BURTON & BURTON, INC has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan FLOWERS, INC. INSURANCE PLAN
401k plan membership statisitcs for FLOWERS, INC. INSURANCE PLAN
| Measure | Date | Value |
|---|
| 2023: FLOWERS, INC. INSURANCE PLAN 2023 401k membership |
|---|
| Total participants, beginning-of-year | 2023-01-01 | 244 |
| Total number of active participants reported on line 7a of the Form 5500 | 2023-01-01 | 244 |
| Number of retired or separated participants receiving benefits | 2023-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2023-01-01 | 0 |
| Total of all active and inactive participants | 2023-01-01 | 244 |
| 2022: FLOWERS, INC. INSURANCE PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 249 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 244 |
| Number of retired or separated participants receiving benefits | 2022-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2022-01-01 | 0 |
| Total of all active and inactive participants | 2022-01-01 | 244 |
| 2021: FLOWERS, INC. INSURANCE PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 345 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 249 |
| Number of retired or separated participants receiving benefits | 2021-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-01-01 | 0 |
| Total of all active and inactive participants | 2021-01-01 | 249 |
| 2020: FLOWERS, INC. INSURANCE PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 351 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 345 |
| Number of retired or separated participants receiving benefits | 2020-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2020-01-01 | 0 |
| Total of all active and inactive participants | 2020-01-01 | 345 |
| 2019: FLOWERS, INC. INSURANCE PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 348 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 351 |
| Number of retired or separated participants receiving benefits | 2019-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-01-01 | 0 |
| Total of all active and inactive participants | 2019-01-01 | 351 |
| 2018: FLOWERS, INC. INSURANCE PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 373 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 348 |
| Number of retired or separated participants receiving benefits | 2018-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-01-01 | 0 |
| Total of all active and inactive participants | 2018-01-01 | 348 |
| 2017: FLOWERS, INC. INSURANCE PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 347 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 373 |
| Number of retired or separated participants receiving benefits | 2017-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-01-01 | 0 |
| Total of all active and inactive participants | 2017-01-01 | 373 |
| 2016: FLOWERS, INC. INSURANCE PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 349 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 347 |
| Number of retired or separated participants receiving benefits | 2016-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2016-01-01 | 0 |
| Total of all active and inactive participants | 2016-01-01 | 347 |
| 2015: FLOWERS, INC. INSURANCE PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 324 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 349 |
| Number of retired or separated participants receiving benefits | 2015-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2015-01-01 | 0 |
| Total of all active and inactive participants | 2015-01-01 | 349 |
| 2014: FLOWERS, INC. INSURANCE PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 326 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 324 |
| Number of retired or separated participants receiving benefits | 2014-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2014-01-01 | 0 |
| Total of all active and inactive participants | 2014-01-01 | 324 |
| 2013: FLOWERS, INC. INSURANCE PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 341 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 326 |
| Total of all active and inactive participants | 2013-01-01 | 326 |
| 2012: FLOWERS, INC. INSURANCE PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 231 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 341 |
| Total of all active and inactive participants | 2012-01-01 | 341 |
| 2011: FLOWERS, INC. INSURANCE PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-01-01 | 287 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 231 |
| Total of all active and inactive participants | 2011-01-01 | 231 |
| 2010: FLOWERS, INC. INSURANCE PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-01-01 | 316 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-01-01 | 287 |
| Total of all active and inactive participants | 2010-01-01 | 287 |
| 2009: FLOWERS, INC. INSURANCE PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-01-01 | 325 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 316 |
| Total of all active and inactive participants | 2009-01-01 | 316 |
| PROACT, INC. (National Association of Insurance Commissioners NAIC id number: 45411 ) |
| Policy contract number | BAB |
| Policy instance | 4 |
| Insurance contract or identification number | BAB | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of fees paid to insurance company | USD $5,861 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 ) |
| Policy contract number | IISI 3602 |
| Policy instance | 3 |
| Insurance contract or identification number | IISI 3602 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $263,949 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00513631 |
