401k Plan data: HOUCHENS FOOD GROUP, INC. ANCILLARY BENEFIT PLAN plan

HOUCHENS FOOD GROUP, INC. ANCILLARY BENEFIT PLAN 401k Plan overview

Plan Name	HOUCHENS FOOD GROUP, INC. ANCILLARY BENEFIT PLAN
Plan identification number	502

HOUCHENS FOOD GROUP, INC. ANCILLARY BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	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

HOUCHENS FOOD GROUP, INC. has sponsored the creation of one or more 401k plans.

Company Name: HOUCHENS FOOD GROUP, INC.

Employer identification number (EIN): 610395075

NAIC Classification: 445110
NAIC Description: Supermarkets and Other Grocery (except Convenience) Stores

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HOUCHENS FOOD GROUP, INC. ANCILLARY BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2022-01-01
502 2021-01-01
502 2020-01-01
502 2019-01-01
502 2018-01-01 GORDON MINTER GORDON MINTER 2019-07-24
502 2017-01-01 GORDON MINTER GORDON MINTER 2018-07-31
502 2016-01-01 GORDON MINTER GORDON MINTER 2017-08-31
502 2015-01-01 GORDON MINTER GORDON MINTER 2016-07-29

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
502	2022-01-01
502	2021-01-01
502	2020-01-01
502	2019-01-01
502	2018-01-01	GORDON MINTER	GORDON MINTER	2019-07-24
502	2017-01-01	GORDON MINTER	GORDON MINTER	2018-07-31
502	2016-01-01	GORDON MINTER	GORDON MINTER	2017-08-31
502	2015-01-01	GORDON MINTER	GORDON MINTER	2016-07-29

Plan Statistics for HOUCHENS FOOD GROUP, INC. ANCILLARY BENEFIT PLAN

401k plan membership statisitcs for HOUCHENS FOOD GROUP, INC. ANCILLARY BENEFIT PLAN

Measure Date Value
2022: HOUCHENS FOOD GROUP, INC. ANCILLARY BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 2,028
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 1,790
Number of retired or separated participants receiving benefits 2022-01-01 22
Number of other retired or separated participants entitled to future benefits 2022-01-01 99
Total of all active and inactive participants 2022-01-01 1,911
2021: HOUCHENS FOOD GROUP, INC. ANCILLARY BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 2,039
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 1,834
Number of retired or separated participants receiving benefits 2021-01-01 136
Number of other retired or separated participants entitled to future benefits 2021-01-01 507
Total of all active and inactive participants 2021-01-01 2,477
2020: HOUCHENS FOOD GROUP, INC. ANCILLARY BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 2,329
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 2,119
Number of retired or separated participants receiving benefits 2020-01-01 156
Number of other retired or separated participants entitled to future benefits 2020-01-01 579
Total of all active and inactive participants 2020-01-01 2,854
2019: HOUCHENS FOOD GROUP, INC. ANCILLARY BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 2,543
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 2,227
Number of retired or separated participants receiving benefits 2019-01-01 29
Number of other retired or separated participants entitled to future benefits 2019-01-01 316
Total of all active and inactive participants 2019-01-01 2,572
2018: HOUCHENS FOOD GROUP, INC. ANCILLARY BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 2,731
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 3,141
Number of retired or separated participants receiving benefits 2018-01-01 4
Number of other retired or separated participants entitled to future benefits 2018-01-01 253
Total of all active and inactive participants 2018-01-01 3,398
2017: HOUCHENS FOOD GROUP, INC. ANCILLARY BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 3,519
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 3,408
Number of retired or separated participants receiving benefits 2017-01-01 18
Number of other retired or separated participants entitled to future benefits 2017-01-01 25
Total of all active and inactive participants 2017-01-01 3,451
2016: HOUCHENS FOOD GROUP, INC. ANCILLARY BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 3,487
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 3,471
Number of retired or separated participants receiving benefits 2016-01-01 29
Number of other retired or separated participants entitled to future benefits 2016-01-01 228
Total of all active and inactive participants 2016-01-01 3,728
2015: HOUCHENS FOOD GROUP, INC. ANCILLARY BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 3,441
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 3,467
Total of all active and inactive participants 2015-01-01 3,467

