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HERNANDO-PASCO HOSPICE, INC.'S INSURANCE PLAN 401k Plan overview

Plan NameHERNANDO-PASCO HOSPICE, INC.'S INSURANCE PLAN
Plan identification number 501

HERNANDO-PASCO HOSPICE, INC.'S INSURANCE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)
  • Other welfare benefit cover

401k Sponsoring company profile

HERNANDO PASCO HOSPICE, INC. has sponsored the creation of one or more 401k plans.

Company Name:HERNANDO PASCO HOSPICE, INC.
Employer identification number (EIN):592217929
NAIC Classification:621610
NAIC Description:Home Health Care Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HERNANDO-PASCO HOSPICE, INC.'S INSURANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012015-10-01
5012014-10-01
5012013-10-01DOUGLAS FREEMAN
5012012-10-01DOUGLAS FREEMAN
5012011-10-01DOUGLAS FREEMAN
5012009-10-01DOUGLAS FREEMAN DOUGLAS FREEMAN2011-04-21
5012009-04-01DOUGLAS FREEMAN DOUGLAS FREEMAN2011-05-11

Plan Statistics for HERNANDO-PASCO HOSPICE, INC.'S INSURANCE PLAN

401k plan membership statisitcs for HERNANDO-PASCO HOSPICE, INC.'S INSURANCE PLAN

Measure Date Value
2015: HERNANDO-PASCO HOSPICE, INC.'S INSURANCE PLAN 2015 401k membership
Total participants, beginning-of-year2015-10-01519
Total number of active participants reported on line 7a of the Form 55002015-10-01294
Number of retired or separated participants receiving benefits2015-10-010
Number of other retired or separated participants entitled to future benefits2015-10-010
Total of all active and inactive participants2015-10-01294
2014: HERNANDO-PASCO HOSPICE, INC.'S INSURANCE PLAN 2014 401k membership
Total participants, beginning-of-year2014-10-01441
Total number of active participants reported on line 7a of the Form 55002014-10-01519
Number of retired or separated participants receiving benefits2014-10-010
Number of other retired or separated participants entitled to future benefits2014-10-010
Total of all active and inactive participants2014-10-01519
2013: HERNANDO-PASCO HOSPICE, INC.'S INSURANCE PLAN 2013 401k membership
Total participants, beginning-of-year2013-10-01468
Total number of active participants reported on line 7a of the Form 55002013-10-01441
Total of all active and inactive participants2013-10-01441
Total participants2013-10-01441
2012: HERNANDO-PASCO HOSPICE, INC.'S INSURANCE PLAN 2012 401k membership
Total participants, beginning-of-year2012-10-01502
Total number of active participants reported on line 7a of the Form 55002012-10-01468
Total of all active and inactive participants2012-10-01468
Total participants2012-10-01468
2011: HERNANDO-PASCO HOSPICE, INC.'S INSURANCE PLAN 2011 401k membership
Total participants, beginning-of-year2011-10-01549
Total number of active participants reported on line 7a of the Form 55002011-10-01502
Number of retired or separated participants receiving benefits2011-10-010
Number of other retired or separated participants entitled to future benefits2011-10-010
Total of all active and inactive participants2011-10-01502
Total participants2011-10-01502
2009: HERNANDO-PASCO HOSPICE, INC.'S INSURANCE PLAN 2009 401k membership
Total participants, beginning-of-year2009-10-01560
Total number of active participants reported on line 7a of the Form 55002009-10-01560
Number of retired or separated participants receiving benefits2009-10-010
Number of other retired or separated participants entitled to future benefits2009-10-010
Total of all active and inactive participants2009-10-01560
Total participants, beginning-of-year2009-04-01570
Total number of active participants reported on line 7a of the Form 55002009-04-01637
Number of retired or separated participants receiving benefits2009-04-010
Number of other retired or separated participants entitled to future benefits2009-04-010
Total of all active and inactive participants2009-04-01637