| Policy instance | 2 |
| Insurance contract or identification number | 00513631 | | Number of Individuals Covered | 244 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $67,664 | | Total amount of fees paid to insurance company | USD $9,946 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | OTHER (HOSPITAL INDEMNITY) | | Welfare Benefit Premiums Paid to Carrier | USD $383,195 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LUCENT HEALTH (National Association of Insurance Commissioners NAIC id number: 56111 ) |
| Policy contract number | N35 |
| Policy instance | 1 |
| Insurance contract or identification number | N35 | | Number of Individuals Covered | 187 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $177,132 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LUCENT HEALTH (National Association of Insurance Commissioners NAIC id number: 56111 ) |
| Policy contract number | N35 |
| Policy instance | 1 |
| Insurance contract or identification number | N35 | | Number of Individuals Covered | 195 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $196,683 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00513631 |
| Policy instance | 2 |
| Insurance contract or identification number | 00513631 | | Number of Individuals Covered | 244 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $66,786 | | Total amount of fees paid to insurance company | USD $11,521 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | OTHER (HOSPITAL INDEMNITY) | | Welfare Benefit Premiums Paid to Carrier | USD $378,561 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $66,786 | | Amount paid for insurance broker fees | 11521 | | Additional information about fees paid to insurance broker | SALES AND BASE COMMISSION | | Insurance broker organization code? | 3 |
|
| COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 ) |
| Policy contract number | IISI 3602 |
| Policy instance | 3 |
| Insurance contract or identification number | IISI 3602 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $263,288 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PROACT, INC. (National Association of Insurance Commissioners NAIC id number: 45411 ) |
| Policy contract number | BAB |
| Policy instance | 4 |
| Insurance contract or identification number | BAB | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of fees paid to insurance company | USD $2,528 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 2528 | | Insurance broker organization code? | 3 |
|
| PROACT, INC. (National Association of Insurance Commissioners NAIC id number: 45411 ) |
| Policy contract number | BAB |
| Policy instance | 4 |
| Insurance contract or identification number | BAB | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of fees paid to insurance company | USD $1,934 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 1934 | | Insurance broker organization code? | 3 |
|
| COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 ) |
| Policy contract number | IISI 3602 |
| Policy instance | 3 |
| Insurance contract or identification number | IISI 3602 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $257,255 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00513631 |
| Policy instance | 2 |
| Insurance contract or identification number | 00513631 | | Number of Individuals Covered | 249 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $68,555 | | Total amount of fees paid to insurance company | USD $5,399 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | OTHER (HOSPITAL INDEMNITY) | | Welfare Benefit Premiums Paid to Carrier | USD $384,353 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $68,555 | | Amount paid for insurance broker fees | 5399 | | Additional information about fees paid to insurance broker | SALES AND BASE COMMISSION | | Insurance broker organization code? | 3 |
|
| LUCENT HEALTH (National Association of Insurance Commissioners NAIC id number: 56111 ) |
| Policy contract number | N35 |
| Policy instance | 1 |
| Insurance contract or identification number | N35 | | Number of Individuals Covered | 207 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $201,154 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 ) |
| Policy contract number | GA6129 |
| Policy instance | 1 |
| Insurance contract or identification number | GA6129 | | Number of Individuals Covered | 184 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $223 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $-2,188 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $223 | | Additional information about fees paid to insurance broker | SALES AND BASE COMMISSION | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00513631 |
| Policy instance | 2 |
| Insurance contract or identification number | 00513631 | | Number of Individuals Covered | 253 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $60,810 | | Total amount of fees paid to insurance company | USD $9,281 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | OTHER (HOSPITAL INDEMNITY) | | Welfare Benefit Premiums Paid to Carrier | USD $342,380 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $48,342 | | Amount paid for insurance broker fees | 9281 | | Additional information about fees paid to insurance broker | SALES AND BASE COMMISSION | | Insurance broker organization code? | 3 |
|
| PARTNERS RX (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | |
| Policy instance | 3 |
| Number of Individuals Covered | 253 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $20,181 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $20,181 |
|
