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PHIL SMITH AUTOMOTIVE GROUP PRE-TAX CONVERSION PLAN 401k Plan overview

Plan NamePHIL SMITH AUTOMOTIVE GROUP PRE-TAX CONVERSION PLAN
Plan identification number 501

PHIL SMITH AUTOMOTIVE GROUP PRE-TAX CONVERSION PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover

401k Sponsoring company profile

PHIL SMITH MANAGEMENT, INC. DBA PHIL SMITH AUTOMOTIVE GROUP has sponsored the creation of one or more 401k plans.

Company Name:PHIL SMITH MANAGEMENT, INC. DBA PHIL SMITH AUTOMOTIVE GROUP
Employer identification number (EIN):650838041
NAIC Classification:441110
NAIC Description:New Car Dealers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PHIL SMITH AUTOMOTIVE GROUP PRE-TAX CONVERSION PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012019-03-01MICHAEL DAYHOFF2020-11-30 MICHAEL DAYHOFF2020-11-30
5012018-03-01 MIKE DAYHOFF2019-11-22
5012018-03-01MIKE DAYHOFF2019-11-22 MIKE DAYHOFF2019-11-22
5012017-03-01
5012016-03-01
5012015-03-01
5012015-03-01
5012014-03-01
5012013-03-01
5012012-03-01MIKE DAYHOFF
5012012-01-01MICHAEL R. DAYHOFF, CFO
5012011-01-01MICHAEL R. DAYHOFF, CFO
5012009-01-01MICHAEL R. DAYHOFF, CFO

Plan Statistics for PHIL SMITH AUTOMOTIVE GROUP PRE-TAX CONVERSION PLAN

401k plan membership statisitcs for PHIL SMITH AUTOMOTIVE GROUP PRE-TAX CONVERSION PLAN

Measure Date Value
2019: PHIL SMITH AUTOMOTIVE GROUP PRE-TAX CONVERSION PLAN 2019 401k membership
Total participants, beginning-of-year2019-03-01297
Total of all active and inactive participants2019-03-010
Total participants2019-03-010
2018: PHIL SMITH AUTOMOTIVE GROUP PRE-TAX CONVERSION PLAN 2018 401k membership
Total participants, beginning-of-year2018-03-01460
Total of all active and inactive participants2018-03-010
Total participants2018-03-010
2017: PHIL SMITH AUTOMOTIVE GROUP PRE-TAX CONVERSION PLAN 2017 401k membership
Total participants, beginning-of-year2017-03-01460
Total of all active and inactive participants2017-03-010
Total participants2017-03-010
2016: PHIL SMITH AUTOMOTIVE GROUP PRE-TAX CONVERSION PLAN 2016 401k membership
Total participants, beginning-of-year2016-03-01460
Total of all active and inactive participants2016-03-010
Total participants2016-03-010
2015: PHIL SMITH AUTOMOTIVE GROUP PRE-TAX CONVERSION PLAN 2015 401k membership
Total participants, beginning-of-year2015-03-01460
Total of all active and inactive participants2015-03-010
Total participants2015-03-010
2014: PHIL SMITH AUTOMOTIVE GROUP PRE-TAX CONVERSION PLAN 2014 401k membership
Total participants, beginning-of-year2014-03-01460
Total of all active and inactive participants2014-03-010
Total participants2014-03-010
2013: PHIL SMITH AUTOMOTIVE GROUP PRE-TAX CONVERSION PLAN 2013 401k membership
Total participants, beginning-of-year2013-03-01460
Total of all active and inactive participants2013-03-010
Total participants2013-03-010
2012: PHIL SMITH AUTOMOTIVE GROUP PRE-TAX CONVERSION PLAN 2012 401k membership
Total participants, beginning-of-year2012-03-01460
Total of all active and inactive participants2012-03-010
Total participants2012-03-010
Total participants, beginning-of-year2012-01-01466
Total of all active and inactive participants2012-01-010
Total participants2012-01-010
2011: PHIL SMITH AUTOMOTIVE GROUP PRE-TAX CONVERSION PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01466
Total of all active and inactive participants2011-01-010
Total participants2011-01-010
2009: PHIL SMITH AUTOMOTIVE GROUP PRE-TAX CONVERSION PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01410
Total number of active participants reported on line 7a of the Form 55002009-01-01385
Number of retired or separated participants receiving benefits2009-01-0115
Total of all active and inactive participants2009-01-01400

Form 5500 Responses for PHIL SMITH AUTOMOTIVE GROUP PRE-TAX CONVERSION PLAN

2019: PHIL SMITH AUTOMOTIVE GROUP PRE-TAX CONVERSION PLAN 2019 form 5500 responses
2019-03-01Type of plan entitySingle employer plan
2019-03-01Plan funding arrangement – InsuranceYes
2019-03-01Plan benefit arrangement – InsuranceYes
2018: PHIL SMITH AUTOMOTIVE GROUP PRE-TAX CONVERSION PLAN 2018 form 5500 responses
2018-03-01Type of plan entitySingle employer plan
2018-03-01Plan funding arrangement – InsuranceYes
2018-03-01Plan benefit arrangement – InsuranceYes
2017: PHIL SMITH AUTOMOTIVE GROUP PRE-TAX CONVERSION PLAN 2017 form 5500 responses
2017-03-01Type of plan entitySingle employer plan
2017-03-01Plan funding arrangement – InsuranceYes
2017-03-01Plan benefit arrangement – InsuranceYes
2016: PHIL SMITH AUTOMOTIVE GROUP PRE-TAX CONVERSION PLAN 2016 form 5500 responses
2016-03-01Type of plan entitySingle employer plan
2016-03-01Plan funding arrangement – InsuranceYes
2016-03-01Plan benefit arrangement – InsuranceYes
2015: PHIL SMITH AUTOMOTIVE GROUP PRE-TAX CONVERSION PLAN 2015 form 5500 responses
2015-03-01Type of plan entitySingle employer plan
2015-03-01Plan funding arrangement – InsuranceYes
2015-03-01Plan benefit arrangement – InsuranceYes
2014: PHIL SMITH AUTOMOTIVE GROUP PRE-TAX CONVERSION PLAN 2014 form 5500 responses
2014-03-01Type of plan entitySingle employer plan
2014-03-01Plan funding arrangement – InsuranceYes
2014-03-01Plan benefit arrangement – InsuranceYes
2013: PHIL SMITH AUTOMOTIVE GROUP PRE-TAX CONVERSION PLAN 2013 form 5500 responses
2013-03-01Type of plan entitySingle employer plan
2013-03-01Plan funding arrangement – InsuranceYes
2013-03-01Plan benefit arrangement – InsuranceYes
2012: PHIL SMITH AUTOMOTIVE GROUP PRE-TAX CONVERSION PLAN 2012 form 5500 responses
2012-03-01Type of plan entitySingle employer plan
2012-03-01Plan funding arrangement – InsuranceYes
2012-03-01Plan benefit arrangement – InsuranceYes
2012-01-01Type of plan entitySingle employer plan
2012-01-01This return/report is a short plan year return/report (less than 12 months)Yes
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: PHIL SMITH AUTOMOTIVE GROUP PRE-TAX CONVERSION PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – InsuranceYes
2009: PHIL SMITH AUTOMOTIVE GROUP PRE-TAX CONVERSION PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01This submission is the final filingNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AC82
Policy instance 6
Insurance contract or identification numberG000AC82
Number of Individuals Covered12
Insurance policy start date2019-03-01
Insurance policy end date2020-02-29
Total amount of commissions paid to insurance brokerUSD $2,086
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $10,432
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,086
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number857515G
Policy instance 18
Insurance contract or identification number857515G
Number of Individuals Covered20
Insurance policy start date2019-03-01
Insurance policy end date2020-02-29
Total amount of commissions paid to insurance brokerUSD $2,368
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $11,814
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,368
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number851899G
Policy instance 19
Insurance contract or identification number851899G
Number of Individuals Covered37
Insurance policy start date2019-03-01
Insurance policy end date2020-02-29
Total amount of commissions paid to insurance brokerUSD $9,507
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $47,536
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,507
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number938991
Policy instance 20
Insurance contract or identification number938991
Number of Individuals Covered49
Insurance policy start date2019-03-01
Insurance policy end date2020-02-29
Total amount of commissions paid to insurance brokerUSD $2,032
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $20,308
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,032
Additional information about fees paid to insurance brokerBENEFITS CONSUTATION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AAKC
Policy instance 4
Insurance contract or identification numberG000AAKC
Number of Individuals Covered54
Insurance policy start date2019-03-01
Insurance policy end date2020-02-28
Total amount of commissions paid to insurance brokerUSD $5,616
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $28,077
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,808
Additional information about fees paid to insurance brokerBROKERS SERVICES
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 95089 )
Policy contract number29303
Policy instance 3
Insurance contract or identification number29303
Number of Individuals Covered38
Insurance policy start date2019-03-01
Insurance policy end date2020-02-29
Total amount of commissions paid to insurance brokerUSD $13,344
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,344
Additional information about fees paid to insurance brokerBENEFITS CONSULTATION
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 )
Policy contract number29303
Policy instance 2
Insurance contract or identification number29303
Number of Individuals Covered22
Insurance policy start date2019-03-01
Insurance policy end date2020-02-29
Total amount of commissions paid to insurance brokerUSD $11,152
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,152
Additional information about fees paid to insurance brokerBENEFITS CONSULTATION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AINX
Policy instance 1
Insurance contract or identification numberG000AINX
Number of Individuals Covered60
Insurance policy start date2019-03-01
Insurance policy end date2020-02-29
Total amount of commissions paid to insurance brokerUSD $3,394
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $16,971
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,394
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
Policy contract number780562
Policy instance 13
Insurance contract or identification number780562
Number of Individuals Covered96
Insurance policy start date2019-03-01
Insurance policy end date2020-02-29
Total amount of commissions paid to insurance brokerUSD $5,770
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $57,176
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,454
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number8553353G
Policy instance 17
Insurance contract or identification number8553353G
Number of Individuals Covered24
Insurance policy start date2019-03-01
Insurance policy end date2020-02-29
Total amount of commissions paid to insurance brokerUSD $2,573
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $12,869
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,573
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
Policy contract number796822
Policy instance 15
Insurance contract or identification number796822
Number of Individuals Covered24
Insurance policy start date2019-03-01
Insurance policy end date2020-02-29
Total amount of commissions paid to insurance brokerUSD $1,668
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $18,996
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,314
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number854844G
Policy instance 16
Insurance contract or identification number854844G
Number of Individuals Covered20
Insurance policy start date2019-03-01
Insurance policy end date2020-02-29
Total amount of commissions paid to insurance brokerUSD $1,684
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $8,421
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,684
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AAQ5
Policy instance 7
Insurance contract or identification numberG000AAQ5
Number of Individuals Covered27
Insurance policy start date2019-03-01
Insurance policy end date2020-02-29
Total amount of commissions paid to insurance brokerUSD $2,968
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $14,838
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,968
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number5722841
Policy instance 8
Insurance contract or identification number5722841
Number of Individuals Covered73
Insurance policy start date2019-03-01
Insurance policy end date2020-02-29
Total amount of commissions paid to insurance brokerUSD $1,299
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $18,738
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,299
