CORINTH COCA-COLA BOTTLING WORKS, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan CORINTH COCA-COLA BOTTLING WORKS, INC. WELFARE PLAN
401k plan membership statisitcs for CORINTH COCA-COLA BOTTLING WORKS, INC. WELFARE PLAN
| Measure | Date | Value |
|---|
| 2022: CORINTH COCA-COLA BOTTLING WORKS, INC. WELFARE PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 731 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 742 |
| Total of all active and inactive participants | 2022-01-01 | 742 |
| 2021: CORINTH COCA-COLA BOTTLING WORKS, INC. WELFARE PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 735 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 731 |
| Total of all active and inactive participants | 2021-01-01 | 731 |
| 2020: CORINTH COCA-COLA BOTTLING WORKS, INC. WELFARE PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 325 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 735 |
| Total of all active and inactive participants | 2020-01-01 | 735 |
| 2019: CORINTH COCA-COLA BOTTLING WORKS, INC. WELFARE PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 284 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 325 |
| Number of retired or separated participants receiving benefits | 2019-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-01-01 | 0 |
| Total of all active and inactive participants | 2019-01-01 | 325 |
| 2018: CORINTH COCA-COLA BOTTLING WORKS, INC. WELFARE PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 117 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 107 |
| Number of retired or separated participants receiving benefits | 2018-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-01-01 | 0 |
| Total of all active and inactive participants | 2018-01-01 | 107 |
| 2017: CORINTH COCA-COLA BOTTLING WORKS, INC. WELFARE PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 211 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 275 |
| Total of all active and inactive participants | 2017-01-01 | 275 |
| 2016: CORINTH COCA-COLA BOTTLING WORKS, INC. WELFARE PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 211 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 297 |
| Total of all active and inactive participants | 2016-01-01 | 297 |
| 2015: CORINTH COCA-COLA BOTTLING WORKS, INC. WELFARE PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 150 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 211 |
| Total of all active and inactive participants | 2015-01-01 | 211 |
| 2014: CORINTH COCA-COLA BOTTLING WORKS, INC. WELFARE PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 150 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 153 |
| Total of all active and inactive participants | 2014-01-01 | 153 |
| 2013: CORINTH COCA-COLA BOTTLING WORKS, INC. WELFARE PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 146 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 150 |
| Total of all active and inactive participants | 2013-01-01 | 150 |
| 2012: CORINTH COCA-COLA BOTTLING WORKS, INC. WELFARE PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 144 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 146 |
| Number of retired or separated participants receiving benefits | 2012-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2012-01-01 | 0 |
| Total of all active and inactive participants | 2012-01-01 | 146 |
| 2011: CORINTH COCA-COLA BOTTLING WORKS, INC. WELFARE PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-03-01 | 0 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-03-01 | 144 |
| Total of all active and inactive participants | 2011-03-01 | 144 |
| 2022: CORINTH COCA-COLA BOTTLING WORKS, INC. WELFARE 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: CORINTH COCA-COLA BOTTLING WORKS, INC. WELFARE 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: CORINTH COCA-COLA BOTTLING WORKS, INC. WELFARE 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: CORINTH COCA-COLA BOTTLING WORKS, INC. WELFARE 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: CORINTH COCA-COLA BOTTLING WORKS, INC. WELFARE PLAN 2018 form 5500 responses |
|---|
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | First time form 5500 has been submitted | Yes |
| 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 – General assets of the sponsor | Yes |
| 2018-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: CORINTH COCA-COLA BOTTLING WORKS, INC. WELFARE 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: CORINTH COCA-COLA BOTTLING WORKS, INC. WELFARE 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: CORINTH COCA-COLA BOTTLING WORKS, INC. WELFARE PLAN 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Single employer plan |
| 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 |
| 2014: CORINTH COCA-COLA BOTTLING WORKS, INC. WELFARE PLAN 2014 form 5500 responses |
|---|
| 2014-01-01 | Type of plan entity | Single employer plan |
| 2014-01-01 | Submission has been amended | No |
| 2014-01-01 | This submission is the final filing | No |
| 2014-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-01-01 | Plan is a collectively bargained plan | No |
| 2014-01-01 | Plan funding arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: CORINTH COCA-COLA BOTTLING WORKS, INC. WELFARE PLAN 2013 form 5500 responses |
|---|
| 2013-01-01 | Type of plan entity | Single employer plan |
| 2013-01-01 | Submission has been amended | No |
| 2013-01-01 | This submission is the final filing | No |
| 2013-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-01-01 | Plan is a collectively bargained plan | No |
| 2013-01-01 | Plan funding arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: CORINTH COCA-COLA BOTTLING WORKS, INC. WELFARE PLAN 2012 form 5500 responses |
|---|
| 2012-01-01 | Type of plan entity | Single employer plan |
| 2012-01-01 | Submission has been amended | No |