Measure	Date	Value
2022: HOUCHENS FOOD GROUP, INC. ANCILLARY BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	2,028
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	1,790
Number of retired or separated participants receiving benefits	2022-01-01	22
Number of other retired or separated participants entitled to future benefits	2022-01-01	99
Total of all active and inactive participants	2022-01-01	1,911
2021: HOUCHENS FOOD GROUP, INC. ANCILLARY BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	2,039
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	1,834
Number of retired or separated participants receiving benefits	2021-01-01	136
Number of other retired or separated participants entitled to future benefits	2021-01-01	507
Total of all active and inactive participants	2021-01-01	2,477
2020: HOUCHENS FOOD GROUP, INC. ANCILLARY BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	2,329
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	2,119
Number of retired or separated participants receiving benefits	2020-01-01	156
Number of other retired or separated participants entitled to future benefits	2020-01-01	579
Total of all active and inactive participants	2020-01-01	2,854
2019: HOUCHENS FOOD GROUP, INC. ANCILLARY BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	2,543
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	2,227
Number of retired or separated participants receiving benefits	2019-01-01	29
Number of other retired or separated participants entitled to future benefits	2019-01-01	316
Total of all active and inactive participants	2019-01-01	2,572
2018: HOUCHENS FOOD GROUP, INC. ANCILLARY BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	2,731
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	3,141
Number of retired or separated participants receiving benefits	2018-01-01	4
Number of other retired or separated participants entitled to future benefits	2018-01-01	253
Total of all active and inactive participants	2018-01-01	3,398
2017: HOUCHENS FOOD GROUP, INC. ANCILLARY BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	3,519
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	3,408
Number of retired or separated participants receiving benefits	2017-01-01	18
Number of other retired or separated participants entitled to future benefits	2017-01-01	25
Total of all active and inactive participants	2017-01-01	3,451
2016: HOUCHENS FOOD GROUP, INC. ANCILLARY BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	3,487
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	3,471
Number of retired or separated participants receiving benefits	2016-01-01	29
Number of other retired or separated participants entitled to future benefits	2016-01-01	228
Total of all active and inactive participants	2016-01-01	3,728
2015: HOUCHENS FOOD GROUP, INC. ANCILLARY BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	3,441
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	3,467
Total of all active and inactive participants	2015-01-01	3,467

Form 5500 Responses for HOUCHENS FOOD GROUP, INC. ANCILLARY BENEFIT PLAN

2022: HOUCHENS FOOD GROUP, INC. ANCILLARY BENEFIT PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Submission has been amended	No
2022-01-01	This submission is the final filing	No
2022-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-01-01	Plan is a collectively bargained plan	No
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2021: HOUCHENS FOOD GROUP, INC. ANCILLARY BENEFIT PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Submission has been amended	No
2021-01-01	This submission is the final filing	No
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2020: HOUCHENS FOOD GROUP, INC. ANCILLARY BENEFIT PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2019: HOUCHENS FOOD GROUP, INC. ANCILLARY BENEFIT PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2018: HOUCHENS FOOD GROUP, INC. ANCILLARY BENEFIT PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2017: HOUCHENS FOOD GROUP, INC. ANCILLARY BENEFIT PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2016: HOUCHENS FOOD GROUP, INC. ANCILLARY BENEFIT PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: HOUCHENS FOOD GROUP, INC. ANCILLARY BENEFIT PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	First time form 5500 has been submitted	Yes
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E7408834

Policy instance

Insurance contract or identification number	E7408834
Number of Individuals Covered	1358
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $79,770
Total amount of fees paid to insurance company	USD $12,603
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	CANCER, MEDICAL BRIDGE
Welfare Benefit Premiums Paid to Carrier	USD $410,518
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $69,384
Amount paid for insurance broker fees	8915
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

GLTD0357K

Policy instance

Insurance contract or identification number	GLTD0357K
Number of Individuals Covered	37
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $7,107
Total amount of fees paid to insurance company	USD $2,710
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $32,306
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,107
Amount paid for insurance broker fees	2299
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

GUC 0357K

Policy instance

Insurance contract or identification number	GUC 0357K
Number of Individuals Covered	1384
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $181,093
Total amount of fees paid to insurance company	USD $67,241
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $823,150
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $181,093
Amount paid for insurance broker fees	57053
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

DELTA DENTAL OF KENTUCKY (National Association of Insurance Commissioners NAIC id number: 54674 )

Policy contract number

0697670

Policy instance

Insurance contract or identification number	0697670
Number of Individuals Covered	2775
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $93,597
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $93,597
Insurance broker organization code?	3

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

Policy contract number

GUPR 0357K

Policy instance

Insurance contract or identification number	GUPR 0357K
Number of Individuals Covered	1046
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $52,933
Total amount of fees paid to insurance company	USD $18,011
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $240,603
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $52,933
Amount paid for insurance broker fees	15282
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

