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THE HARVEST COMPANIES/NORTHEAST CARE CENTER, INC. WELFARE PLAN 401k Plan overview

Plan NameTHE HARVEST COMPANIES/NORTHEAST CARE CENTER, INC. WELFARE PLAN
Plan identification number 501

THE HARVEST COMPANIES/NORTHEAST CARE CENTER, INC. WELFARE PLAN Benefits

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

401k Sponsoring company profile

NCC SOLUTIONS, INC. has sponsored the creation of one or more 401k plans.

Company Name:NCC SOLUTIONS, INC.
Employer identification number (EIN):710914784
NAIC Classification:623000
NAIC Description: Nursing and Residential Care Facilities

Additional information about NCC SOLUTIONS, INC.

Jurisdiction of Incorporation: Ohio Secretary of State Business Services Division
Incorporation Date: 2002-11-25
Company Identification Number: 1353605
Legal Registered Office Address: 200 PUBLIC SQUARE
SUITE 2300
CLEVELAND
United States of America (USA)
441142378

More information about NCC SOLUTIONS, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan THE HARVEST COMPANIES/NORTHEAST CARE CENTER, INC. WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01
5012021-01-01
5012020-01-01
5012019-01-01
5012018-01-01
5012017-01-01MARGARET LANUM
5012016-01-01MARGARET LANUM
5012015-01-01ANTHONY DEAN ANTHONY DEAN2016-10-07
5012014-01-01ANTHONY DEAN
5012013-01-01ANTHONY DEAN
5012012-01-01ANTHONY DEAN
5012011-01-01ANTHONY DEAN
5012010-01-01ANTHONY DEAN
5012009-01-01ANTHONY DEAN
5012008-01-01ANTHONY DEAN
5012007-01-01ANTHONY DEAN
5012004-01-01ANTHONY DEAN

Plan Statistics for THE HARVEST COMPANIES/NORTHEAST CARE CENTER, INC. WELFARE PLAN

401k plan membership statisitcs for THE HARVEST COMPANIES/NORTHEAST CARE CENTER, INC. WELFARE PLAN