| ATLANTIC SPECIALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 27154 ) |
| Policy contract number | 417005412204 |
| Policy instance | 4 |
| Insurance contract or identification number | 417005412204 | | Number of Individuals Covered | 197 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $15,838 | | Welfare Benefit Premiums Paid to Carrier | USD $321,196 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,174 | | Additional information about fees paid to insurance broker | SALES AND BASE COMMISSION | | Insurance broker organization code? | 3 |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 883042G |
| Policy instance | 7 |
| Insurance contract or identification number | 883042G | | Number of Individuals Covered | 81 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $2,891 | | Welfare Benefit Premiums Paid to Carrier | USD $28,908 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,553 | | Additional information about fees paid to insurance broker | SALES AND COMMISIONS | | Insurance broker organization code? | 3 |
|
| PARTNERS RX (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | |
| Policy instance | 6 |
| Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $21,524 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $21,524 |
|
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | 19204 |
| Policy instance | 5 |
| Insurance contract or identification number | 19204 | | Number of Individuals Covered | 73 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $4,533 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $30,191 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,075 | | Additional information about fees paid to insurance broker | SALE AND BASE COMMISSIONS | | Insurance broker organization code? | 3 |
|
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | 19204 |
| Policy instance | 4 |
| Insurance contract or identification number | 19204 | | Number of Individuals Covered | 74 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $11,844 | | Other welfare benefits provided | OTHER (CANCER) | | Welfare Benefit Premiums Paid to Carrier | USD $23,742 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,922 | | Additional information about fees paid to insurance broker | SALE AND BASE COMMISSION | | Insurance broker organization code? | 3 |
|
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | 19204 |
| Policy instance | 3 |
| Insurance contract or identification number | 19204 | | Number of Individuals Covered | 165 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $5,246 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $38,433 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,163 | | Additional information about fees paid to insurance broker | SALE AND BASE COMMISSIONS | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00513631 |
| Policy instance | 2 |
| Insurance contract or identification number | 00513631 | | Number of Individuals Covered | 244 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $40,645 | | Total amount of fees paid to insurance company | USD $2,132 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | OTHER (AD&D) | | Welfare Benefit Premiums Paid to Carrier | USD $219,733 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $38,541 | | Amount paid for insurance broker fees | 2132 | | Additional information about fees paid to insurance broker | SALES AND BASE COMMISSION | | Insurance broker organization code? | 3 |
|
| BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 ) |
| Policy contract number | GA6129 |
| Policy instance | 1 |
| Insurance contract or identification number | GA6129 | | Number of Individuals Covered | 187 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $2,598 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $26,135 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,498 | | Additional information about fees paid to insurance broker | SALES AND BASE COMMISSION | | Insurance broker organization code? | 3 |
|
| ATLANTIC SPECIALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 27154 ) |
| Policy contract number | 417005412204 |
| Policy instance | 8 |
| Insurance contract or identification number | 417005412204 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $15,253 | | Welfare Benefit Premiums Paid to Carrier | USD $308,613 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,453 | | Additional information about fees paid to insurance broker | SALES AND BASE COMMISSION | | Insurance broker organization code? | 3 |
|
| BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 ) |
| Policy contract number | GA6129 |
| Policy instance | 1 |
| Insurance contract or identification number | GA6129 | | Number of Individuals Covered | 178 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $2,602 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $25,952 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,535 | | Additional information about fees paid to insurance broker | SALES AND BASE COMMISSION | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00513631 |
| Policy instance | 2 |
| Insurance contract or identification number | 00513631 | | Number of Individuals Covered | 237 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $36,865 | | Total amount of fees paid to insurance company | USD $7,344 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | OTHER (OPTIONAL LIFE) | | Welfare Benefit Premiums Paid to Carrier | USD $190,546 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $36,865 | | Amount paid for insurance broker fees | 7344 | | Additional information about fees paid to insurance broker | SALES AND BASE COMMISSION | | Insurance broker organization code? | 3 |