GVTL 0357K

Policy instance

Insurance contract or identification number	GVTL 0357K
Number of Individuals Covered	1327
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $121,968
Total amount of fees paid to insurance company	USD $50,044
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $625,478
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $121,968
Amount paid for insurance broker fees	42462
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

GLUG0357K

Policy instance

Insurance contract or identification number	GLUG0357K
Number of Individuals Covered	5300
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $54,620
Total amount of fees paid to insurance company	USD $20,212
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $248,272
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $54,620
Amount paid for insurance broker fees	17150
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 )

Policy contract number

W29648

Policy instance

Insurance contract or identification number	W29648
Number of Individuals Covered	2753
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $16,453
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $176,533
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16,453
Insurance broker organization code?	3

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

Policy contract number

GLTD0357K

Policy instance

Insurance contract or identification number	GLTD0357K
Number of Individuals Covered	39
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $7,389
Total amount of fees paid to insurance company	USD $1,855
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $33,585
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,389
Amount paid for insurance broker fees	1574
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

THE PAUL REVERE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67598 )

Policy contract number

E7408834

Policy instance

Insurance contract or identification number	E7408834
Number of Individuals Covered	0
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $12
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	CANCER, MEDICAL BRIDGE
Welfare Benefit Premiums Paid to Carrier	USD $243
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
Insurance broker organization code?	3

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

Policy contract number

GUC 0357K

Policy instance

Insurance contract or identification number	GUC 0357K
Number of Individuals Covered	1407
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $182,234
Total amount of fees paid to insurance company	USD $63,611
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $828,337
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $182,234
Amount paid for insurance broker fees	52500
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

DELTA DENTAL OF KENTUCKY (National Association of Insurance Commissioners NAIC id number: 54674 )

Policy contract number

0697670

Policy instance

Insurance contract or identification number	0697670
Number of Individuals Covered	2885
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $86,159
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $86,159
Insurance broker organization code?	3

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

Policy contract number

GUPR 0357K

Policy instance

Insurance contract or identification number	GUPR 0357K
Number of Individuals Covered	924
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $48,887
Total amount of fees paid to insurance company	USD $20,245
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $222,216
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $48,887
Amount paid for insurance broker fees	17178
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

GVTL 0357K

Policy instance

Insurance contract or identification number	GVTL 0357K
Number of Individuals Covered	1321
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $128,054
Total amount of fees paid to insurance company	USD $46,808
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $582,062
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $128,054
Amount paid for insurance broker fees	39350
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

GLUG0357K

Policy instance

Insurance contract or identification number	GLUG0357K
Number of Individuals Covered	4883
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $50,434
Total amount of fees paid to insurance company	USD $15,168
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $229,246
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $50,434
Amount paid for insurance broker fees	12870
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 )

Policy contract number

W29648

Policy instance

Insurance contract or identification number	W29648
Number of Individuals Covered	2857
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $17,053
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $170,309
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $17,053
Insurance broker organization code?	3

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E7408834

Policy instance

Insurance contract or identification number	E7408834
Number of Individuals Covered	1288
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $77,490
Total amount of fees paid to insurance company	USD $5,692
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	CANCER, MEDICAL BRIDGE
Welfare Benefit Premiums Paid to Carrier	USD $510,163
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $65,704
Amount paid for insurance broker fees	3681
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker organization code?	3

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

Policy contract number

GLTD0357K

Policy instance

Insurance contract or identification number	GLTD0357K
Number of Individuals Covered	39
Insurance policy start date	2020-06-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $4,332
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $19,686
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,332
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

THE PAUL REVERE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67598 )

Policy contract number

E7408834

Policy instance

Insurance contract or identification number	E7408834
Number of Individuals Covered	1
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $21
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	CANCER, MEDICAL BRIDGE
Welfare Benefit Premiums Paid to Carrier	USD $378
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
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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

Policy contract number

GUC 0357K

Policy instance

Insurance contract or identification number	GUC 0357K
Number of Individuals Covered	1579
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $191,015
Total amount of fees paid to insurance company	USD $41,748
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $868,250
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $191,015
Amount paid for insurance broker fees	30360
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

GUPR 0357K

Policy instance

Insurance contract or identification number	GUPR 0357K
Number of Individuals Covered	1055
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $52,522
Total amount of fees paid to insurance company	USD $20,781
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $238,738
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $52,522
Amount paid for insurance broker fees	17615
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