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00533699
Policy instance 9
Insurance contract or identification number00533699
Number of Individuals Covered60
Insurance policy start date2019-03-01
Insurance policy end date2020-02-29
Total amount of commissions paid to insurance brokerUSD $1,200
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $10,534
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,177
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
Policy contract number780670
Policy instance 10
Insurance contract or identification number780670
Number of Individuals Covered35
Insurance policy start date2019-03-01
Insurance policy end date2020-02-29
Total amount of commissions paid to insurance brokerUSD $3,211
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $37,438
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,538
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
COMPBENEFITS COMPANY (National Association of Insurance Commissioners NAIC id number: 52015 )
Policy contract number780670
Policy instance 11
Insurance contract or identification number780670
Number of Individuals Covered16
Insurance policy start date2019-03-01
Insurance policy end date2020-02-29
Total amount of commissions paid to insurance brokerUSD $326
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,868
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $297
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
Policy contract number780642
Policy instance 12
Insurance contract or identification number780642
Number of Individuals Covered57
Insurance policy start date2019-03-01
Insurance policy end date2020-02-29
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $44,984
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 numberG000ABLA
Policy instance 5
Insurance contract or identification numberG000ABLA
Number of Individuals Covered24
Insurance policy start date2019-03-01
Insurance policy end date2020-02-29
Total amount of commissions paid to insurance brokerUSD $3,896
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $19,479
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,896
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
COMPBENEFITS COMPANY (National Association of Insurance Commissioners NAIC id number: 52015 )
Policy contract number780562
Policy instance 14
Insurance contract or identification number780562
Number of Individuals Covered57
Insurance policy start date2019-03-01
Insurance policy end date2020-02-29
Total amount of commissions paid to insurance brokerUSD $1,804
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $89,121
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,654
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGVTLOAINX
Policy instance 1
Insurance contract or identification numberGVTLOAINX
Number of Individuals Covered19
Insurance policy start date2018-03-01
Insurance policy end date2019-02-28
Total amount of commissions paid to insurance brokerUSD $2,106
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $10,532
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,106
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number857515
Policy instance 29
Insurance contract or identification number857515
Number of Individuals Covered8
Insurance policy start date2018-03-01
Insurance policy end date2019-02-28
Total amount of commissions paid to insurance brokerUSD $2,829
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $15,116
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,829
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
Policy contract number780642
Policy instance 2
Insurance contract or identification number780642
Number of Individuals Covered41
Insurance policy start date2018-03-01
Insurance policy end date2019-02-28
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $35,688
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 numberG00AC82
Policy instance 20
Insurance contract or identification numberG00AC82
Number of Individuals Covered21
Insurance policy start date2018-03-01
Insurance policy end date2019-02-28
Total amount of commissions paid to insurance brokerUSD $1,856
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $9,281
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,856
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
GUARDIAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number533699
Policy instance 4
Insurance contract or identification number533699
Number of Individuals Covered52
Insurance policy start date2018-03-01
Insurance policy end date2019-02-28
Total amount of commissions paid to insurance brokerUSD $1,695
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $10,198
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,147
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
FIRSTCAROLINACARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 77950 )
Policy contract number208000
Policy instance 3
Insurance contract or identification number208000
Number of Individuals Covered110
Insurance policy start date2018-03-01
Insurance policy end date2019-02-28
Total amount of commissions paid to insurance brokerUSD $22,736
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $568,390
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $22,736
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number5722841
Policy instance 5
Insurance contract or identification number5722841
Number of Individuals Covered80
Insurance policy start date2018-03-01
Insurance policy end date2019-02-28
Total amount of commissions paid to insurance brokerUSD $1,174
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $17,864
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,174
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AC82
Policy instance 7
Insurance contract or identification numberG000AC82
Number of Individuals Covered21
Insurance policy start date2018-03-01
Insurance policy end date2019-02-28
Total amount of commissions paid to insurance brokerUSD $1,856
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $9,281
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,856
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGVTLA0AAQ5
Policy instance 19
Insurance contract or identification numberGVTLA0AAQ5
Number of Individuals Covered43
Insurance policy start date2018-03-01
Insurance policy end date2019-02-28
Total amount of commissions paid to insurance brokerUSD $3,185
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $15,924
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,185
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AKCC
Policy instance 18
Insurance contract or identification numberG000AKCC
Number of Individuals Covered60
Insurance policy start date2018-03-01
Insurance policy end date2019-02-28
Total amount of commissions paid to insurance brokerUSD $5,388
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $26,938
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,694
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
Policy contract number780562
Policy instance 17
Insurance contract or identification number780562
Number of Individuals Covered101
Insurance policy start date2018-03-01
Insurance policy end date2019-02-28
Total amount of commissions paid to insurance brokerUSD $4,605
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $86,839
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,605
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 )
Policy contract number46225
Policy instance 8
Insurance contract or identification number46225
Number of Individuals Covered51
Insurance policy start date2018-03-01
Insurance policy end date2019-02-28
Total amount of commissions paid to insurance brokerUSD $38,272
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $38,272
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
CAPITAL HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95112 )
Policy contract number00366
Policy instance 11
Insurance contract or identification number00366
Number of Individuals Covered92
Insurance policy start date2018-03-01
Insurance policy end date2019-02-28
Total amount of commissions paid to insurance brokerUSD $18,884
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $625,137
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $18,884
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
AMERICAN PUBLIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60801 )
Policy contract number19146
Policy instance 15
Insurance contract or identification number19146
Number of Individuals Covered112
Insurance policy start date2018-03-01
Insurance policy end date2019-02-21
Total amount of commissions paid to insurance brokerUSD $19,782
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $116,483
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,474
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number119740
Policy instance 14
Insurance contract or identification number119740
Number of Individuals Covered15
Insurance policy start date2018-03-01
Insurance policy end date2019-02-28
Total amount of commissions paid to insurance brokerUSD $269
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,695
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $269
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
Policy contract number780670
Policy instance 12
Insurance contract or identification number780670
Number of Individuals Covered36
Insurance policy start date2018-03-01
Insurance policy end date2019-02-28
Total amount of commissions paid to insurance brokerUSD $2,051
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $38,017
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,051
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL146022
Policy instance 13
Insurance contract or identification numberGL146022
Number of Individuals Covered68
Insurance policy start date2018-03-01
Insurance policy end date2019-02-28
Total amount of commissions paid to insurance brokerUSD $372
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,723
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $372
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
Policy contract number796822
Policy instance 9
Insurance contract or identification number796822
Number of Individuals Covered23
Insurance policy start date2018-03-01
Insurance policy end date2019-02-28
Total amount of commissions paid to insurance brokerUSD $1,035
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $20,202
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,035
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 )
Policy contract number46225
Policy instance 21
Insurance contract or identification number46225
Number of Individuals Covered51
Insurance policy start date2018-03-01
Insurance policy end date2019-02-28
Total amount of commissions paid to insurance brokerUSD $38,272
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $38,272
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGVTL0ABLA
Policy instance 10
Insurance contract or identification numberGVTL0ABLA
Number of Individuals Covered30
Insurance policy start date2018-03-01
Insurance policy end date2019-02-28
Total amount of commissions paid to insurance brokerUSD $4,399
Commission paid to Insurance BrokerUSD $4,399
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number697614
Policy instance 16
Insurance contract or identification number697614
Number of Individuals Covered139
Insurance policy start date2018-03-01
Insurance policy end date2019-02-28
Total amount of commissions paid to insurance brokerUSD $40,527
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,097,596
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $40,527
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number855353G
Policy instance 28
Insurance contract or identification number855353G
Number of Individuals Covered13
Insurance policy start date2018-03-01
Insurance policy end date2019-02-28
Total amount of commissions paid to insurance brokerUSD $2,485
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $12,426
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,485
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number854844G
Policy instance 27
Insurance contract or identification number854844G
Number of Individuals Covered7
Insurance policy start date2018-03-01
Insurance policy end date2019-02-28
Total amount of commissions paid to insurance brokerUSD $2,390