| 2012-01-01 | This submission is the final filing | No |
| 2012-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-01-01 | Plan is a collectively bargained plan | No |
| 2012-01-01 | Plan funding arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: CORINTH COCA-COLA BOTTLING WORKS, INC. WELFARE PLAN 2011 form 5500 responses |
|---|
| 2011-03-01 | Type of plan entity | Single employer plan |
| 2011-03-01 | Submission has been amended | No |
| 2011-03-01 | This submission is the final filing | No |
| 2011-03-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2011-03-01 | Plan is a collectively bargained plan | No |
| 2011-03-01 | Plan funding arrangement – Insurance | Yes |
| 2011-03-01 | Plan benefit arrangement – Insurance | Yes |
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 936218 |
| Policy instance | 6 |
| Insurance contract or identification number | 936218 | | Number of Individuals Covered | 338 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $7,387 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $256,105 | | Commission paid to Insurance Broker | USD $7,387 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010258938 |
| Policy instance | 5 |
| Insurance contract or identification number | 000010258938 | | Number of Individuals Covered | 343 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $24,777 | | Total amount of fees paid to insurance company | USD $1,570 | | Other welfare benefits provided | WEEKLY INCOME | | Welfare Benefit Premiums Paid to Carrier | USD $165,178 | | Commission paid to Insurance Broker | USD $18,583 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 1570 | | Additional information about fees paid to insurance broker | BROKER BONUS |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010258936 |
| Policy instance | 4 |
| Insurance contract or identification number | 000010258936 | | Number of Individuals Covered | 450 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $24,061 | | Total amount of fees paid to insurance company | USD $1,507 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $160,412 | | Commission paid to Insurance Broker | USD $18,046 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 1507 | | Additional information about fees paid to insurance broker | BROKER BONUS |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000400258937 |
| Policy instance | 3 |
| Insurance contract or identification number | 000400258937 | | Number of Individuals Covered | 187 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $11,440 | | Total amount of fees paid to insurance company | USD $732 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $76,262 | | Commission paid to Insurance Broker | USD $8,580 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 732 | | Additional information about fees paid to insurance broker | BROKER BONUS |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 3343418 |
| Policy instance | 2 |
| Insurance contract or identification number | 3343418 | | Number of Individuals Covered | 742 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $109,766 | | Total amount of fees paid to insurance company | USD $20,780 | | Welfare Benefit Premiums Paid to Carrier | USD $1,097,663 | | Commission paid to Insurance Broker | USD $109,766 | | Amount paid for insurance broker fees | 20780 | | Insurance broker organization code? | 3 |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010258932 |
| Policy instance | 1 |
| Insurance contract or identification number | 000010258932 | | Number of Individuals Covered | 311 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $13,001 | | Total amount of fees paid to insurance company | USD $847 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $86,675 | | Commission paid to Insurance Broker | USD $9,751 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 847 | | Additional information about fees paid to insurance broker | BROKER BONUS |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010258932 |
| Policy instance | 1 |
| Insurance contract or identification number | 000010258932 | | Number of Individuals Covered | 294 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $12,699 | | Total amount of fees paid to insurance company | USD $0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $84,654 | | Commission paid to Insurance Broker | USD $9,524 | | Insurance broker organization code? | 3 |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 3343418 |
| Policy instance | 2 |
| Insurance contract or identification number | 3343418 | | Number of Individuals Covered | 338 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $116,113 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $1,161,437 | | Commission paid to Insurance Broker | USD $116,113 | | Insurance broker organization code? | 3 |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000400258937 |
| Policy instance | 3 |
| Insurance contract or identification number | 000400258937 | | Number of Individuals Covered | 187 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $10,984 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $73,231 | | Commission paid to Insurance Broker | USD $8,238 | | Insurance broker organization code? | 3 |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010258936 |
| Policy instance | 4 |
| Insurance contract or identification number | 000010258936 | | Number of Individuals Covered | 416 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $22,609 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $150,731 | | Commission paid to Insurance Broker | USD $16,957 | | Insurance broker organization code? | 3 |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010258938 |
| Policy instance | 5 |