DELTA DENTAL OF KENTUCKY (National Association of Insurance Commissioners NAIC id number: 54674 )

Policy contract number

0697670

Policy instance

Insurance contract or identification number	0697670
Number of Individuals Covered	3286
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $102,726
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $102,726
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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

Policy contract number

GVTL 0357K

Policy instance

Insurance contract or identification number	GVTL 0357K
Number of Individuals Covered	1482
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $135,636
Total amount of fees paid to insurance company	USD $35,884
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $616,603
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $135,636
Amount paid for insurance broker fees	27754
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

GLUG0357K

Policy instance

Insurance contract or identification number	GLUG0357K
Number of Individuals Covered	5279
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $44,138
Total amount of fees paid to insurance company	USD $16,843
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $200,626
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $44,138
Amount paid for insurance broker fees	14291
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 )

Policy contract number

W29648

Policy instance

Insurance contract or identification number	W29648
Number of Individuals Covered	3199
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $17,303
Total amount of fees paid to insurance company	USD $1,912
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $186,572
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $17,303
Amount paid for insurance broker fees	1912
Insurance broker organization code?	3

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E7408834

Policy instance

Insurance contract or identification number	E7408834
Number of Individuals Covered	1442
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $83,333
Total amount of fees paid to insurance company	USD $6,931
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	CANCER, MEDICAL BRIDGE
Welfare Benefit Premiums Paid to Carrier	USD $498,444
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $70,052
Amount paid for insurance broker fees	4512
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker organization code?	3

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E7408834

Policy instance

Insurance contract or identification number	E7408834
Number of Individuals Covered	1580
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $118,475
Total amount of fees paid to insurance company	USD $7,476
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	CANCER, MEDICAL BRIDGE
Welfare Benefit Premiums Paid to Carrier	USD $702,769
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $98,470
Amount paid for insurance broker fees	3897
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker organization code?	3

ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 )

Policy contract number

001003726

Policy instance

Insurance contract or identification number	001003726
Number of Individuals Covered	3391
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $19,485
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $199,626
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $19,485
Insurance broker organization code?	3

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

Policy contract number

GLUG0357K

Policy instance

Insurance contract or identification number	GLUG0357K
Number of Individuals Covered	5300
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $44,914
Total amount of fees paid to insurance company	USD $8,569
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $204,156
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $44,914
Amount paid for insurance broker fees	8569
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

GVTL 0357K

Policy instance

Insurance contract or identification number	GVTL 0357K
Number of Individuals Covered	1549
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $144,085
Total amount of fees paid to insurance company	USD $18,001
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $654,931
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $144,085
Amount paid for insurance broker fees	18001
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

GUPR 0357K

Policy instance

Insurance contract or identification number	GUPR 0357K
Number of Individuals Covered	1182
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $56,542
Total amount of fees paid to insurance company	USD $8,633
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $257,009
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $56,542
Amount paid for insurance broker fees	8633
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

DELTA DENTAL OF KENTUCKY (National Association of Insurance Commissioners NAIC id number: 54674 )

Policy contract number

0697670

Policy instance

Insurance contract or identification number	0697670
Number of Individuals Covered	3415
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $99,548
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $99,548
Insurance broker organization code?	3

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

Policy contract number

GUC 0357K

Policy instance

Insurance contract or identification number	GUC 0357K
Number of Individuals Covered	1686
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $203,917
Total amount of fees paid to insurance company	USD $19,135
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $926,896
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $203,917
Amount paid for insurance broker fees	19135
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

THE PAUL REVERE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67598 )

Policy contract number

E7408834

Policy instance

Insurance contract or identification number	E7408834
Number of Individuals Covered	2
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $34
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	CANCER, MEDICAL BRIDGE
Welfare Benefit Premiums Paid to Carrier	USD $754
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18
Insurance broker organization code?	3

THE PAUL REVERE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67598 )

Policy contract number

E7408834

Policy instance

Insurance contract or identification number	E7408834
Number of Individuals Covered	2
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $44
Total amount of fees paid to insurance company	USD $19
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	CANCER, MEDICAL BRIDGE
Welfare Benefit Premiums Paid to Carrier	USD $836
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14
Insurance broker organization code?	3
Amount paid for insurance broker fees	19

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

Policy contract number

GUC 0357K

Policy instance

Insurance contract or identification number	GUC 0357K
Number of Individuals Covered	1023
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $118,801
Total amount of fees paid to insurance company	USD $26,461
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $540,006
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $118,801
Amount paid for insurance broker fees	26461
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