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $11,952
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,390
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number8W6088
Policy instance 6
Insurance contract or identification number8W6088
Number of Individuals Covered43
Insurance policy start date2018-03-01
Insurance policy end date2018-02-28
Total amount of commissions paid to insurance brokerUSD $11,714
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $349,406
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,714
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
CAPITAL HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95112 )
Policy contract number00366
Policy instance 24
Insurance contract or identification number00366
Number of Individuals Covered92
Insurance policy start date2018-03-01
Insurance policy end date2019-02-28
Total amount of commissions paid to insurance brokerUSD $18,884
Welfare Benefit Premiums Paid to CarrierUSD $625,137
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $18,884
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number851899G
Policy instance 26
Insurance contract or identification number851899G
Number of Individuals Covered38
Insurance policy start date2018-03-01
Insurance policy end date2019-02-28
Total amount of commissions paid to insurance brokerUSD $10,087
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $50,437
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,087
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
Policy contract number780670
Policy instance 25
Insurance contract or identification number780670
Number of Individuals Covered36
Insurance policy start date2018-03-01
Insurance policy end date2019-02-28
Total amount of commissions paid to insurance brokerUSD $2,052
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $38,017
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,052
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000ABLA
Policy instance 23
Insurance contract or identification numberG000ABLA
Number of Individuals Covered30
Insurance policy start date2018-03-01
Insurance policy end date2019-02-28
Total amount of commissions paid to insurance brokerUSD $4,399
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $21,966
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,399
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
Policy contract number796822
Policy instance 22
Insurance contract or identification number796822
Number of Individuals Covered23
Insurance policy start date2018-03-01
Insurance policy end date2019-02-28
Total amount of commissions paid to insurance brokerUSD $1,035
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $20,202
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,035
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 )
Policy contract numberCD3721, CP3721,
Policy instance 30
Insurance contract or identification numberCD3721, CP3721,
Number of Individuals Covered40
Insurance policy start date2017-03-01
Insurance policy end date2018-02-28
Total amount of commissions paid to insurance brokerUSD $1,448
Welfare Benefit Premiums Paid to CarrierUSD $20,635
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $191
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker namePRIMEGROUP INSURANCE SERVICES
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
Policy contract number780670
Policy instance 32
Insurance contract or identification number780670
Number of Individuals Covered268
Insurance policy start date2017-03-01
Insurance policy end date2018-02-28
Total amount of commissions paid to insurance brokerUSD $269
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,995
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $269
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker namePRIMEGROUP INSURANCE SERVICES
THE HARTFORD (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number854844G
Policy instance 20
Insurance contract or identification number854844G
Number of Individuals Covered34
Insurance policy start date2017-03-01
Insurance policy end date2018-02-28
Total amount of commissions paid to insurance brokerUSD $2,522
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $13,831
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,522
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker namePRO HEALTH USA
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
Policy contract number780562
Policy instance 31
Insurance contract or identification number780562
Number of Individuals Covered80
Insurance policy start date2017-03-01
Insurance policy end date2018-02-28
Total amount of commissions paid to insurance brokerUSD $784
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $8,760
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $784
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker namePRIMEGROUP INSURANCE SERVICES
COMPBENEFITS COMPANY (National Association of Insurance Commissioners NAIC id number: 52015 )
Policy contract numberCD0393, CP0393,
Policy instance 29
Insurance contract or identification numberCD0393, CP0393,
Number of Individuals Covered15
Insurance policy start date2017-03-01
Insurance policy end date2018-02-28
Total amount of commissions paid to insurance brokerUSD $911
Welfare Benefit Premiums Paid to CarrierUSD $14,152
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $130
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker namePRIMEGROUP INSURANCE SERVICES
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number08W6088
Policy instance 4
Insurance contract or identification number08W6088
Number of Individuals Covered49
Insurance policy start date2017-03-01
Insurance policy end date2018-02-28
Total amount of commissions paid to insurance brokerUSD $13,376
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $365,301
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,376
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker nameDAVIS BLAIR ADAMS
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AC82
Policy instance 16
Insurance contract or identification numberG000AC82
Number of Individuals Covered16
Insurance policy start date2017-03-01
Insurance policy end date2018-02-28
Total amount of commissions paid to insurance brokerUSD $2,174
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $10,870
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,174
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker namePRO HEALTH USA
UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number655323
Policy instance 7
Insurance contract or identification number655323
Number of Individuals Covered80
Insurance policy start date2017-03-01
Insurance policy end date2018-02-28
Total amount of commissions paid to insurance brokerUSD $24,235
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $329,372
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $24,235
Additional information about fees paid to insurance brokerBROKER SEWRVICES
Insurance broker organization code?3
Insurance broker nameDAVID BLAIR ADAMS
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AAKC
Policy instance 15
Insurance contract or identification numberG000AAKC
Number of Individuals Covered59
Insurance policy start date2017-03-01
Insurance policy end date2018-02-28
Total amount of commissions paid to insurance brokerUSD $4,924
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $24,619
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,462
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker nameSTEVEN CHOCRANE
COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 )
Policy contract numberCD3729, CP3729,
Policy instance 28
Insurance contract or identification numberCD3729, CP3729,
Number of Individuals Covered49
Insurance policy start date2017-03-01
Insurance policy end date2018-02-28
Total amount of commissions paid to insurance brokerUSD $1,935
Welfare Benefit Premiums Paid to CarrierUSD $28,074
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $276
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker namePRIMEGROUP INSURANCE SERVICES
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AAQ5
Policy instance 13
Insurance contract or identification numberG000AAQ5
Number of Individuals Covered22
Insurance policy start date2017-03-01
Insurance policy end date2018-02-28
Total amount of commissions paid to insurance brokerUSD $2,794
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $13,970
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,794
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker namePRO HEALTH USA
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number857515G
Policy instance 12
Insurance contract or identification number857515G
Number of Individuals Covered6
Insurance policy start date2017-03-01
Insurance policy end date2018-02-28
Total amount of commissions paid to insurance brokerUSD $2,899
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $13,527
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,899
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker namePRO HEALTH USA
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number851899G
Policy instance 11
Insurance contract or identification number851899G
Number of Individuals Covered40
Insurance policy start date2017-03-01
Insurance policy end date2018-02-28
Total amount of commissions paid to insurance brokerUSD $10,715
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $53,577
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,715
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker namePRO HEALTH USA
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number92729303
Policy instance 10
Insurance contract or identification number92729303
Number of Individuals Covered60
Insurance policy start date2017-03-01
Insurance policy end date2018-02-28
Total amount of commissions paid to insurance brokerUSD $1,824
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $28,448
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,824
Additional information about fees paid to insurance broker3
Insurance broker nameEBS ADVISORS
AMERICAN PUBLIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60801 )
Policy contract number19146
Policy instance 9
Insurance contract or identification number19146
Number of Individuals Covered119
Insurance policy start date2017-03-01
Insurance policy end date2018-02-28
Total amount of commissions paid to insurance brokerUSD $24,218
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $111,309
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,455
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker nameDAVID ADAMS
AMERICAN PUBLIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60801 )
Policy contract number19146
Policy instance 8
Insurance contract or identification number19146
Number of Individuals Covered119
Insurance policy start date2017-03-01
Insurance policy end date2018-02-28
Total amount of commissions paid to insurance brokerUSD $24,220
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $134,625
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,456
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker nameDAVID ADAMS
CAPITAL HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95112 )
Policy contract number00366
Policy instance 6
Insurance contract or identification number00366
Number of Individuals Covered111
Insurance policy start date2017-03-01
Insurance policy end date2018-02-28
Total amount of commissions paid to insurance brokerUSD $17,417
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $599,717
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,417
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker nameDAVID ADAMS
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract numberKE818,KE13,9K30
Policy instance 5
Insurance contract or identification numberKE818,KE13,9K30
Number of Individuals Covered50
Insurance policy start date2016-12-01
Insurance policy end date2017-11-30
Total amount of commissions paid to insurance brokerUSD $1,319
Total amount of fees paid to insurance companyUSD $36
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $10,898
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,227
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Amount paid for insurance broker fees36
Insurance broker nameADAMS BENEFIT CORP