Form 5500 Responses for HERNANDO-PASCO HOSPICE, INC.'S INSURANCE PLAN

2015: HERNANDO-PASCO HOSPICE, INC.'S INSURANCE PLAN 2015 form 5500 responses
2015-10-01Type of plan entitySingle employer plan
2015-10-01Submission has been amendedNo
2015-10-01This submission is the final filingNo
2015-10-01This return/report is a short plan year return/report (less than 12 months)Yes
2015-10-01Plan is a collectively bargained planNo
2015-10-01Plan funding arrangement – InsuranceYes
2015-10-01Plan funding arrangement – General assets of the sponsorYes
2015-10-01Plan benefit arrangement – InsuranceYes
2015-10-01Plan benefit arrangement – General assets of the sponsorYes
2014: HERNANDO-PASCO HOSPICE, INC.'S INSURANCE PLAN 2014 form 5500 responses
2014-10-01Type of plan entitySingle employer plan
2014-10-01Submission has been amendedNo
2014-10-01This submission is the final filingNo
2014-10-01This return/report is a short plan year return/report (less than 12 months)No
2014-10-01Plan is a collectively bargained planNo
2014-10-01Plan funding arrangement – InsuranceYes
2014-10-01Plan funding arrangement – General assets of the sponsorYes
2014-10-01Plan benefit arrangement – InsuranceYes
2014-10-01Plan benefit arrangement – General assets of the sponsorYes
2013: HERNANDO-PASCO HOSPICE, INC.'S INSURANCE PLAN 2013 form 5500 responses
2013-10-01Type of plan entitySingle employer plan
2013-10-01Plan funding arrangement – InsuranceYes
2013-10-01Plan benefit arrangement – InsuranceYes
2012: HERNANDO-PASCO HOSPICE, INC.'S INSURANCE PLAN 2012 form 5500 responses
2012-10-01Type of plan entitySingle employer plan
2012-10-01Plan funding arrangement – InsuranceYes
2012-10-01Plan benefit arrangement – InsuranceYes
2011: HERNANDO-PASCO HOSPICE, INC.'S INSURANCE PLAN 2011 form 5500 responses
2011-10-01Type of plan entitySingle employer plan
2011-10-01Plan funding arrangement – InsuranceYes
2011-10-01Plan benefit arrangement – InsuranceYes
2009: HERNANDO-PASCO HOSPICE, INC.'S INSURANCE PLAN 2009 form 5500 responses
2009-10-01Type of plan entitySingle employer plan
2009-10-01Submission has been amendedNo
2009-10-01This submission is the final filingNo
2009-10-01This return/report is a short plan year return/report (less than 12 months)No
2009-10-01Plan is a collectively bargained planNo
2009-10-01Plan funding arrangement – InsuranceYes
2009-10-01Plan benefit arrangement – InsuranceYes
2009-04-01Type of plan entitySingle employer plan
2009-04-01Submission has been amendedNo
2009-04-01This submission is the final filingNo
2009-04-01This return/report is a short plan year return/report (less than 12 months)Yes
2009-04-01Plan is a collectively bargained planNo
2009-04-01Plan funding arrangement – InsuranceYes
2009-04-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

ADVANTICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 12278 )
Policy contract number13102801
Policy instance 1
Insurance contract or identification number13102801
Number of Individuals Covered294
Insurance policy start date2015-10-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $797
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $5,690
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $797
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerN/A
Insurance broker organization code?3
Insurance broker nameALLTRUST INSURANCE
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000ACN8
Policy instance 2
Insurance contract or identification numberG000ACN8
Number of Individuals Covered272
Insurance policy start date2015-10-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $482
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&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 CarrierUSD $4,825
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $482
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
Insurance broker nameALLTRUST INSURANCE
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000ACN8
Policy instance 3
Insurance contract or identification numberG000ACN8
Number of Individuals Covered185
Insurance policy start date2015-10-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $2,949
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $19,661
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,949
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerOTHER
Insurance broker organization code?3
Insurance broker nameALLTRUST INSURANCE
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number708004
Policy instance 4
Insurance contract or identification number708004
Number of Individuals Covered0
Insurance policy start date2015-10-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $4,257
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $39,545
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $4,257
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerN/A
Insurance broker organization code?3
Insurance broker nameALLTRUST INSURANCE
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000ACN8
Policy instance 5
Insurance contract or identification numberG000ACN8
Number of Individuals Covered272
Insurance policy start date2015-10-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $1,718
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $17,176
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,718
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
Insurance broker nameALLTRUST INSURANCE
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000ACN8
Policy instance 6
Insurance contract or identification numberG000ACN8
Number of Individuals Covered115
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $8,414
Total amount of fees paid to insurance companyUSD $2,504
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedVOLUNTARY LIFE & 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 CarrierUSD $56,095
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,414
Amount paid for insurance broker fees2504
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
Insurance broker nameALLTRUST INSURANCE
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number708004
Policy instance 4
Insurance contract or identification number708004
Number of Individuals Covered519
Insurance policy start date2014-10-01
Insurance policy end date2015-09-30
Total amount of commissions paid to insurance brokerUSD $36,864
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $338,916
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $36,864
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerN/A
Insurance broker organization code?3
Insurance broker nameALLTRUST INSURANCE
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000ACN8
Policy instance 5
Insurance contract or identification numberG000ACN8
Number of Individuals Covered297
Insurance policy start date2014-10-01
Insurance policy end date2015-09-30
Total amount of commissions paid to insurance brokerUSD $8,479
Total amount of fees paid to insurance companyUSD $3,460
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $84,791
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,479
Amount paid for insurance broker fees3460
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
Insurance broker nameALLTRUST INSURANCE
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000ACN8
Policy instance 3
Insurance contract or identification numberG000ACN8
Number of Individuals Covered209
Insurance policy start date2014-10-01
Insurance policy end date2015-09-30
Total amount of commissions paid to insurance brokerUSD $15,199
Total amount of fees paid to insurance companyUSD $4,276
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $101,324
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,199
Amount paid for insurance broker fees4276
Additional information about fees paid to insurance brokerOTHER
Insurance broker organization code?3
Insurance broker nameALLTRUST INSURANCE
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000ACN8
Policy instance 2
Insurance contract or identification numberG000ACN8
Number of Individuals Covered297
Insurance policy start date2014-10-01
Insurance policy end date2015-09-30
Total amount of commissions paid to insurance brokerUSD $2,352
Total amount of fees paid to insurance companyUSD $875
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&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 CarrierUSD $23,516
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,352
Amount paid for insurance broker fees875
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
Insurance broker nameALLTRUST INSURANCE
ADVANTICA REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number13102801