Measure Date Value
2022: THE HARVEST COMPANIES/NORTHEAST CARE CENTER, INC. WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01168
Total number of active participants reported on line 7a of the Form 55002022-01-0198
Total of all active and inactive participants2022-01-0198
Total participants2022-01-0198
2021: THE HARVEST COMPANIES/NORTHEAST CARE CENTER, INC. WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01212
Total number of active participants reported on line 7a of the Form 55002021-01-01117
Number of retired or separated participants receiving benefits2021-01-010
Total of all active and inactive participants2021-01-01117
Total participants2021-01-01117
2020: THE HARVEST COMPANIES/NORTHEAST CARE CENTER, INC. WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01228
Total number of active participants reported on line 7a of the Form 55002020-01-01193
Number of retired or separated participants receiving benefits2020-01-011
Total of all active and inactive participants2020-01-01194
Total participants2020-01-01194
2019: THE HARVEST COMPANIES/NORTHEAST CARE CENTER, INC. WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01264
Total number of active participants reported on line 7a of the Form 55002019-01-01112
Number of retired or separated participants receiving benefits2019-01-010
Total of all active and inactive participants2019-01-01112
Total participants2019-01-01112
2018: THE HARVEST COMPANIES/NORTHEAST CARE CENTER, INC. WELFARE PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01178
Total number of active participants reported on line 7a of the Form 55002018-01-01133
Number of retired or separated participants receiving benefits2018-01-010
Total of all active and inactive participants2018-01-01133
Total participants2018-01-01133
2017: THE HARVEST COMPANIES/NORTHEAST CARE CENTER, INC. WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01232
Total number of active participants reported on line 7a of the Form 55002017-01-01178
Total of all active and inactive participants2017-01-01178
Total participants2017-01-01178
2016: THE HARVEST COMPANIES/NORTHEAST CARE CENTER, INC. WELFARE PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01224
Total number of active participants reported on line 7a of the Form 55002016-01-01229
Number of retired or separated participants receiving benefits2016-01-013
Total of all active and inactive participants2016-01-01232
Total participants2016-01-01232
2015: THE HARVEST COMPANIES/NORTHEAST CARE CENTER, INC. WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01236
Total number of active participants reported on line 7a of the Form 55002015-01-01224
Total of all active and inactive participants2015-01-01224
Total participants2015-01-01224
2014: THE HARVEST COMPANIES/NORTHEAST CARE CENTER, INC. WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01228
Total number of active participants reported on line 7a of the Form 55002014-01-01236
Total of all active and inactive participants2014-01-01236
Total participants2014-01-01236
2013: THE HARVEST COMPANIES/NORTHEAST CARE CENTER, INC. WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01174
Total number of active participants reported on line 7a of the Form 55002013-01-01228
Total of all active and inactive participants2013-01-01228
Total participants2013-01-01228
2012: THE HARVEST COMPANIES/NORTHEAST CARE CENTER, INC. WELFARE PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01148
Total number of active participants reported on line 7a of the Form 55002012-01-01174
Total of all active and inactive participants2012-01-01174
Total participants2012-01-01174
2011: THE HARVEST COMPANIES/NORTHEAST CARE CENTER, INC. WELFARE PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01154
Total number of active participants reported on line 7a of the Form 55002011-01-01148
Total of all active and inactive participants2011-01-01148
Total participants2011-01-01148
2010: THE HARVEST COMPANIES/NORTHEAST CARE CENTER, INC. WELFARE PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-01148
Total number of active participants reported on line 7a of the Form 55002010-01-01154
Total of all active and inactive participants2010-01-01154
Total participants2010-01-01154
2009: THE HARVEST COMPANIES/NORTHEAST CARE CENTER, INC. WELFARE PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01145
Total number of active participants reported on line 7a of the Form 55002009-01-01147
Number of retired or separated participants receiving benefits2009-01-011
Total of all active and inactive participants2009-01-01148
Total participants2009-01-01148
2008: THE HARVEST COMPANIES/NORTHEAST CARE CENTER, INC. WELFARE PLAN 2008 401k membership
Total participants, beginning-of-year2008-01-01129
Total number of active participants reported on line 7a of the Form 55002008-01-01144
Number of retired or separated participants receiving benefits2008-01-011
Total of all active and inactive participants2008-01-01145
Total participants2008-01-01145
2007: THE HARVEST COMPANIES/NORTHEAST CARE CENTER, INC. WELFARE PLAN 2007 401k membership
Total participants, beginning-of-year2007-01-01118
Total number of active participants reported on line 7a of the Form 55002007-01-01128
Number of retired or separated participants receiving benefits2007-01-011
Total of all active and inactive participants2007-01-01129
Total participants2007-01-01129
2004: THE HARVEST COMPANIES/NORTHEAST CARE CENTER, INC. WELFARE PLAN 2004 401k membership
Total participants, beginning-of-year2004-01-01129
Total number of active participants reported on line 7a of the Form 55002004-01-01141
Number of retired or separated participants receiving benefits2004-01-011
Total of all active and inactive participants2004-01-01142
Total participants2004-01-01142

Form 5500 Responses for THE HARVEST COMPANIES/NORTHEAST CARE CENTER, INC. WELFARE PLAN