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberTM05722841
Policy instance 3
Insurance contract or identification numberTM05722841
Number of Individuals Covered53
Insurance policy start date2017-03-01
Insurance policy end date2018-02-28
Total amount of commissions paid to insurance brokerUSD $1,187
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $16,248
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,187
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker nameDAVID ADAMS
FIRSTCAROLINACARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 77950 )
Policy contract number20800
Policy instance 2
Insurance contract or identification number20800
Number of Individuals Covered110
Insurance policy start date2017-03-01
Insurance policy end date2018-02-28
Total amount of commissions paid to insurance brokerUSD $23,152
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $578,821
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,991
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker nameGEORGE LITTLE AND ASSOCIATES
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000ABLA
Policy instance 14
Insurance contract or identification numberG000ABLA
Number of Individuals Covered28
Insurance policy start date2017-03-01
Insurance policy end date2018-02-28
Total amount of commissions paid to insurance brokerUSD $4,280
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $21,399
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,280
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker namePRO HEALTH USA
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number439653
Policy instance 1
Insurance contract or identification number439653
Number of Individuals Covered157
Insurance policy start date2017-03-01
Insurance policy end date2018-02-28
Total amount of commissions paid to insurance brokerUSD $35,907
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $589,063
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $35,907
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker nameADAMS BENEFIT CORP
COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 )
Policy contract numberCD3727, CP3727,
Policy instance 27
Insurance contract or identification numberCD3727, CP3727,
Number of Individuals Covered11
Insurance policy start date2017-03-01
Insurance policy end date2018-02-28
Total amount of commissions paid to insurance brokerUSD $491
Welfare Benefit Premiums Paid to CarrierUSD $6,530
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $70
Additional information about fees paid to insurance brokerBROKER SERVICESD
Insurance broker organization code?3
Insurance broker namePRIMEGROUP INSURANCE SERVICES
COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 )
Policy contract numberCD3733, CD3734
Policy instance 26
Insurance contract or identification numberCD3733, CD3734
Number of Individuals Covered48
Insurance policy start date2017-03-01
Insurance policy end date2018-02-28
Total amount of commissions paid to insurance brokerUSD $518
Welfare Benefit Premiums Paid to CarrierUSD $37,890
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $183
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker namePRIMEGROUP INSURANCE SERVICES
COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 )
Policy contract numberCD3723, CP3723,
Policy instance 25
Insurance contract or identification numberCD3723, CP3723,
Number of Individuals Covered70
Insurance policy start date2017-03-01
Insurance policy end date2017-02-28
Total amount of commissions paid to insurance brokerUSD $2,659
Welfare Benefit Premiums Paid to CarrierUSD $38,267
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $379
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker namePRIMEGROUP INSURANCE SERVICES
AMERICAN PUBLIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60801 )
Policy contract number19146
Policy instance 24
Insurance contract or identification number19146
Number of Individuals Covered119
Insurance policy start date2017-03-01
Insurance policy end date2018-02-28
Total amount of commissions paid to insurance brokerUSD $24,220
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $111,309
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,456
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker nameDAVID ADAMS
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number851899G
Policy instance 23
Insurance contract or identification number851899G
Number of Individuals Covered88
Insurance policy start date2017-03-01
Insurance policy end date2018-02-28
Total amount of commissions paid to insurance brokerUSD $10,715
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $53,577
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,715
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker namePRO HEALTH USA
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberLTD119740
Policy instance 22
Insurance contract or identification numberLTD119740
Number of Individuals Covered12
Insurance policy start date2017-03-01
Insurance policy end date2018-02-28
Total amount of commissions paid to insurance brokerUSD $215
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,155
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $215
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker nameCUNDY INC
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL146022
Policy instance 21
Insurance contract or identification numberGL146022
Number of Individuals Covered67
Insurance policy start date2017-03-01
Insurance policy end date2018-02-28
Total amount of commissions paid to insurance brokerUSD $286
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,868
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $286
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker nameCUNDY INC
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number855353G
Policy instance 19
Insurance contract or identification number855353G
Number of Individuals Covered25
Insurance policy start date2017-03-01
Insurance policy end date2018-02-28
Total amount of commissions paid to insurance brokerUSD $22,224
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $11,120
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $22,224
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker namePRO HEALTH USA
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number857515G
Policy instance 18
Insurance contract or identification number857515G
Number of Individuals Covered20
Insurance policy start date2017-03-01
Insurance policy end date2018-02-28
Total amount of commissions paid to insurance brokerUSD $2,899
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $13,527
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,899
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker namePRO HEALTH USA
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number02X3757
Policy instance 17
Insurance contract or identification number02X3757
Number of Individuals Covered94
Insurance policy start date2017-03-01
Insurance policy end date2018-02-28
Total amount of commissions paid to insurance brokerUSD $21,201
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $403,830
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $21,201
Additional information about fees paid to insurance brokerBENEFITS CONSULTATION
Insurance broker organization code?3
Insurance broker nameEBS ADVISORS, INC
COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 )
Policy contract numberCD3727 28 CP372
Policy instance 9
Insurance contract or identification numberCD3727 28 CP372
Number of Individuals Covered9
Insurance policy start date2015-03-01
Insurance policy end date2016-02-29
Total amount of commissions paid to insurance brokerUSD $343
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $4,536
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $44
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker namePRIMEGROUP INSURANCE SERVICES
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number855353G
Policy instance 2
Insurance contract or identification number855353G
Number of Individuals Covered11
Insurance policy start date2015-03-01
Insurance policy end date2016-02-29
Total amount of commissions paid to insurance brokerUSD $2,838
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $14,191
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,838
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker namePRO HEALTH USA
COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 )
Policy contract numberCD3729 30 CP372
Policy instance 10
Insurance contract or identification numberCD3729 30 CP372
Number of Individuals Covered37
Insurance policy start date2015-03-01
Insurance policy end date2016-02-29
Total amount of commissions paid to insurance brokerUSD $2,224
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $25,581
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $252
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker namePRIMEGROUP INSURANCE SERVICES
COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 )
Policy contract numberCD3723 24 CP372
Policy instance 8
Insurance contract or identification numberCD3723 24 CP372
Number of Individuals Covered62
Insurance policy start date2015-03-01
Insurance policy end date2016-02-29
Total amount of commissions paid to insurance brokerUSD $2,857
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $37,403
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $370
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker namePRIMEGROUP INSURANCE SERVICES
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number92929303
Policy instance 7
Insurance contract or identification number92929303
Number of Individuals Covered58
Insurance policy start date2015-03-01
Insurance policy end date2016-02-29
Total amount of commissions paid to insurance brokerUSD $21,330
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $362,147
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $21,330
Additional information about fees paid to insurance brokerCONSULTING SERVICES
Insurance broker organization code?3
Insurance broker nameEBS ADVISORS, INC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AC82
Policy instance 6
Insurance contract or identification numberG000AC82
Number of Individuals Covered24
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $2,246
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $11,230
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,246
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker namePRO HEALTH USA
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AAQ5
Policy instance 5
Insurance contract or identification numberG000AAQ5
Number of Individuals Covered28
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $2,359
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $11,796
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,359
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker namePRO HEALTH USA
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number857515G
Policy instance 4
Insurance contract or identification number857515G
Number of Individuals Covered6
Insurance policy start date2015-03-01
Insurance policy end date2016-02-29
Total amount of commissions paid to insurance brokerUSD $1,570
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $7,850
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,570
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker namePRO HEALTH USA
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number854844G
Policy instance 3
Insurance contract or identification number854844G
Number of Individuals Covered11
Insurance policy start date2015-03-01
Insurance policy end date2016-02-29
Total amount of commissions paid to insurance brokerUSD $2,451
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $12,255
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,451
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker namePRO HEALTH USA
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number851899G
Policy instance 1
Insurance contract or identification number851899G
Number of Individuals Covered22
Insurance policy start date2015-03-01
Insurance policy end date2016-02-29
Total amount of commissions paid to insurance brokerUSD $6,174
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $30,870
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,174
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker namePRO HEALTH USA
COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 )
Policy contract numberCD3733 34
Policy instance 11
Insurance contract or identification numberCD3733 34
Number of Individuals Covered50
Insurance policy start date2015-03-01
Insurance policy end date2016-02-29
Total amount of commissions paid to insurance brokerUSD $377
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $34,633
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $332
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker namePRIMEGROUP INSURANCE SERVICES
COMPBENEFITS COMPANY (National Association of Insurance Commissioners NAIC id number: 52015 )
Policy contract numberVS5263
Policy instance 12
Insurance contract or identification numberVS5263
Number of Individuals Covered10
Insurance policy start date2015-03-01
Insurance policy end date2016-02-29
Total amount of commissions paid to insurance brokerUSD $88
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $979
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $88
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker namePRIMEGROUP INSURANCE SERVICES
COMPBENEFITS COMPANY (National Association of Insurance Commissioners NAIC id number: 52015 )
Policy contract numberVS5261
Policy instance 13
Insurance contract or identification numberVS5261
Number of Individuals Covered49
Insurance policy start date2015-03-01
Insurance policy end date2016-02-29
Total amount of commissions paid to insurance brokerUSD $483
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,396
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $483
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker namePRIMEGROUP INSURANCE GROUP
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberTM05722841
Policy instance 21
Insurance contract or identification numberTM05722841
Number of Individuals Covered47
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $993
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $12,204
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $687
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker nameDAVID ADAMS
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number655323
Policy instance 20
Insurance contract or identification number655323
Number of Individuals Covered47
Insurance policy start date2015-03-01
Insurance policy end date2016-02-29
Total amount of commissions paid to insurance brokerUSD $12,699
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $253,998
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,699
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker nameDAVID BLAIR ADAMS
CAPITAL HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95112 )
Policy contract number00366
Policy instance 19
Insurance contract or identification number00366
Number of Individuals Covered84
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $13,247
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $479,348
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,247
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker nameDAVID ADAMS
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50019725
Policy instance 18
Insurance contract or identification number50019725
Number of Individuals Covered27
Insurance policy start date2014-12-01
Insurance policy end date2015-11-30
Total amount of commissions paid to insurance brokerUSD $682
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,022
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $116
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker nameMOSAIC GROUP
COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 )
Policy contract numberCD3719 CP3719 2
Policy instance 17
Insurance contract or identification numberCD3719 CP3719 2
Number of Individuals Covered10
Insurance policy start date2015-03-01
Insurance policy end date2016-02-29
Total amount of commissions paid to insurance brokerUSD $234
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $10,693
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $33
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker namePRIMEGROUP INSURANCE SERVICES
COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 )
Policy contract numberCD3721 22 CP372
Policy instance 16
Insurance contract or identification numberCD3721 22 CP372
Number of Individuals Covered46
Insurance policy start date2015-03-01
Insurance policy end date2016-02-29
Total amount of commissions paid to insurance brokerUSD $1,661
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $20,959
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $193
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker namePRIMEGROUP INSURANCE SERVICES
COMPBENEFITS COMPANY (National Association of Insurance Commissioners NAIC id number: 52015 )
Policy contract numberVS6327
Policy instance 15
Insurance contract or identification numberVS6327
Number of Individuals Covered11
Insurance policy start date2015-03-01
Insurance policy end date2016-02-29
Total amount of commissions paid to insurance brokerUSD $84
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $939
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $84
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker namePRIMEGROUP INSURANCE SERVICES
COMPBENEFITS COMPANY (National Association of Insurance Commissioners NAIC id number: 52015 )
Policy contract numberVS5268
Policy instance 14
Insurance contract or identification numberVS5268
Number of Individuals Covered5
Insurance policy start date2015-03-01
Insurance policy end date2016-02-29
Total amount of commissions paid to insurance brokerUSD $25
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $283
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $25
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker namePRIMEGROUP INSURANCE SERVICES
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number655323
Policy instance 7
Insurance contract or identification number655323
Number of Individuals Covered49
Insurance policy start date2014-03-01
Insurance policy end date2015-02-28
Total amount of commissions paid to insurance brokerUSD $12,250
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $233,343
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,250
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker nameDAVID BLAIR ADAMS
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number855353G
Policy instance 6
Insurance contract or identification number855353G
Number of Individuals Covered12
Insurance policy start date2014-03-01
Insurance policy end date2015-02-28
Total amount of commissions paid to insurance brokerUSD $2,526
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $12,630
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,526
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker namePRO HEALTH USA
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGOOOABLA
Policy instance 5
Insurance contract or identification numberGOOOABLA
Number of Individuals Covered20
Insurance policy start date2014-03-01
Insurance policy end date2015-02-28
Total amount of commissions paid to insurance brokerUSD $3,035
Other welfare benefits providedVOL LIFE
Welfare Benefit Premiums Paid to CarrierUSD $15,174
Commission paid to Insurance BrokerUSD $3,035
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker namePRO HEALTH USA
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number857515G
Policy instance 4
Insurance contract or identification number857515G
Number of Individuals Covered6
Insurance policy start date2014-03-01
Insurance policy end date2015-02-28
Total amount of commissions paid to insurance brokerUSD $1,465
Other welfare benefits providedVOL LIFE
Welfare Benefit Premiums Paid to CarrierUSD $7,325
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,465
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker namePRO HEALTH USA
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGOOOAAQ5
Policy instance 3
Insurance contract or identification numberGOOOAAQ5
Number of Individuals Covered14
Insurance policy start date2014-03-01
Insurance policy end date2015-02-28
Total amount of commissions paid to insurance brokerUSD $1,377
Other welfare benefits providedVOL LIFE
Welfare Benefit Premiums Paid to CarrierUSD $6,885
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,377
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker namePRO HEALTH USA
FIRSTCAROLINACARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 77950 )
Policy contract number208000
Policy instance 2
Insurance contract or identification number208000
Number of Individuals Covered92
Insurance policy start date2014-03-01
Insurance policy end date2015-02-28
Total amount of commissions paid to insurance brokerUSD $17,172
Welfare Benefit Premiums Paid to CarrierUSD $429,303
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,172
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker nameTHE MGN COMPANY
BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 95089 )
Policy contract number29303
Policy instance 9
Insurance contract or identification number29303
Number of Individuals Covered36
Insurance policy start date2014-03-01
Insurance policy end date2015-02-28
Total amount of commissions paid to insurance brokerUSD $7,150
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,150
Additional information about fees paid to insurance brokerBENEFITS CONSULTATION
Insurance broker organization code?3
Insurance broker nameEBS ADVISORS, INC
BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 )
Policy contract number29303
Policy instance 8
Insurance contract or identification number29303
Number of Individuals Covered17
Insurance policy start date2014-03-01
Insurance policy end date2015-02-28
Total amount of commissions paid to insurance brokerUSD $6,522
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,522
Additional information about fees paid to insurance brokerBENEFIT CONSULTATION
Insurance broker organization code?3
Insurance broker nameEBS ADVISORS, INC
BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )
Policy contract number079503
Policy instance 10
Insurance contract or identification number079503
Number of Individuals Covered40
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $13,152
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,152
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker nameDAVID B ADAMS
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGOOOAAKC
Policy instance 11
Insurance contract or identification numberGOOOAAKC
Number of Individuals Covered45
Insurance policy start date2014-03-01
Insurance policy end date2015-02-28
Total amount of commissions paid to insurance brokerUSD $2,726
Other welfare benefits providedVOL LIFE
Welfare Benefit Premiums Paid to CarrierUSD $27,259
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,726
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker nameKENNETH ROBERTS
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number851899G
Policy instance 12
Insurance contract or identification number851899G
Number of Individuals Covered19
Insurance policy start date2014-03-01
Insurance policy end date2015-02-28
Total amount of commissions paid to insurance brokerUSD $6,991
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $34,956
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,991
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker namePRO HEALTH USA
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGOOOAC82
Policy instance 13
Insurance contract or identification numberGOOOAC82
Number of Individuals Covered16
Insurance policy start date2014-03-01
Insurance policy end date2015-02-28
Total amount of commissions paid to insurance brokerUSD $1,702
Other welfare benefits providedVOL LIFE
Welfare Benefit Premiums Paid to CarrierUSD $8,512
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,702
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker namePRO HEALTH USA
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number854844G
Policy instance 14
Insurance contract or identification number854844G
Number of Individuals Covered13
Insurance policy start date2014-03-01
Insurance policy end date2015-02-28
Total amount of commissions paid to insurance brokerUSD $2,703
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $13,515
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,703