|
| J ALLAN HALL AND ASSOCIATES (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | 417004412204 |
| Policy instance | 3 |
| Insurance contract or identification number | 417004412204 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $214,123 | | Welfare Benefit Premiums Paid to Carrier | USD $290,596 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $154,999 | | Additional information about fees paid to insurance broker | CLAIMS PROCESSING | | Insurance broker organization code? | 5 |
|
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | 19204 |
| Policy instance | 4 |
| Insurance contract or identification number | 19204 | | Number of Individuals Covered | 193 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $6,807 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $35,692 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,242 | | Additional information about fees paid to insurance broker | SALE AND BASE COMMISSIONS | | Insurance broker organization code? | 3 |
|
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | 19204 |
| Policy instance | 5 |
| Insurance contract or identification number | 19204 | | Number of Individuals Covered | 90 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $5,883 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $28,061 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,395 | | Additional information about fees paid to insurance broker | SALE AND BASE COMMISSIONS | | Insurance broker organization code? | 3 |
|
| PARTNERS RX (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | |
| Policy instance | 6 |
| Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $22,525 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $22,525 |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 883042G |
| Policy instance | 7 |
| Insurance contract or identification number | 883042G | | Number of Individuals Covered | 76 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $4,640 | | Total amount of fees paid to insurance company | USD $1,531 | | Welfare Benefit Premiums Paid to Carrier | USD $27,789 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,640 | | Additional information about fees paid to insurance broker | SALES AND COMMISIONS | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 1531 |
|
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | 19204 |
| Policy instance | 5 |
| Insurance contract or identification number | 19204 | | Number of Individuals Covered | 72 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $6,626 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $29,199 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,727 | | Additional information about fees paid to insurance broker | SALE AND BASE COMMISSIONS | | Insurance broker organization code? | 3 | | Insurance broker name | ENRIQUE ARAICO |
|
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | 19204 |
| Policy instance | 4 |
| Insurance contract or identification number | 19204 | | Number of Individuals Covered | 169 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $7,091 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $38,706 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,724 | | Additional information about fees paid to insurance broker | SALE AND BASE COMMISSIONS | | Insurance broker organization code? | 3 | | Insurance broker name | REGIONS INSURANCE INC |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | 417003412204 |
| Policy instance | 3 |
| Insurance contract or identification number | 417003412204 | | Number of Individuals Covered | 184 | | Insurance policy start date | 2016-07-01 | | Insurance policy end date | 2017-07-01 | | Total amount of commissions paid to insurance broker | USD $286,400 | | Welfare Benefit Premiums Paid to Carrier | USD $240,409 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $199,182 | | Additional information about fees paid to insurance broker | CLAIMS PROCESSING | | Insurance broker organization code? | 5 | | Insurance broker name | THE AI GROUP |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00513631 |
| Policy instance | 2 |
| Insurance contract or identification number | 00513631 | | Number of Individuals Covered | 247 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $36,741 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | OTHER (OPTIONAL LIFE) | | Welfare Benefit Premiums Paid to Carrier | USD $184,516 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $35,164 | | Additional information about fees paid to insurance broker | SALES AND BASE COMMISSION | | Insurance broker organization code? | 3 | | Insurance broker name | REGIONS INSURANCE INC |
|
| BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 ) |
| Policy contract number | GA6129 |
| Policy instance | 1 |
| Insurance contract or identification number | GA6129 | | Number of Individuals Covered | 184 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $2,609 | | Total amount of fees paid to insurance company | USD $97 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $24,062 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,609 | | Amount paid for insurance broker fees | 97 | | Additional information about fees paid to insurance broker | SALES AND BASE COMMISSION | | Insurance broker organization code? | 3 | | Insurance broker name | REGIONS INSURANCE INC |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG0ALQ6 |
| Policy instance | 1 |