2022: THE HARVEST COMPANIES/NORTHEAST CARE CENTER, INC. WELFARE PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: THE HARVEST COMPANIES/NORTHEAST CARE CENTER, INC. WELFARE PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: THE HARVEST COMPANIES/NORTHEAST CARE CENTER, INC. WELFARE PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: THE HARVEST COMPANIES/NORTHEAST CARE CENTER, INC. WELFARE PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – General assets of the sponsorYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – General assets of the sponsorYes
2018: THE HARVEST COMPANIES/NORTHEAST CARE CENTER, INC. WELFARE PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: THE HARVEST COMPANIES/NORTHEAST CARE CENTER, INC. WELFARE PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: THE HARVEST COMPANIES/NORTHEAST CARE CENTER, INC. WELFARE PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – General assets of the sponsorYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – General assets of the sponsorYes
2015: THE HARVEST COMPANIES/NORTHEAST CARE CENTER, INC. WELFARE PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – General assets of the sponsorYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – General assets of the sponsorYes
2014: THE HARVEST COMPANIES/NORTHEAST CARE CENTER, INC. WELFARE PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – General assets of the sponsorYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – General assets of the sponsorYes
2013: THE HARVEST COMPANIES/NORTHEAST CARE CENTER, INC. WELFARE PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – General assets of the sponsorYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – General assets of the sponsorYes
2012: THE HARVEST COMPANIES/NORTHEAST CARE CENTER, INC. WELFARE PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – General assets of the sponsorYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – General assets of the sponsorYes
2011: THE HARVEST COMPANIES/NORTHEAST CARE CENTER, INC. WELFARE PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – General assets of the sponsorYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – General assets of the sponsorYes
2010: THE HARVEST COMPANIES/NORTHEAST CARE CENTER, INC. WELFARE PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan funding arrangement – General assets of the sponsorYes
2010-01-01Plan benefit arrangement – InsuranceYes
2010-01-01Plan benefit arrangement – General assets of the sponsorYes
2009: THE HARVEST COMPANIES/NORTHEAST CARE CENTER, INC. WELFARE PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – General assets of the sponsorYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – General assets of the sponsorYes
2008: THE HARVEST COMPANIES/NORTHEAST CARE CENTER, INC. WELFARE PLAN 2008 form 5500 responses
2008-01-01Type of plan entitySingle employer plan
2008-01-01Plan funding arrangement – InsuranceYes
2008-01-01Plan funding arrangement – General assets of the sponsorYes
2008-01-01Plan benefit arrangement – InsuranceYes
2008-01-01Plan benefit arrangement – General assets of the sponsorYes
2007: THE HARVEST COMPANIES/NORTHEAST CARE CENTER, INC. WELFARE PLAN 2007 form 5500 responses
2007-01-01Type of plan entitySingle employer plan
2007-01-01Plan funding arrangement – InsuranceYes
2007-01-01Plan funding arrangement – General assets of the sponsorYes
2007-01-01Plan benefit arrangement – InsuranceYes
2007-01-01Plan benefit arrangement – General assets of the sponsorYes
2004: THE HARVEST COMPANIES/NORTHEAST CARE CENTER, INC. WELFARE PLAN 2004 form 5500 responses
2004-01-01Type of plan entitySingle employer plan
2004-01-01Plan funding arrangement – InsuranceYes
2004-01-01Plan funding arrangement – General assets of the sponsorYes
2004-01-01Plan benefit arrangement – InsuranceYes
2004-01-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00302254
Policy instance 5
Insurance contract or identification number00302254
Number of Individuals Covered192
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $12,964
Total amount of fees paid to insurance companyUSD $3,966
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D, ACCIDENT, VOL CI
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $114,951
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,808
Amount paid for insurance broker fees3966
Additional information about fees paid to insurance brokerFEES PAID
Insurance broker organization code?3
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberDU434
Policy instance 4
Insurance contract or identification numberDU434
Number of Individuals Covered36
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $2,223
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $24,011
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $315
Insurance broker organization code?3
Additional information about fees paid to insurance brokerFEES PAID
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract numberAD469
Policy instance 3
Insurance contract or identification numberAD469
Number of Individuals Covered3
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $75
Other welfare benefits providedACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $783
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7
Insurance broker organization code?3
MEDICAL MUTUAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 29076 )
Policy contract number
Policy instance 2
Number of Individuals Covered107
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $30,510
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $319,210
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $27,894
Insurance broker organization code?3
CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )
Policy contract number12917
Policy instance 1
Insurance contract or identification number12917
Number of Individuals Covered10
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $435
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,698
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $27
Insurance broker organization code?3
MEDICAL MUTUAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 29076 )
Policy contract number
Policy instance 2
Number of Individuals Covered107
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $32,496
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $330,473
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $32,496
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00302254
Policy instance 3
Insurance contract or identification number00302254
Number of Individuals Covered188
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $14,560
Total amount of fees paid to insurance companyUSD $1,284
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D, ACCIDENT, VOL CI
Welfare Benefit Premiums Paid to CarrierUSD $119,237
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,560
Amount paid for insurance broker fees1284
Additional information about fees paid to insurance brokerFEES PAID
Insurance broker organization code?3
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberDU434
Policy instance 1