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker namePRO HEALTH USA
NEIGHBORHOOD HEALTH PARTNERSHIP (National Association of Insurance Commissioners NAIC id number: 95123 )
Policy contract numberB15448
Policy instance 15
Insurance contract or identification numberB15448
Number of Individuals Covered145
Insurance policy start date2014-03-01
Insurance policy end date2015-02-28
Total amount of commissions paid to insurance brokerUSD $1,196
Total amount of fees paid to insurance companyUSD $31,145
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $746,286
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,196
Amount paid for insurance broker fees31145
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker nameADAMS BENEFIT CORP
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number438652 439653
Policy instance 16
Insurance contract or identification number438652 439653
Number of Individuals Covered38
Insurance policy start date2014-03-01
Insurance policy end date2015-02-28
Total amount of commissions paid to insurance brokerUSD $11,193
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $273,130
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,193
Additional information about fees paid to insurance brokerBROKER SERVICED
Insurance broker organization code?3
Insurance broker nameADAMS BENEFIT CORP
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGOOOAINX
Policy instance 1
Insurance contract or identification numberGOOOAINX
Number of Individuals Covered19
Insurance policy start date2014-03-01
Insurance policy end date2015-02-28
Total amount of commissions paid to insurance brokerUSD $2,197
Other welfare benefits providedVOL LIFE
Welfare Benefit Premiums Paid to CarrierUSD $10,983
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,197
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker namePRO HEALTH USA
COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 )
Policy contract numberVS5269
Policy instance 11
Insurance contract or identification numberVS5269
Number of Individuals Covered50
Insurance policy start date2013-03-01
Insurance policy end date2014-02-28
Total amount of commissions paid to insurance brokerUSD $112
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,138
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $112
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker nameJB INSURANCE SERVICES
NEIGHBORHOOD HEALTH PARTNERSHIP (National Association of Insurance Commissioners NAIC id number: 95123 )
Policy contract numberB15448
Policy instance 1
Insurance contract or identification numberB15448
Number of Individuals Covered136
Insurance policy start date2013-03-01
Insurance policy end date2014-02-28
Total amount of fees paid to insurance companyUSD $33,193
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $672,714
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees33193
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker nameADAMS BENEFIT CORPORATION
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract number6231,AAKC,AC82,
Policy instance 14
Insurance contract or identification number6231,AAKC,AC82,
Number of Individuals Covered165
Insurance policy start date2013-01-01
Insurance policy end date2014-01-01
Total amount of commissions paid to insurance brokerUSD $12,508
Commission paid to Insurance BrokerUSD $6,414
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker nameSTEVEN COCHRANE
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number851899G,854844G
Policy instance 13
Insurance contract or identification number851899G,854844G
Number of Individuals Covered226
Insurance policy start date2013-03-01
Insurance policy end date2014-02-28
Total amount of commissions paid to insurance brokerUSD $16,019
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $81,302
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,543
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker nameDEANNA AUTREY
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number438652
Policy instance 2
Insurance contract or identification number438652
Number of Individuals Covered141
Insurance policy start date2012-03-01
Insurance policy end date2014-02-28
Total amount of commissions paid to insurance brokerUSD $14,443
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $350,578
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,443
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker nameADAMS BENEFIT CORPORATION
COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 )
Policy contract number3721,3729,CD530
Policy instance 12
Insurance contract or identification number3721,3729,CD530
Number of Individuals Covered128
Insurance policy start date2013-03-01
Insurance policy end date2014-02-28
Total amount of commissions paid to insurance brokerUSD $4,113
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $61,672
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $531
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker namePRIMEGROUP INSURANCE SERVICES
COMPBENEFITS COMPANY (National Association of Insurance Commissioners NAIC id number: 52015 )
Policy contract numberVS5268
Policy instance 10
Insurance contract or identification numberVS5268
Number of Individuals Covered5
Insurance policy start date2013-03-01
Insurance policy end date2014-02-28
Total amount of commissions paid to insurance brokerUSD $52
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $582
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $52
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker namePRIMEGROUP INSURANCE SERVICES
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number146022
Policy instance 9
Insurance contract or identification number146022
Insurance policy start date2013-03-01
Insurance policy end date2014-02-28
Total amount of commissions paid to insurance brokerUSD $2,430
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,160
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,430
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker nameCUNDY INC
SECURIAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93742 )
Policy contract number002646
Policy instance 8
Insurance contract or identification number002646
Number of Individuals Covered3
Insurance policy start date2013-03-01
Insurance policy end date2014-02-28
Total amount of commissions paid to insurance brokerUSD $366
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,440
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $366
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker nameEBENCONCEPTS
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number119740
Policy instance 7
Insurance contract or identification number119740
Number of Individuals Covered11
Insurance policy start date2013-03-01
Insurance policy end date2014-02-28
Total amount of commissions paid to insurance brokerUSD $200
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,995
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $200
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker nameCUNDY INC
FIRSTCAROLINACARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 77950 )
Policy contract number208000
Policy instance 6
Insurance contract or identification number208000
Number of Individuals Covered107
Insurance policy start date2013-03-01
Insurance policy end date2014-02-28
Total amount of commissions paid to insurance brokerUSD $17,002
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $425,055
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,002
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker nameTHE MGN GROUP
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberTM05599796
Policy instance 5
Insurance contract or identification numberTM05599796
Number of Individuals Covered116
Insurance policy start date2013-03-01
Insurance policy end date2014-02-28
Total amount of commissions paid to insurance brokerUSD $1,319
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $18,640
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,319
Additional information about fees paid to insurance brokerBENEFITS CONSULTATION
Insurance broker organization code?3
Insurance broker nameEBS ADVISORS, INC
BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 )
Policy contract number29303
Policy instance 3
Insurance contract or identification number29303
Number of Individuals Covered14
Insurance policy start date2013-03-01
Insurance policy end date2014-02-28
Total amount of commissions paid to insurance brokerUSD $4,713
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $117,830
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,713
Additional information about fees paid to insurance brokerBENEFITS CONSULTATION
Insurance broker organization code?3
Insurance broker nameEBS ADVISORS, INC
BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 95089 )
Policy contract number29303
Policy instance 4
Insurance contract or identification number29303
Number of Individuals Covered39
Insurance policy start date2013-03-01
Insurance policy end date2014-02-28
Total amount of commissions paid to insurance brokerUSD $8,126
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $203,141
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,126
Additional information about fees paid to insurance brokerBENEFITS CONSULTATION
Insurance broker organization code?3
Insurance broker nameEBS ADVISORS, INC
SECURIAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93742 )
Policy contract numberSD26460001
Policy instance 11
Insurance contract or identification numberSD26460001
Number of Individuals Covered5
Insurance policy start date2012-03-01
Insurance policy end date2012-02-28
Total amount of commissions paid to insurance brokerUSD $533
Welfare Benefit Premiums Paid to CarrierUSD $3,553
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $462
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker nameMEL SCHLESINGER
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberTM05599796
Policy instance 12
Insurance contract or identification numberTM05599796
Number of Individuals Covered131
Insurance policy start date2012-04-01
Insurance policy end date2013-03-31
Total amount of commissions paid to insurance brokerUSD $1,057
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $25,930
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,057
Insurance broker organization code?3
Insurance broker nameEBS ADVISORS, INC
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL146022
Policy instance 14
Insurance contract or identification numberGL146022
Number of Individuals Covered70
Insurance policy start date2012-03-01
Insurance policy end date2013-02-28
Total amount of commissions paid to insurance brokerUSD $245
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,464
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $245
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker nameCUNDY, INC
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number119740
Policy instance 13
Insurance contract or identification number119740
Number of Individuals Covered13
Insurance policy start date2012-03-01
Insurance policy end date2013-02-28
Total amount of commissions paid to insurance brokerUSD $280
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,791
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $280
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker nameCUNDY, INC
COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 )
Policy contract numberVS8183
Policy instance 10
Insurance contract or identification numberVS8183
Number of Individuals Covered17
Insurance policy start date2012-03-01
Insurance policy end date2013-02-28
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,298
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NEIGHBORHOOD HEALTH PARTNERSHIP (National Association of Insurance Commissioners NAIC id number: 95123 )
Policy contract numberB15448
Policy instance 9
Insurance contract or identification numberB15448
Number of Individuals Covered161
Insurance policy start date2012-03-01
Insurance policy end date2013-02-28
Total amount of commissions paid to insurance brokerUSD $31,868
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $730,790
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $31,868
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker nameADAMS BENEFIT CORP
FIRSTCAROLINACARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 77950 )