| Insurance contract or identification number | 000010258938 | | Number of Individuals Covered | 321 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $23,544 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | WEEKLY INCOME | | Commission paid to Insurance Broker | USD $17,658 | | Insurance broker organization code? | 3 |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 936218 |
| Policy instance | 6 |
| Insurance contract or identification number | 936218 | | Number of Individuals Covered | 321 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $7,027 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $234,736 | | Commission paid to Insurance Broker | USD $7,027 | | Insurance broker organization code? | 3 |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010258932 |
| Policy instance | 1 |
| Insurance contract or identification number | 000010258932 | | Number of Individuals Covered | 299 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $11,810 | | Total amount of fees paid to insurance company | USD $1,875 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $78,730 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,857 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 1875 | | Additional information about fees paid to insurance broker | BROKER BONUS |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 3343418 |
| Policy instance | 2 |
| Insurance contract or identification number | 3343418 | | Number of Individuals Covered | 735 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $99,791 | | Total amount of fees paid to insurance company | USD $19,365 | | Welfare Benefit Premiums Paid to Carrier | USD $998,910 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $99,791 | | Amount paid for insurance broker fees | 19365 | | Insurance broker organization code? | 3 |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000400258937 |
| Policy instance | 3 |
| Insurance contract or identification number | 000400258937 | | Number of Individuals Covered | 169 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $10,513 | | Total amount of fees paid to insurance company | USD $1,875 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $70,088 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,885 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 1875 | | Additional information about fees paid to insurance broker | BROKER BONUS |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010258936 |
| Policy instance | 4 |
| Insurance contract or identification number | 000010258936 | | Number of Individuals Covered | 413 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $21,481 | | Total amount of fees paid to insurance company | USD $1,875 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $143,204 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $16,111 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 1875 | | Additional information about fees paid to insurance broker | BROKER BONUS |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010258938 |
| Policy instance | 5 |
| Insurance contract or identification number | 000010258938 | | Number of Individuals Covered | 323 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $21,671 | | Total amount of fees paid to insurance company | USD $1,875 | | Other welfare benefits provided | WEEKLY INCOME | | Welfare Benefit Premiums Paid to Carrier | USD $144,471 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $16,253 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 1875 | | Additional information about fees paid to insurance broker | BROKER BONUS |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 936218 |
| Policy instance | 6 |
| Insurance contract or identification number | 936218 | | Number of Individuals Covered | 315 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $6,905 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $225,208 | | Commission paid to Insurance Broker | USD $6,905 | | Insurance broker organization code? | 3 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30045912 |
| Policy instance | 3 |
| Insurance contract or identification number | 30045912 | | Number of Individuals Covered | 286 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $1,620 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $39,207 | | Commission paid to Insurance Broker | USD $1,620 | | Insurance broker organization code? | 3 |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 230997 |
| Policy instance | 2 |
| Insurance contract or identification number | 230997 | | Number of Individuals Covered | 408 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $22,439 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $460,582 | | Commission paid to Insurance Broker | USD $13,779 | | Insurance broker organization code? | 3 |
|
| PHEONIX EXCESS RISK UNDERWRITERS/GERBER LIFE (National Association of Insurance Commissioners NAIC id number: 70939 ) |
| Policy contract number | |
| Policy instance | 1 |
| Number of Individuals Covered | 325 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $97,107 | | Total amount of fees paid to insurance company | USD $168,066 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $873,960 | | Commission paid to Insurance Broker | USD $97,107 | | Amount paid for insurance broker fees | 106435 | | Insurance broker organization code? | 3 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 230997 |
| Policy instance | 6 |
| Insurance contract or identification number | 230997 | | Number of Individuals Covered | 415 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $3,694 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $94,586 | | Commission paid to Insurance Broker | USD $2,529 | | Insurance broker organization code? | 3 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30045912 |
| Policy instance | 7 |