Insurance contract or identification numberDU434
Number of Individuals Covered56
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $6,047
Total amount of fees paid to insurance companyUSD $272
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $43,610
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $766
Insurance broker organization code?3
Amount paid for insurance broker fees39
Additional information about fees paid to insurance brokerFEES PAID
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberDU434
Policy instance 3
Insurance contract or identification numberDU434
Number of Individuals Covered56
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $6,047
Total amount of fees paid to insurance companyUSD $272
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $43,610
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $766
Insurance broker organization code?3
Amount paid for insurance broker fees39
Additional information about fees paid to insurance brokerFEES PAID
AMERICAN NATIONAL INSURANCE/BARDON INSURANCE GROUP (National Association of Insurance Commissioners NAIC id number: 000 )
Policy contract numberAN-1801007
Policy instance 4
Insurance contract or identification numberAN-1801007
Number of Individuals Covered106
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $33,000
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $276,354
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $33,000
Insurance broker organization code?3
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract numberAD469
Policy instance 2
Insurance contract or identification numberAD469
Number of Individuals Covered3
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $85
Other welfare benefits providedACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $931
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00302254
Policy instance 1
Insurance contract or identification number00302254
Number of Individuals Covered194
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $5,487
Total amount of fees paid to insurance companyUSD $364
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $96,300
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,487
Amount paid for insurance broker fees364
Additional information about fees paid to insurance brokerFEES PAID
Insurance broker organization code?3
AMERICAN NATIONAL INSURANCE/BARDON INSURANCE GROUP (National Association of Insurance Commissioners NAIC id number: 000 )
Policy contract numberAN-1801007
Policy instance 3
Insurance contract or identification numberAN-1801007
Number of Individuals Covered109
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $33,240
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $216,333
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $33,240
Insurance broker organization code?3
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberDU434
Policy instance 1
Insurance contract or identification numberDU434
Number of Individuals Covered60
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $9,392
Total amount of fees paid to insurance companyUSD $344
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $45,407
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $828
Insurance broker organization code?3
Amount paid for insurance broker fees49
Additional information about fees paid to insurance brokerFEES PAID
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract numberAD469
Policy instance 4
Insurance contract or identification numberAD469
Number of Individuals Covered3
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $105
Other welfare benefits providedACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $1,086
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00302254
Policy instance 2
Insurance contract or identification number00302254
Number of Individuals Covered117
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $4,820
Total amount of fees paid to insurance companyUSD $1,158
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $87,823
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,242
Amount paid for insurance broker fees1158
Additional information about fees paid to insurance brokerFEES PAID
Insurance broker organization code?3
AMERICAN NATIONAL INSURANCE/BARDON INSURANCE GROUP (National Association of Insurance Commissioners NAIC id number: 000 )
Policy contract numberAN-1801007
Policy instance 4
Insurance contract or identification numberAN-1801007
Number of Individuals Covered117
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $35,400
Welfare Benefit Premiums Paid to CarrierUSD $236,846
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $35,400
Insurance broker organization code?3
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberDU434
Policy instance 3
Insurance contract or identification numberDU434
Number of Individuals Covered64
Insurance policy start date2018-08-01
Insurance policy end date2019-07-31
Total amount of commissions paid to insurance brokerUSD $9,119
Total amount of fees paid to insurance companyUSD $158
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $48,453
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $976
Insurance broker organization code?3
Amount paid for insurance broker fees23
Additional information about fees paid to insurance brokerFEES
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00302254
Policy instance 2
Insurance contract or identification number00302254
Number of Individuals Covered133
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $5,104
Total amount of fees paid to insurance companyUSD $334
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $95,250
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees334
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $5,104
ALLSTATE (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract numberAD469
Policy instance 1
Insurance contract or identification numberAD469
Number of Individuals Covered7
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $164
Other welfare benefits providedACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $1,696
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00302254
Policy instance 4
Insurance contract or identification number00302254
Number of Individuals Covered178
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $9,049
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $103,725
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,398
Insurance broker organization code?3
Insurance broker nameASSUREDPARTNERS NL,LLC
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberDU434
Policy instance 3
Insurance contract or identification numberDU434
Number of Individuals Covered65
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $7,545
Total amount of fees paid to insurance companyUSD $418
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $49,609
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,251
Insurance broker organization code?3
Amount paid for insurance broker fees298
Additional information about fees paid to insurance brokerFEES
Insurance broker nameHEIDI GLAUB