Policy contract number208000
Policy instance 8
Insurance contract or identification number208000
Number of Individuals Covered118
Insurance policy start date2012-03-01
Insurance policy end date2013-02-28
Total amount of commissions paid to insurance brokerUSD $17,766
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $444,153
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,766
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker nameTHE MGN COMPANY
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number857515G,854844G
Policy instance 7
Insurance contract or identification number857515G,854844G
Number of Individuals Covered231
Insurance policy start date2012-03-01
Insurance policy end date2013-02-28
Total amount of commissions paid to insurance brokerUSD $18,129
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $91,862
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,140
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker nameDEANNA AUTREY
BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 95089 )
Policy contract number29303
Policy instance 6
Insurance contract or identification number29303
Number of Individuals Covered49
Insurance policy start date2012-04-01
Insurance policy end date2013-03-31
Total amount of commissions paid to insurance brokerUSD $8,058
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,058
Additional information about fees paid to insurance brokerBENEFIT CONSULTATION
Insurance broker organization code?3
Insurance broker nameEBS ADVISORS, INC
BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 )
Policy contract number29303
Policy instance 5
Insurance contract or identification number29303
Number of Individuals Covered12
Insurance policy start date2012-04-01
Insurance policy end date2013-03-31
Total amount of commissions paid to insurance brokerUSD $3,834
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,834
Additional information about fees paid to insurance brokerBENEFIT CONSULTATION
Insurance broker organization code?3
Insurance broker nameEBS ADVISORS, INC
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number438652 / 439653
Policy instance 4
Insurance contract or identification number438652 / 439653
Number of Individuals Covered157
Insurance policy start date2012-03-01
Insurance policy end date2013-02-28
Total amount of commissions paid to insurance brokerUSD $10,736
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $284,222
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,736
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker nameADAMS BENEFIT CORP
BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 )
Policy contract number1036221000
Policy instance 3
Insurance contract or identification number1036221000
Number of Individuals Covered68
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $18,896
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $394,862
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $18,896
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker nameFIDELITY INSURANCE AGENCY
COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 )
Policy contract numberCD3735, CP3736
Policy instance 2
Insurance contract or identification numberCD3735, CP3736
Number of Individuals Covered38
Insurance policy start date2012-03-01
Insurance policy end date2013-02-28
Total amount of commissions paid to insurance brokerUSD $1,052
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $20,392
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $122
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker nameFIRST FINANCIAL ADVISORS OF FLORIDA
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000623I
Policy instance 1
Insurance contract or identification numberG000623I
Number of Individuals Covered46
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $19,091
Other welfare benefits providedVOLUNTARY LIFE
Welfare Benefit Premiums Paid to CarrierUSD $95,455
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,877
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
Insurance broker nameSTEVEN COCHRANE
COMPBENEFITS COMPANY (National Association of Insurance Commissioners NAIC id number: 52015 )
Policy contract numberVS5261,5262,526
Policy instance 2
Insurance contract or identification numberVS5261,5262,526
Number of Individuals Covered63
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract number6231,AAKC
Policy instance 5
Insurance contract or identification number6231,AAKC
Number of Individuals Covered105
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Other welfare benefits providedVOLUNTARY LIFE
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 )
Policy contract numberCD 393,394,3719
Policy instance 1
Insurance contract or identification numberCD 393,394,3719
Number of Individuals Covered86
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number851899G,854844G
Policy instance 3
Insurance contract or identification number851899G,854844G
Number of Individuals Covered210
Insurance policy start date2011-01-01
Insurance policy end date2012-12-31
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberABLA,AG7H,AAQ5,
Policy instance 4
Insurance contract or identification numberABLA,AG7H,AAQ5,
Number of Individuals Covered80
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Other welfare benefits providedVOLUNTARY LIFE
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
FIRSTCAROLINACARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 77950 )
Policy contract number20800
Policy instance 14
Insurance contract or identification number20800
Number of Individuals Covered116
Insurance policy start date2010-03-01
Insurance policy end date2011-02-28
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number439653
Policy instance 13
Insurance contract or identification number439653
Number of Individuals Covered38
Insurance policy start date2010-03-01
Insurance policy end date2011-02-28
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberTM05599796
Policy instance 11
Insurance contract or identification numberTM05599796
Number of Individuals Covered122
Insurance policy start date2010-04-01
Insurance policy end date2011-03-31
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number146022
Policy instance 10
Insurance contract or identification number146022
Number of Individuals Covered79
Insurance policy start date2010-04-01
Insurance policy end date2011-03-31
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number119740
Policy instance 9
Insurance contract or identification number119740
Number of Individuals Covered14
Insurance policy start date2010-04-01
Insurance policy end date2011-03-31
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 )
Policy contract number29303
Policy instance 8
Insurance contract or identification number29303
Number of Individuals Covered69
Insurance policy start date2010-05-01
Insurance policy end date2011-04-30
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 )
Policy contract number1036221000
Policy instance 7
Insurance contract or identification number1036221000
Number of Individuals Covered96
Insurance policy start date2010-07-01
Insurance policy end date2011-06-30
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
NEIGHBORHOOD HEALTH PARTNERSHIP (National Association of Insurance Commissioners NAIC id number: 95123 )
Policy contract numberB15448
Policy instance 6
Insurance contract or identification numberB15448
Number of Individuals Covered188
Insurance policy start date2010-08-01
Insurance policy end date2011-02-28
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 )
Policy contract number1036221000
Policy instance 7
Insurance contract or identification number1036221000
Number of Individuals Covered96
Insurance policy start date2010-07-01
Insurance policy end date2011-06-30
Total amount of commissions paid to insurance brokerUSD $12,598
Total amount of fees paid to insurance companyUSD $18
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $249,670
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NEIGHBORHOOD HEALTH PARTNERSHIP (National Association of Insurance Commissioners NAIC id number: 95123 )
Policy contract numberB15448
Policy instance 6
Insurance contract or identification numberB15448
Number of Individuals Covered188
Insurance policy start date2010-08-01
Insurance policy end date2011-02-28
Total amount of commissions paid to insurance brokerUSD $26,633
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $448,507
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number851899G,854844G
Policy instance 3
Insurance contract or identification number851899G,854844G
Number of Individuals Covered210
Insurance policy start date2011-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $16,870
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $81,840
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 number6231,AAKC
Policy instance 5
Insurance contract or identification number6231,AAKC
Number of Individuals Covered105
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $10,573
Other welfare benefits providedVOLUNTARY LIFE
Welfare Benefit Premiums Paid to CarrierUSD $52,860
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
COMPBENEFITS COMPANY (National Association of Insurance Commissioners NAIC id number: 52015 )
Policy contract numberVS5261,5262,526
Policy instance 2
Insurance contract or identification numberVS5261,5262,526
Number of Individuals Covered63
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $3,234
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $19,989
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 )
Policy contract numberCD 393,394,3719
Policy instance 1
Insurance contract or identification numberCD 393,394,3719
Number of Individuals Covered86
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $4,630
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $56,505
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 numberABLA,AG7H,AAQ5,
Policy instance 4
Insurance contract or identification numberABLA,AG7H,AAQ5,
Number of Individuals Covered80
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $7,531
Other welfare benefits providedVOLUNTARY LIFE
Welfare Benefit Premiums Paid to CarrierUSD $37,654
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 )
Policy contract number29303
Policy instance 8
Insurance contract or identification number29303
Number of Individuals Covered69
Insurance policy start date2010-05-01
Insurance policy end date2011-04-30
Total amount of commissions paid to insurance brokerUSD $12,421
Health Insurance Welfare BenefitYes
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number119740
Policy instance 9
Insurance contract or identification number119740
Number of Individuals Covered14
Insurance policy start date2010-04-01
Insurance policy end date2011-03-31
Total amount of commissions paid to insurance brokerUSD $230
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,300
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number146022
Policy instance 10
Insurance contract or identification number146022
Number of Individuals Covered79
Insurance policy start date2010-04-01
Insurance policy end date2011-03-31
Total amount of commissions paid to insurance brokerUSD $289
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,893
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberTM05599796
Policy instance 11
Insurance contract or identification numberTM05599796
Number of Individuals Covered122
Insurance policy start date2010-04-01
Insurance policy end date2011-03-31
Total amount of commissions paid to insurance brokerUSD $1,451
Total amount of fees paid to insurance companyUSD $26
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $23,255
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number439653
Policy instance 13
Insurance contract or identification number439653
Number of Individuals Covered38
Insurance policy start date2010-03-01
Insurance policy end date2011-02-28
Total amount of commissions paid to insurance brokerUSD $14,213
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $231,030
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
FIRSTCAROLINACARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 77950 )
Policy contract number20800
Policy instance 14
Insurance contract or identification number20800
Number of Individuals Covered116
Insurance policy start date2010-03-01