| Insurance contract or identification number | GLUG0ALQ6 | | Number of Individuals Covered | 244 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-07-01 | | Total amount of commissions paid to insurance broker | USD $6,231 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $41,538 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,231 | | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD | | Insurance broker organization code? | 3 | | Insurance broker name | A I GROUP |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUPR0ALQ6 |
| Policy instance | 2 |
| Insurance contract or identification number | GUPR0ALQ6 | | Number of Individuals Covered | 140 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-07-01 | | Total amount of commissions paid to insurance broker | USD $5,098 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $33,989 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,098 | | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD | | Insurance broker organization code? | 3 | | Insurance broker name | THE A. I. GROUP INC |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GVTL0ALQ6 |
| Policy instance | 3 |
| Insurance contract or identification number | GVTL0ALQ6 | | Number of Individuals Covered | 111 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-07-01 | | Total amount of commissions paid to insurance broker | USD $5,422 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $36,145 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,422 | | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD | | Insurance broker organization code? | 3 | | Insurance broker name | THE A I GROUP |
|
| BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 ) |
| Policy contract number | GA6129 |
| Policy instance | 4 |
| Insurance contract or identification number | GA6129 | | Number of Individuals Covered | 202 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Total amount of commissions paid to insurance broker | USD $57,289 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,528,530 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $57,289 | | Additional information about fees paid to insurance broker | SALES AND BASE COMMISSION | | Insurance broker organization code? | 3 | | Insurance broker name | THE A I GROUP |
|
| BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 ) |
| Policy contract number | GA6129 |
| Policy instance | 5 |
| Insurance contract or identification number | GA6129 | | Number of Individuals Covered | 216 | | Insurance policy start date | 2015-07-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $6,365 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $178,804 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,365 | | Additional information about fees paid to insurance broker | SALES AND BASE COMMISSION | | Insurance broker organization code? | 3 | | Insurance broker name | THE A I GROUP |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUC0ALQ6 |
| Policy instance | 6 |
| Insurance contract or identification number | GUC0ALQ6 | | Number of Individuals Covered | 126 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-07-01 | | Total amount of commissions paid to insurance broker | USD $4,628 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $30,855 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,628 | | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD | | Insurance broker organization code? | 3 | | Insurance broker name | THE AI GROUP |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00513631 |
| Policy instance | 7 |
| Insurance contract or identification number | 00513631 | | Number of Individuals Covered | 214 | | Insurance policy start date | 2015-07-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $5,766 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $13,254 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,903 | | Additional information about fees paid to insurance broker | SALES AND BASE COMMISSION | | Insurance broker organization code? | 3 | | Insurance broker name | REGIONS INSURANCE INC |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUC0ALQ6 |
| Policy instance | 6 |
| Insurance contract or identification number | GUC0ALQ6 | | Number of Individuals Covered | 109 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Total amount of commissions paid to insurance broker | USD $4,023 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $26,821 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,023 | | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD | | Insurance broker organization code? | 3 | | Insurance broker name | THE AI GROUP |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG0ALQ6 |
| Policy instance | 1 |
| Insurance contract or identification number | GLUG0ALQ6 | | Number of Individuals Covered | 234 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Total amount of commissions paid to insurance broker | USD $4,425 | | Total amount of fees paid to insurance company | USD $181 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $29,503 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,425 | | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 181 | | Insurance broker name | A I GROUP |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUPR0ALQ6 |
| Policy instance | 2 |
| Insurance contract or identification number | GUPR0ALQ6 | | Number of Individuals Covered | 135 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Total amount of commissions paid to insurance broker | USD $4,400 | | Total amount of fees paid to insurance company | USD $176 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $29,336 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,400 | | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 176 | | Insurance broker name | THE A. I. GROUP INC |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GVTL0ALQ6 |