Policy instance 1
Insurance contract or identification number13102801
Number of Individuals Covered352
Insurance policy start date2014-10-01
Insurance policy end date2015-09-30
Total amount of commissions paid to insurance brokerUSD $3,865
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $27,606
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,865
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerN/A
Insurance broker organization code?3
Insurance broker nameALLTRUST INSURANCE
ADVANTICA ADMINISTRATIVE SERVICES (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberADVANTICA -HPHH
Policy instance 6
Insurance contract or identification numberADVANTICA -HPHH
Number of Individuals Covered213
Insurance policy start date2013-10-01
Insurance policy end date2014-09-30
Total amount of commissions paid to insurance brokerUSD $3,317
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $28,348
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,317
Insurance broker organization code?3
Insurance broker nameALLTRUST INSURANCE INC.
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLTD0ACN8
Policy instance 5
Insurance contract or identification numberGLTD0ACN8
Number of Individuals Covered434
Insurance policy start date2013-10-01
Insurance policy end date2014-10-01
Total amount of commissions paid to insurance brokerUSD $9,840
Total amount of fees paid to insurance companyUSD $3,720
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $98,403
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,840
Amount paid for insurance broker fees3720
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
Insurance broker nameALLTRUST INSURANCE, INC.
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUC0ACN8
Policy instance 3
Insurance contract or identification numberGUC0ACN8
Number of Individuals Covered292
Insurance policy start date2013-10-01
Insurance policy end date2014-10-01
Total amount of commissions paid to insurance brokerUSD $18,730
Total amount of fees paid to insurance companyUSD $4,959
Other welfare benefits providedPREFERRED CHOICE VOLUNTARY - STD
Welfare Benefit Premiums Paid to CarrierUSD $124,866
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $18,730
Amount paid for insurance broker fees4959
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
Insurance broker nameALLTRUST INSURANCE, INC.
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGVTL0ACN8
Policy instance 2
Insurance contract or identification numberGVTL0ACN8
Number of Individuals Covered169
Insurance policy start date2014-01-01
Insurance policy end date2015-01-01
Total amount of commissions paid to insurance brokerUSD $10,628
Total amount of fees paid to insurance companyUSD $2,632
Other welfare benefits providedLIFE & AD&D - VOLUNTARY
Welfare Benefit Premiums Paid to CarrierUSD $70,855
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,628
Amount paid for insurance broker fees2632
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
Insurance broker nameALLTRUST INSURANCE INC.
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number708004
Policy instance 1
Insurance contract or identification number708004
Number of Individuals Covered377
Insurance policy start date2013-10-01
Insurance policy end date2014-09-30
Total amount of commissions paid to insurance brokerUSD $34,369
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $372,936
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $34,369
Insurance broker organization code?3
Insurance broker nameALLTRUST INSURANCE, INC.
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0ACN8
Policy instance 4
Insurance contract or identification numberGLUG0ACN8
Number of Individuals Covered434
Insurance policy start date2013-10-01
Insurance policy end date2014-10-01
Total amount of commissions paid to insurance brokerUSD $2,509
Total amount of fees paid to insurance companyUSD $969
Other welfare benefits providedLIFE & AD&D
Welfare Benefit Premiums Paid to CarrierUSD $25,089
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,509
Amount paid for insurance broker fees969
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
Insurance broker nameALLTRUST INSURANCE, INC.
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGVTL0ACN8
Policy instance 2
Insurance contract or identification numberGVTL0ACN8
Number of Individuals Covered468
Insurance policy start date2013-01-01
Insurance policy end date2014-01-01
Total amount of commissions paid to insurance brokerUSD $11,286
Total amount of fees paid to insurance companyUSD $2,346
Other welfare benefits providedLIFE & AD &D - VOLUNTARY
Welfare Benefit Premiums Paid to CarrierUSD $75,241
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,286
Amount paid for insurance broker fees2346
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
Insurance broker nameALLTRUST INSURANCE INC.
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLTD0ACN8
Policy instance 5
Insurance contract or identification numberGLTD0ACN8
Number of Individuals Covered68
Insurance policy start date2012-10-01
Insurance policy end date2013-10-01
Total amount of commissions paid to insurance brokerUSD $10,782
Total amount of fees paid to insurance companyUSD $2,394
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $107,819
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,782
Amount paid for insurance broker fees2394
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
Insurance broker nameALLTRUST INSURANCE, INC.
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0ACN8
Policy instance 4
Insurance contract or identification numberGLUG0ACN8
Number of Individuals Covered468
Insurance policy start date2012-10-01
Insurance policy end date2013-10-01
Total amount of commissions paid to insurance brokerUSD $2,812
Total amount of fees paid to insurance companyUSD $668