Insurance policy end date2011-02-28
Total amount of commissions paid to insurance brokerUSD $15,570
Welfare Benefit Premiums Paid to CarrierUSD $389,255
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 numberG000AG7H
Policy instance 36
Insurance contract or identification numberG000AG7H
Number of Individuals Covered12
Insurance policy start date2010-06-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $385
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,927
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 numberGVTL0AAQ5
Policy instance 27
Insurance contract or identification numberGVTL0AAQ5
Number of Individuals Covered13
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $897
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $4,484
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NEIGHBORHOOD HEALTH PARTNERSHIP (National Association of Insurance Commissioners NAIC id number: 95123 )
Policy contract numberB15448
Policy instance 18
Insurance contract or identification numberB15448
Number of Individuals Covered146
Insurance policy start date2009-03-01
Insurance policy end date2010-02-28
Total amount of commissions paid to insurance brokerUSD $32,862
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $547,698
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 numberGVTL0623I
Policy instance 14
Insurance contract or identification numberGVTL0623I
Number of Individuals Covered24
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $2,890
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $14,448
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 )
Policy contract numberCD3729 & CD3730
Policy instance 10
Insurance contract or identification numberCD3729 & CD3730
Number of Individuals Covered28
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $1,357
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $18,195
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 )
Policy contract number46225
Policy instance 1
Insurance contract or identification number46225
Number of Individuals Covered25
Insurance policy start date2009-03-01
Insurance policy end date2010-02-28
Total amount of commissions paid to insurance brokerUSD $10,497
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
FIRSTCAROLINACARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 77950 )
Policy contract number208000
Policy instance 2
Insurance contract or identification number208000
Number of Individuals Covered119
Insurance policy start date2009-03-01
Insurance policy end date2010-02-28
Total amount of commissions paid to insurance brokerUSD $12,431
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $310,775
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COMPBENEFITS COMPANY (National Association of Insurance Commissioners NAIC id number: 52015 )
Policy contract numberVS5261
Policy instance 3
Insurance contract or identification numberVS5261
Number of Individuals Covered17
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $204
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,001
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number854844G
Policy instance 21
Insurance contract or identification number854844G
Number of Individuals Covered62
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $3,359
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $18,504
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number855353G
Policy instance 22
Insurance contract or identification number855353G
Number of Individuals Covered35
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $2,226
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $11,132
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number439653
Policy instance 23
Insurance contract or identification number439653
Number of Individuals Covered31
Insurance policy start date2009-03-01
Insurance policy end date2010-02-28
Total amount of commissions paid to insurance brokerUSD $9,927
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $154,735
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COMPBENEFITS COMPANY (National Association of Insurance Commissioners NAIC id number: 52015 )
Policy contract numberVS5263
Policy instance 24
Insurance contract or identification numberVS5263
Number of Individuals Covered3
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $43
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $403
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 )
Policy contract numberCD3719, CP3719
Policy instance 25
Insurance contract or identification numberCD3719, CP3719
Number of Individuals Covered7
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $531
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $6,583
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 )
Policy contract numberCD3733
Policy instance 26
Insurance contract or identification numberCD3733
Number of Individuals Covered29
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $1,497
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $21,761
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 numberGVTL0ABLA
Policy instance 28
Insurance contract or identification numberGVTL0ABLA
Number of Individuals Covered20
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $2,441
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $12,203
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 numberGVTL0AAKC
Policy instance 29
Insurance contract or identification numberGVTL0AAKC
Number of Individuals Covered48
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $5,588
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $27,936
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 )
Policy contract number29303
Policy instance 30
Insurance contract or identification number29303
Number of Individuals Covered71
Insurance policy start date2009-04-01
Insurance policy end date2010-03-31
Total amount of commissions paid to insurance brokerUSD $10,908
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberTM05599796
Policy instance 31
Insurance contract or identification numberTM05599796
Number of Individuals Covered120
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $1,445
Total amount of fees paid to insurance companyUSD $26
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $21,418
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE7900061
Policy instance 32
Insurance contract or identification numberE7900061
Number of Individuals Covered27
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $1,665
Total amount of fees paid to insurance companyUSD $287
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $17,742
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CAPITAL HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95112 )
Policy contract number00366
Policy instance 33
Insurance contract or identification number00366
Number of Individuals Covered55
Insurance policy start date2009-09-01
Insurance policy end date2010-08-31
Total amount of commissions paid to insurance brokerUSD $4,720
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $260,769
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number857515G
Policy instance 20
Insurance contract or identification number857515G
Number of Individuals Covered28
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $1,688
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $8,439
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number851899G
Policy instance 19
Insurance contract or identification number851899G
Number of Individuals Covered96
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $8,826
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $44,130
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 numberG000AC82
Policy instance 35
Insurance contract or identification numberG000AC82
Number of Individuals Covered23
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $2,301
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $11,503
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 )
Policy contract numberCD3727 & CP3727
Policy instance 4
Insurance contract or identification numberCD3727 & CP3727
Number of Individuals Covered7
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $369
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $4,809
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 )
Policy contract numberCD3723 & CD3724
Policy instance 5
Insurance contract or identification numberCD3723 & CD3724
Number of Individuals Covered47
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $2,470
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $30,694
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COMPBENEFITS COMPANY (National Association of Insurance Commissioners NAIC id number: 52015 )
Policy contract numberVS6327
Policy instance 6
Insurance contract or identification numberVS6327
Number of Individuals Covered12
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $88
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $856
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 )
Policy contract numberVS5269
Policy instance 7
Insurance contract or identification numberVS5269
Number of Individuals Covered17
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $161
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,952
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 )
Policy contract numberCD0394 & CD0393
Policy instance 8
Insurance contract or identification numberCD0394 & CD0393
Number of Individuals Covered22
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $577
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $12,095
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 )
Policy contract number3721/3722/5262
Policy instance 9
Insurance contract or identification number3721/3722/5262
Number of Individuals Covered43
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $1,420
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $18,290
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 )
Policy contract numberCD3735 & CD3736
Policy instance 11
Insurance contract or identification numberCD3735 & CD3736
Number of Individuals Covered32
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $1,380
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $20,011
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SECURIAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93742 )
Policy contract numberSD26460001
Policy instance 12
Insurance contract or identification numberSD26460001
Number of Individuals Covered13
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $694
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,337
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 numberGVTL0133J
Policy instance 13
Insurance contract or identification numberGVTL0133J
Number of Individuals Covered2
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $170
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $850
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 numberGVTL0951I
Policy instance 15
Insurance contract or identification numberGVTL0951I
Number of Individuals Covered7
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $667
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,337
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 )
Policy contract number1036221000
Policy instance 16
Insurance contract or identification number1036221000
Number of Individuals Covered115
Insurance policy start date2009-07-01
Insurance policy end date2010-06-30
Total amount of commissions paid to insurance brokerUSD $12,917
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COMPBENEFITS COMPANY (National Association of Insurance Commissioners NAIC id number: 52015 )
Policy contract numberVS5268
Policy instance 17
Insurance contract or identification numberVS5268
Number of Individuals Covered4
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $47
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $483
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 )
Policy contract number64557
Policy instance 34
Insurance contract or identification number64557
Number of Individuals Covered7
Insurance policy start date2009-09-01
Insurance policy end date2010-08-31
Total amount of commissions paid to insurance brokerUSD $3,710
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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