| Insurance contract or identification number | 30045912 | | Number of Individuals Covered | 284 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $1,604 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $38,578 | | Commission paid to Insurance Broker | USD $1,604 | | Insurance broker organization code? | 3 |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 230997 |
| Policy instance | 5 |
| Insurance contract or identification number | 230997 | | Number of Individuals Covered | 415 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $6,368 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $155,774 | | Commission paid to Insurance Broker | USD $4,347 | | Insurance broker organization code? | 3 |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 230997 |
| Policy instance | 4 |
| Insurance contract or identification number | 230997 | | Number of Individuals Covered | 415 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $2,178 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $53,471 | | Commission paid to Insurance Broker | USD $1,504 | | Insurance broker organization code? | 3 |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 230997 |
| Policy instance | 3 |
| Insurance contract or identification number | 230997 | | Number of Individuals Covered | 415 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $5,727 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $141,399 | | Commission paid to Insurance Broker | USD $3,929 | | Insurance broker organization code? | 3 |
|
| PHEONIX EXCESS RISK UNDERWRITERS/GERBER LIFE (National Association of Insurance Commissioners NAIC id number: 70939 ) |
| Policy contract number | |
| Policy instance | 2 |
| Number of Individuals Covered | 235 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $104,103 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $556,769 | | Commission paid to Insurance Broker | USD $65,973 | | Insurance broker organization code? | 3 |
|
| BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 ) |
| Policy contract number | 130167 |
| Policy instance | 1 |
| Insurance contract or identification number | 130167 | | Number of Individuals Covered | 255 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $56,935 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,104,204 | | Commission paid to Insurance Broker | USD $56,935 | | Insurance broker organization code? | 3 |
|
| BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 ) |
| Policy contract number | 130167 |
| Policy instance | 1 |
| Insurance contract or identification number | 130167 | | Number of Individuals Covered | 236 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $39,387 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $980,425 | | Commission paid to Insurance Broker | USD $39,387 | | Additional information about fees paid to insurance broker | ACQ/RET | | Insurance broker organization code? | 3 | | Insurance broker name | ORMA SMITH |
|
| PHEONIX EXCESS RISK UNDERWRITERS/GERBER LIFE (National Association of Insurance Commissioners NAIC id number: 70939 ) |
| Policy contract number | |
| Policy instance | 2 |
| Number of Individuals Covered | 235 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $77,420 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $389,248 | | Commission paid to Insurance Broker | USD $51,100 | | Additional information about fees paid to insurance broker | ACCOUNT SERVICE | | Insurance broker organization code? | 3 | | Insurance broker name | CIGNA |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 230997 |
| Policy instance | 3 |
| Insurance contract or identification number | 230997 | | Number of Individuals Covered | 400 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $5,219 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $140,796 | | Commission paid to Insurance Broker | USD $5,219 | | Insurance broker organization code? | 3 | | Insurance broker name | SAMUEL C. KEMP |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 230997 |
| Policy instance | 4 |
| Insurance contract or identification number | 230997 | | Number of Individuals Covered | 400 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $2,047 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $53,946 | | Commission paid to Insurance Broker | USD $2,047 | | Insurance broker organization code? | 3 | | Insurance broker name | SAMUEL C. KEMP |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 230997 |
| Policy instance | 6 |
| Insurance contract or identification number | 230997 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $780 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $19,523 | | Commission paid to Insurance Broker | USD $780 | | Insurance broker organization code? | 3 | | Insurance broker name | SAMUEL C. KEMP |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 230997 |
| Policy instance | 5 |
| Insurance contract or identification number | 230997 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $5,620 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $148,613 | | Commission paid to Insurance Broker | USD $5,620 | | Insurance broker organization code? | 3 | | Insurance broker name | SAMUEL KEMP |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30045912 |
| Policy instance | 7 |
| Insurance contract or identification number | 30045912 | | Number of Individuals Covered | 275 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $1,337 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $27,711 | | Commission paid to Insurance Broker | USD $1,337 | | Insurance broker organization code? | 3 | | Insurance broker name | JAS. D. COLLIER & CO. |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 230997 |
| Policy instance | 2 |