Other welfare benefits providedLIFE & AD&D
Welfare Benefit Premiums Paid to CarrierUSD $28,125
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,812
Amount paid for insurance broker fees668
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
Insurance broker nameALLTRUST INSURANCE, INC.
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUC0ACN8
Policy instance 3
Insurance contract or identification numberGUC0ACN8
Number of Individuals Covered338
Insurance policy start date2012-10-01
Insurance policy end date2013-10-01
Total amount of commissions paid to insurance brokerUSD $21,690
Total amount of fees paid to insurance companyUSD $3,671
Other welfare benefits providedPREFERRED CHOICE VOLUNTARY STD
Welfare Benefit Premiums Paid to CarrierUSD $144,600
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $21,690
Amount paid for insurance broker fees3671
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
Insurance broker nameALLTRUST INSURANCE, INC.
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number708004
Policy instance 1
Insurance contract or identification number708004
Number of Individuals Covered414
Insurance policy start date2012-10-01
Insurance policy end date2013-09-30
Total amount of commissions paid to insurance brokerUSD $42,904
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $565,768
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $42,904
Insurance broker organization code?3
Insurance broker nameALLTRUST INSURANCE, INC.
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number708004
Policy instance 2
Insurance contract or identification number708004
Number of Individuals Covered456
Insurance policy start date2011-10-01
Insurance policy end date2012-09-30
Total amount of commissions paid to insurance brokerUSD $39,849
Welfare Benefit Premiums Paid to CarrierUSD $438,844
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGVTL0ACN8
Policy instance 3
Insurance contract or identification numberGVTL0ACN8
Number of Individuals Covered173
Insurance policy start date2012-01-01
Insurance policy end date2013-01-01
Total amount of commissions paid to insurance brokerUSD $13,089
Other welfare benefits providedLIFE & AD &D - VOLUNTARY
Welfare Benefit Premiums Paid to CarrierUSD $87,260
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUC0ACN8
Policy instance 4
Insurance contract or identification numberGUC0ACN8
Number of Individuals Covered378
Insurance policy start date2011-10-01
Insurance policy end date2012-10-01
Total amount of commissions paid to insurance brokerUSD $28,132
Other welfare benefits providedPREFERRED CHOICE VOLUNTARY STD
Welfare Benefit Premiums Paid to CarrierUSD $166,510
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0ACN8
Policy instance 5
Insurance contract or identification numberGLUG0ACN8
Number of Individuals Covered492
Insurance policy start date2011-10-01
Insurance policy end date2012-10-01
Total amount of commissions paid to insurance brokerUSD $3,732
Other welfare benefits providedLIFE & AD&D
Welfare Benefit Premiums Paid to CarrierUSD $30,189
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number136-002751
Policy instance 1
Insurance contract or identification number136-002751
Number of Individuals Covered1104
Insurance policy start date2011-10-01
Insurance policy end date2012-09-30
Total amount of commissions paid to insurance brokerUSD $11,235
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $224,700
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLTD0ACN8
Policy instance 6
Insurance contract or identification numberGLTD0ACN8
Number of Individuals Covered492
Insurance policy start date2011-10-01
Insurance policy end date2012-10-01
Total amount of commissions paid to insurance brokerUSD $13,152
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $106,636
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUC0ACN8
Policy instance 5
Insurance contract or identification numberGUC0ACN8
Number of Individuals Covered413
Insurance policy start date2011-01-01
Insurance policy end date2011-10-01
Total amount of commissions paid to insurance brokerUSD $18,926
Other welfare benefits providedVOLUNTARY STD
Welfare Benefit Premiums Paid to CarrierUSD $126,176
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLTD0ACN8
Policy instance 3
Insurance contract or identification numberGLTD0ACN8
Number of Individuals Covered558
Insurance policy start date2010-10-01
Insurance policy end date2011-09-30
Total amount of commissions paid to insurance brokerUSD $11,037
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $110,368
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number708004
Policy instance 2
Insurance contract or identification number708004
Number of Individuals Covered499
Insurance policy start date2010-10-01
Insurance policy end date2011-09-30
Total amount of commissions paid to insurance brokerUSD $52,645
Welfare Benefit Premiums Paid to CarrierUSD $486,664
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number136-002751
Policy instance 1
Insurance contract or identification number136-002751
Number of Individuals Covered1207
Insurance policy start date2010-10-01
Insurance policy end date2011-09-30
Total amount of commissions paid to insurance brokerUSD $11,596
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $231,925
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0ACN8
Policy instance 4
Insurance contract or identification numberGLUG0ACN8
Number of Individuals Covered558
Insurance policy start date2010-10-01
Insurance policy end date2011-09-30
Total amount of commissions paid to insurance brokerUSD $3,176
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $31,763
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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