| Policy instance | 3 |
| Insurance contract or identification number | GVTL0ALQ6 | | Number of Individuals Covered | 123 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Total amount of commissions paid to insurance broker | USD $5,570 | | Total amount of fees paid to insurance company | USD $172 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $37,136 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,570 | | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 172 | | Insurance broker name | THE A I GROUP |
|
| BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 ) |
| Policy contract number | GA6129 |
| Policy instance | 4 |
| Insurance contract or identification number | GA6129 | | Number of Individuals Covered | 211 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Total amount of commissions paid to insurance broker | USD $55,602 | | Welfare Benefit Premiums Paid to Carrier | USD $1,390,740 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $55,602 | | Additional information about fees paid to insurance broker | SALES AND BASE COMMISSION | | Insurance broker organization code? | 3 | | Insurance broker name | THE A I GROUP |
|
| BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 ) |
| Policy contract number | GA6129 |
| Policy instance | 5 |
| Insurance contract or identification number | GA6129 | | Number of Individuals Covered | 173 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Total amount of commissions paid to insurance broker | USD $7,582 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $186,903 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,582 | | Additional information about fees paid to insurance broker | SALES AND BASE COMMISSION | | Insurance broker organization code? | 3 | | Insurance broker name | THE A I GROUP |
|
| BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 ) |
| Policy contract number | GA6129 |
| Policy instance | 4 |
| Insurance contract or identification number | GA6129 | | Number of Individuals Covered | 194 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Total amount of commissions paid to insurance broker | USD $48,475 | | Welfare Benefit Premiums Paid to Carrier | USD $1,279,116 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $48,475 | | Additional information about fees paid to insurance broker | SALES AND BASE COMMISSION | | Insurance broker organization code? | 3 | | Insurance broker name | THE A I GROUP |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUPR0ALQ6 |
| Policy instance | 2 |
| Insurance contract or identification number | GUPR0ALQ6 | | Number of Individuals Covered | 132 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-07-01 | | Total amount of commissions paid to insurance broker | USD $4,510 | | Total amount of fees paid to insurance company | USD $317 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $30,065 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,510 | | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 317 | | Insurance broker name | THE A. I. GROUP INC |
|
| BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 ) |
| Policy contract number | GA6129 |
| Policy instance | 5 |
| Insurance contract or identification number | GA6129 | | Number of Individuals Covered | 212 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Total amount of commissions paid to insurance broker | USD $5,386 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $134,531 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,386 | | Additional information about fees paid to insurance broker | SALES AND BASE COMMISSION | | Insurance broker organization code? | 3 | | Insurance broker name | THE A I GROUP |
|
| BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 ) |
| Policy contract number | 1052572000 |
| Policy instance | 6 |
| Insurance contract or identification number | 1052572000 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Total amount of commissions paid to insurance broker | USD $998 | | Dental Insurance Welfare Benefit | Yes | | Vision 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 $998 | | Additional information about fees paid to insurance broker | SALES AND BASE COMMISSION | | Insurance broker organization code? | 3 | | Insurance broker name | THE A I GROUP |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG0ALQ6 |
| Policy instance | 1 |
| Insurance contract or identification number | GLUG0ALQ6 | | Number of Individuals Covered | 326 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-07-01 | | Total amount of commissions paid to insurance broker | USD $4,770 | | Total amount of fees paid to insurance company | USD $326 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $31,801 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,770 | | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 326 | | Insurance broker name | A I GROUP |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GVTL0ALQ6 |
| Policy instance | 3 |
| Insurance contract or identification number | GVTL0ALQ6 | | Number of Individuals Covered | 115 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-07-01 | | Total amount of commissions paid to insurance broker | USD $4,945 | | Total amount of fees paid to insurance company | USD $310 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $32,965 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,945 | | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 310 | | Insurance broker name | THE A I GROUP |
|