DELTA DENTAL OF KENTUCKY (National Association of Insurance Commissioners NAIC id number: 54674 )

Policy contract number

0697670

Policy instance

Insurance contract or identification number	0697670
Number of Individuals Covered	2462
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $75,276
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $75,276
Insurance broker organization code?	3

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

Policy contract number

GUPR 0357K

Policy instance

Insurance contract or identification number	GUPR 0357K
Number of Individuals Covered	729
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $34,469
Total amount of fees paid to insurance company	USD $11,537
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $156,676
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $34,469
Amount paid for insurance broker fees	11537
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

GVTL 0357K

Policy instance

Insurance contract or identification number	GVTL 0357K
Number of Individuals Covered	1147
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $100,158
Total amount of fees paid to insurance company	USD $25,762
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $455,262
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $100,158
Amount paid for insurance broker fees	25762
Additional information about fees paid to insurance broker	OTHER COMPENSASTION
Insurance broker organization code?	3

ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 )

Policy contract number

001003726

Policy instance

Insurance contract or identification number	001003726
Number of Individuals Covered	3758
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $13,683
Total amount of fees paid to insurance company	USD $3,897
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $218,335
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,081
Insurance broker organization code?	3
Amount paid for insurance broker fees	3897
Additional information about fees paid to insurance broker	FEES PAID

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

Policy contract number

GLUG0357K

Policy instance

Insurance contract or identification number	GLUG0357K
Number of Individuals Covered	3413
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $31,596
Total amount of fees paid to insurance company	USD $9,165
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $143,617
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $31,596
Amount paid for insurance broker fees	9165
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E7408834

Policy instance

Insurance contract or identification number	E7408834
Number of Individuals Covered	1822
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $88,078
Total amount of fees paid to insurance company	USD $10,107
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	CANCER, MEDICAL BRIDGE
Welfare Benefit Premiums Paid to Carrier	USD $438,463
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $73,048
Amount paid for insurance broker fees	4731
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker organization code?	3

THE PAUL REVERE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67598 )

Policy contract number

E7408834

Policy instance

Insurance contract or identification number	E7408834
Number of Individuals Covered	3
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $38
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	CANCER, MEDICAL BRIDGE
Welfare Benefit Premiums Paid to Carrier	USD $1,114
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
Insurance broker organization code?	3
Insurance broker name	TED BENNETT

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

Policy contract number

GUC 0357K

Policy instance

Insurance contract or identification number	GUC 0357K
Number of Individuals Covered	981
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $114,067
Total amount of fees paid to insurance company	USD $19,330
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $518,487
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $114,067
Amount paid for insurance broker fees	19330
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker organization code?	3
Insurance broker name	HOUCHENS INSURANCE GROUP, INC

DELTA DENTAL OF KENTUCKY (National Association of Insurance Commissioners NAIC id number: 54674 )

Policy contract number

0697670

Policy instance

Insurance contract or identification number	0697670
Number of Individuals Covered	2568
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $78,545
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $78,545
Insurance broker organization code?	3
Insurance broker name	HOUCHENS INSURANCE GROUP INC

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

Policy contract number

GUPR 0357K

Policy instance

Insurance contract or identification number	GUPR 0357K
Number of Individuals Covered	786
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $36,050
Total amount of fees paid to insurance company	USD $9,580
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $163,862
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $36,050
Amount paid for insurance broker fees	9580
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker organization code?	3
Insurance broker name	HOUCHENS INSURANCE GROUP, INC

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

Policy contract number

GVTL 0357K

Policy instance

Insurance contract or identification number	GVTL 0357K
Number of Individuals Covered	1082
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $107,540
Total amount of fees paid to insurance company	USD $18,627
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $488,817
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $107,540
Amount paid for insurance broker fees	18627
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker organization code?	3
Insurance broker name	HOUCHENS INSURANCE GROUP, INC

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

Policy contract number

GLUG0357K

Policy instance

Insurance contract or identification number	GLUG0357K
Number of Individuals Covered	3544
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $34,371
Total amount of fees paid to insurance company	USD $8,673
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $156,233
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $34,371
Amount paid for insurance broker fees	8673
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker organization code?	3
Insurance broker name	HOUCHENS INSURANCE GROUP, INC

ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 )

Policy contract number

00092086

Policy instance

Insurance contract or identification number	00092086
Number of Individuals Covered	2473
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $14,036
Total amount of fees paid to insurance company	USD $4,736
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $140,568
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,036
Amount paid for insurance broker fees	4736
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker organization code?	3
Insurance broker name	INSURANCE SPECIALISTS LLC

