,441 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,616 | Insurance broker organization code? | 3 | Insurance broker name | RIDGE CONSULTING GROUP INC |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000APTR |
Policy instance | 3 |
Insurance contract or identification number | G000APTR | Number of Individuals Covered | 58 | Insurance policy start date | 2013-06-01 | Insurance policy end date | 2014-05-31 | Total amount of commissions paid to insurance broker | USD $3,120 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D-VOLUNTARY | Welfare Benefit Premiums Paid to Carrier | USD $20,797 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,120 | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD | Insurance broker organization code? | 3 | Insurance broker name | RIDGE CONSULTING GROUP INC |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000APTR |
Policy instance | 2 |
Insurance contract or identification number | G000APTR | Number of Individuals Covered | 136 | Insurance policy start date | 2013-06-01 | Insurance policy end date | 2014-05-31 | Total amount of commissions paid to insurance broker | USD $2,308 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $15,582 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,308 | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD | Insurance broker organization code? | 3 | Insurance broker name | RIDGE CONSULTING GROUP INC |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000APTR |
Policy instance | 1 |
Insurance contract or identification number | G000APTR | Number of Individuals Covered | 136 | Insurance policy start date | 2013-06-01 | Insurance policy end date | 2014-05-31 | Total amount of commissions paid to insurance broker | USD $1,174 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $11,744 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,174 | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD | Insurance broker organization code? | 3 | Insurance broker name | RIDGE CONSULTING GROUP INC |
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ADVANCE INSURANCE COMPANY OF KANSAS (National Association of Insurance Commissioners NAIC id number: 12143 ) |
Policy contract number | 00009128 |
Policy instance | 1 |
Insurance contract or identification number | 00009128 | Number of Individuals Covered | 139 | Insurance policy start date | 2012-06-01 | Insurance policy end date | 2013-05-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $37,617 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Insurance broker organization code? | 3 | Insurance broker name | HARRINGTON BENEFIT SERVICES |
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ADVANCE INSURANCE COMPANY OF KANSAS (National Association of Insurance Commissioners NAIC id number: 12143 ) |
Policy contract number | 00009128 |
Policy instance | 1 |
Insurance contract or identification number | 00009128 | Number of Individuals Covered | 140 | Insurance policy start date | 2011-06-01 | Insurance policy end date | 2012-05-31 | Total amount of commissions paid to insurance broker | USD $4,780 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $35,591 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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ADVANCE INSURANCE COMPANY OF KANSAS (National Association of Insurance Commissioners NAIC id number: 12143 ) |
Policy contract number | 00009128 |
Policy instance | 1 |
Insurance contract or identification number | 00009128 | Number of Individuals Covered | 134 | Insurance policy start date | 2010-06-01 | Insurance policy end date | 2011-05-31 | Total amount of commissions paid to insurance broker | USD $3,649 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $32,979 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,649 | Insurance broker organization code? | 3 | Insurance broker name | HARRINGTON BENEFIT SERVICES |
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