| Insurance contract or identification number | 230997 | | Number of Individuals Covered | 78 | | Insurance policy start date | 2015-06-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $5,418 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $40,667 | | Commission paid to Insurance Broker | USD $5,418 | | Insurance broker organization code? | 3 | | Insurance broker name | SAMUEL C. KEMP |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 230997 |
| Policy instance | 3 |
| Insurance contract or identification number | 230997 | | Number of Individuals Covered | 35 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $2,148 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $32,816 | | Commission paid to Insurance Broker | USD $2,148 | | Insurance broker organization code? | 3 | | Insurance broker name | SAMUEL KEMP |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 230997 |
| Policy instance | 4 |
| Insurance contract or identification number | 230997 | | Number of Individuals Covered | 77 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $7,661 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $76,722 | | Commission paid to Insurance Broker | USD $7,661 | | Insurance broker organization code? | 3 | | Insurance broker name | SAMUEL C. KEMP |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30045912 |
| Policy instance | 5 |
| Insurance contract or identification number | 30045912 | | Number of Individuals Covered | 162 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $1,011 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $17,332 | | Commission paid to Insurance Broker | USD $1,011 | | Insurance broker organization code? | 3 | | Insurance broker name | JAS. D. COLLIER & CO. |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 230997 |
| Policy instance | 1 |
| Insurance contract or identification number | 230997 | | Number of Individuals Covered | 21 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $1,131 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $17,475 | | Commission paid to Insurance Broker | USD $1,131 | | Insurance broker organization code? | 3 | | Insurance broker name | SAMUEL C. KEMP |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30045912 |
| Policy instance | 2 |
| Insurance contract or identification number | 30045912 | | Number of Individuals Covered | 87 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $789 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $11,092 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $789 | | Insurance broker organization code? | 3 | | Insurance broker name | JAS. D. COLLIER & CO. |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 230997 |
| Policy instance | 1 |
| Insurance contract or identification number | 230997 | | Number of Individuals Covered | 153 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $9,867 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $129,227 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,867 | | Insurance broker organization code? | 3 | | Insurance broker name | SAMUEL C. KEMP |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AIQV |
| Policy instance | 2 |
| Insurance contract or identification number | G000AIQV | | Number of Individuals Covered | 150 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-06-01 | | Total amount of commissions paid to insurance broker | USD $1,905 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $21,166 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,905 | | Insurance broker organization code? | 3 | | Insurance broker name | HAY HUGGINS PLAN SERVICES, INC |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G00AIQV |
| Policy instance | 1 |
| Insurance contract or identification number | G00AIQV | | Number of Individuals Covered | 120 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-05-31 | | Total amount of commissions paid to insurance broker | USD $580 | | Total amount of fees paid to insurance company | USD $0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,441 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $580 | | Insurance broker organization code? | 3 | | Insurance broker name | HAY HUGGINS PLAN SERVICES, INC |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G00AIQV |
| Policy instance | 1 |
| Insurance contract or identification number | G00AIQV | | Number of Individuals Covered | 117 | | Insurance policy start date | 2012-03-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $668 | | Total amount of fees paid to insurance company | USD $0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,859 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $668 | | Insurance broker organization code? | 3 | | Insurance broker name | HAY HUGGINS PLAN SERVICES, INC |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AIQV |
| Policy instance | 2 |
| Insurance contract or identification number | G000AIQV | | Number of Individuals Covered | 146 | | Insurance policy start date | 2012-03-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $4,426 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $41,034 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,426 | | Insurance broker organization code? | 3 | | Insurance broker name | HAY HUGGINS PLAN SERVICES, INC |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AIQV |
| Policy instance | 2 |
| Insurance contract or identification number | G000AIQV | | Number of Individuals Covered | 144 | | Insurance policy start date | 2011-03-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $3,233 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $35,918 | | 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 number | G00AIQV |
| Policy instance | 1 |
| Insurance contract or identification number | G00AIQV | | Number of Individuals Covered | 113 | | Insurance policy start date | 2011-03-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $214 | | Total amount of fees paid to insurance company | USD $0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,381 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