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E7408834

Policy instance

Insurance contract or identification number	E7408834
Number of Individuals Covered	986
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $55,389
Total amount of fees paid to insurance company	USD $1,854
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	CANCER, MEDICAL BRIDGE
Welfare Benefit Premiums Paid to Carrier	USD $359,734
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $25,576
Amount paid for insurance broker fees	79
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker organization code?	3
Insurance broker name	JACQUELINE MARIE STUEMKY

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

Policy contract number

GUC 0357K

Policy instance

Insurance contract or identification number	GUC 0357K
Number of Individuals Covered	1205
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $128,451
Total amount of fees paid to insurance company	USD $27,649
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $583,870
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $84,055
Insurance broker organization code?	3
Amount paid for insurance broker fees	27649
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker name	INSURANCE SPECIALISTS LLC

DELTA DENTAL OF KENTUCKY (National Association of Insurance Commissioners NAIC id number: 54674 )

Policy contract number

0697670

Policy instance

Insurance contract or identification number	0697670
Number of Individuals Covered	2913
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $88,964
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $60,300
Insurance broker organization code?	3
Insurance broker name	INSURANCE SPECIALISTS LLC

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

Policy contract number

GUPR 0357K

Policy instance

Insurance contract or identification number	GUPR 0357K
Number of Individuals Covered	950
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $38,747
Total amount of fees paid to insurance company	USD $13,151
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $176,120
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,269
Amount paid for insurance broker fees	13151
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	VAN METER INSURANCE AGENCY INC

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

Policy contract number

GVTL 0357K

Policy instance

Insurance contract or identification number	GVTL 0357K
Number of Individuals Covered	1241
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $106,820
Total amount of fees paid to insurance company	USD $26,438
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $485,545
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $69,987
Insurance broker organization code?	3
Amount paid for insurance broker fees	26438
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker name	INSURANCE SPECIALISTS LLC

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

Policy contract number

GLUG0357K

Policy instance

Insurance contract or identification number	GLUG0357K
Number of Individuals Covered	3616
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $35,203
Total amount of fees paid to insurance company	USD $10,267
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $160,012
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $23,549
Insurance broker organization code?	3
Amount paid for insurance broker fees	10267
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker name	INSURANCE SPECIALISTS LLC

ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 )

Policy contract number

1003726

Policy instance

Insurance contract or identification number	1003726
Number of Individuals Covered	4307
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $18,558
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $238,793
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,558
Insurance broker organization code?	3
Insurance broker name	INSURANCE SPECIALISTS LLC

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E7408834

Policy instance

Insurance contract or identification number	E7408834
Number of Individuals Covered	1277
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $81,743
Total amount of fees paid to insurance company	USD $3,080
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	CANCER, MEDICAL BRIDGE
Welfare Benefit Premiums Paid to Carrier	USD $457,357
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $59,789
Amount paid for insurance broker fees	691
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker organization code?	3
Insurance broker name	RALPH E MYERS

THE PAUL REVERE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67598 )

Policy contract number

E7408834

Policy instance

Insurance contract or identification number	E7408834
Number of Individuals Covered	1277
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $107
Total amount of fees paid to insurance company	USD $6
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	CANCER, MEDICAL BRIDGE
Welfare Benefit Premiums Paid to Carrier	USD $2,479
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
Insurance broker organization code?	3
Amount paid for insurance broker fees	6
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker name	ROBERT E ELLIS

Was this data useful?

If you found the data here useful, PLEASE HELP US. We are a start-up and believe in making information freely available. By linking to us, posting on twitter, facebook and linkedin about us and generally spreading the word, you'll help us to grow. Our vision is to provide high quality data about the activities of all the companies in the world and where possible make it free to use and view. Finding and integrating data from thousands of data sources is time consuming and needs lots of effort. By simply spreading the word about us, you will help us. Please use the share buttons. It will only take a few seconds of your time. Thanks for helping

Information Disclaimer

The information provided on this website is not advice, endorsement or recommendation
The information published is supplied by third parties so we make no warranty on the accuracy, completeness etc. This information is provided "as-is". The information is subject to change as we obtain updates and corrections from the primary information sources.
You are free to use the information for your own personal research on the understanding to do so is at your own risk.

See full terms and conditions

Company Name:	HOUCHENS FOOD GROUP, INC.
Employer identification number (EIN):	610395075
NAIC Classification:	445110
NAIC Description:	Supermarkets and Other Grocery (except Convenience) Stores