| ATHENS AREA HEALTH PLAN SELECT, INC. (National Association of Insurance Commissioners NAIC id number: 95691 ) |
| Policy contract number | S2112 |
| Policy instance | 4 |
| Insurance contract or identification number | S2112 | | Number of Individuals Covered | 341 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Total amount of commissions paid to insurance broker | USD $64,484 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $64,484 | | Additional information about fees paid to insurance broker | SERVICE AND SALES COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | THE A I GROUP |
|
| BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 ) |
| Policy contract number | 1052572000 |
| Policy instance | 3 |
| Insurance contract or identification number | 1052572000 | | Number of Individuals Covered | 214 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Total amount of commissions paid to insurance broker | USD $10,978 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $119,788 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,978 | | Additional information about fees paid to insurance broker | SALES & SERVICE COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | THE A. I. GROUP INC |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 93804 |
| Policy instance | 2 |
| Insurance contract or identification number | 93804 | | Number of Individuals Covered | 154 | | Insurance policy start date | 2011-09-01 | | Insurance policy end date | 2012-06-30 | | Total amount of commissions paid to insurance broker | USD $4,867 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $23,987 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,598 | | Additional information about fees paid to insurance broker | SALES & SERVICE COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | A I GROUP |
|
| GREATER GEORGIA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97217 ) |
| Policy contract number | GA2397 |
| Policy instance | 1 |
| Insurance contract or identification number | GA2397 | | Number of Individuals Covered | 281 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Total amount of commissions paid to insurance broker | USD $7,378 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $64,710 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,378 | | Additional information about fees paid to insurance broker | SALES & SERVICE COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | A I GROUP |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00358159 |
| Policy instance | 3 |
| Insurance contract or identification number | 00358159 | | Number of Individuals Covered | 217 | | Insurance policy start date | 2010-05-01 | | Insurance policy end date | 2011-04-30 | | Total amount of commissions paid to insurance broker | USD $2,830 | | Total amount of fees paid to insurance company | USD $1,016 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $14,156 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 34557 |
| Policy instance | 1 |
| Insurance contract or identification number | 34557 | | Number of Individuals Covered | 281 | | Insurance policy start date | 2010-09-01 | | Insurance policy end date | 2011-06-30 | | Total amount of commissions paid to insurance broker | USD $2,383 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $31,770 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 93804 |
| Policy instance | 2 |
| Insurance contract or identification number | 93804 | | Number of Individuals Covered | 231 | | Insurance policy start date | 2010-09-01 | | Insurance policy end date | 2011-08-31 | | Total amount of commissions paid to insurance broker | USD $6,463 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $86,172 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 93804 |
| Policy instance | 2 |
| Insurance contract or identification number | 93804 | | Number of Individuals Covered | 238 | | Insurance policy start date | 2009-09-01 | | Insurance policy end date | 2010-08-31 | | Total amount of commissions paid to insurance broker | USD $8,074 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $97,874 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,341 | | Additional information about fees paid to insurance broker | SALES SERVICE COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | A I GROUP |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00358159 |
| Policy instance | 3 |
| Insurance contract or identification number | 00358159 | | Number of Individuals Covered | 232 | | Insurance policy start date | 2009-05-01 | | Insurance policy end date | 2010-04-30 | | Total amount of commissions paid to insurance broker | USD $3,116 | | Total amount of fees paid to insurance company | USD $633 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $15,585 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,055 | | Additional information about fees paid to insurance broker | SALES SERVICE COMPENSATION | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 633 | | Insurance broker name | ASHFORD ADVISORS, INC |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 34557 |
| Policy instance | 1 |
| Insurance contract or identification number | 34557 | | Number of Individuals Covered | 287 | | Insurance policy start date | 2009-09-01 | | Insurance policy end date | 2010-08-31 | | Total amount of commissions paid to insurance broker | USD $3,272 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $39,516 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,964 | | Additional information about fees paid to insurance broker | SALES SERVICE COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | A I GROUP |
|