ALLSTATE (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract numberAD469
Policy instance 2
Insurance contract or identification numberAD469
Number of Individuals Covered4
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $173
Other welfare benefits providedACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $1,777
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15
Insurance broker organization code?3
Insurance broker nameCHRISTOPHER J CONLEY
MEDICAL MUTUAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 29076 )
Policy contract numberNCCSOL
Policy instance 1
Insurance contract or identification numberNCCSOL
Number of Individuals Covered120
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $37,536
Welfare Benefit Premiums Paid to CarrierUSD $280,109
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $37,536
Insurance broker organization code?3
Insurance broker nameASSURED NEACE LUKENS INS AGENCY INC
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberDU434
Policy instance 4
Insurance contract or identification numberDU434
Number of Individuals Covered69
Insurance policy start date2015-08-01
Insurance policy end date2016-07-31
Total amount of commissions paid to insurance brokerUSD $9,602
Total amount of fees paid to insurance companyUSD $573
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $53,698
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,529
Insurance broker organization code?3
Additional information about fees paid to insurance brokerFEES
Amount paid for insurance broker fees362
Insurance broker nameRENE JIMENEZ
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00302254
Policy instance 5
Insurance contract or identification number00302254
Number of Individuals Covered150
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $7,929
Total amount of fees paid to insurance companyUSD $288
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $105,396
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,929
Amount paid for insurance broker fees288
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
Insurance broker nameEXPRESSLINK GENERAL AGENCY LLC
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberDV564
Policy instance 3
Insurance contract or identification numberDV564
Number of Individuals Covered1
Insurance policy start date2015-08-01
Insurance policy end date2016-07-31
Total amount of commissions paid to insurance brokerUSD $122
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,269
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $81
Insurance broker organization code?3
Insurance broker nameRENE JIMENEZ
KAISER FOUNDATION HEALTH PLAN OF OHIO (National Association of Insurance Commissioners NAIC id number: 95204 )
Policy contract number7681
Policy instance 2
Insurance contract or identification number7681
Number of Individuals Covered224
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $44,442
Welfare Benefit Premiums Paid to CarrierUSD $892,424
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $44,442
Insurance broker organization code?3
Insurance broker nameCORPORATE PLAN INC
ALLSTATE (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract numberAD469
Policy instance 1
Insurance contract or identification numberAD469
Number of Individuals Covered8
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $620
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,910
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $40
Insurance broker organization code?3
Insurance broker nameROYDEAN AVERY
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00302254
Policy instance 4
Insurance contract or identification number00302254
Number of Individuals Covered162
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $8,116
Total amount of fees paid to insurance companyUSD $6,043
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $109,310
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,116
Amount paid for insurance broker fees6043
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
Insurance broker nameEXPRESSLINK GENERAL AGENCY LLC
KAISER FOUNDATION HEALTH PLAN OF OHIO (National Association of Insurance Commissioners NAIC id number: 95204 )
Policy contract number7681
Policy instance 3
Insurance contract or identification number7681
Number of Individuals Covered236
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $43,214
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $864,271
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $43,214
Insurance broker organization code?3
Insurance broker nameCORPORATE PLAN INC
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberDU434
Policy instance 2
Insurance contract or identification numberDU434
Number of Individuals Covered67
Insurance policy start date2014-08-01
Insurance policy end date2015-07-31
Total amount of commissions paid to insurance brokerUSD $8,229
Total amount of fees paid to insurance companyUSD $157
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $49,084
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,277
Amount paid for insurance broker fees62
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
Insurance broker nameHARE AND ASSOCIATES LLC
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberDV564
Policy instance 1
Insurance contract or identification numberDV564
Number of Individuals Covered2
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $218
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,051
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $127
Insurance broker organization code?3
Insurance broker nameKEVIN WRONA
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00302254
Policy instance 4
Insurance contract or identification number00302254
Number of Individuals Covered168
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $9,052
Total amount of fees paid to insurance companyUSD $3,547
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $106,589
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,052
Amount paid for insurance broker fees3547
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
Insurance broker nameEXPRESSLINK GENERAL AGENCY LLC
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract numberAD469
Policy instance 2
Insurance contract or identification numberAD469
Number of Individuals Covered13
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $2,901
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $6,651
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $214
Insurance broker organization code?3
Insurance broker nameCHRISTOPHER J CONLEY
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberDU434
Policy instance 5
Insurance contract or identification numberDU434
Number of Individuals Covered74
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $6,258
Total amount of fees paid to insurance companyUSD $100
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $42,555
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,826
Amount paid for insurance broker fees62
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
Insurance broker nameSTUDIO-10
KAISER FOUNDATION HEALTH PLAN OF OHIO (National Association of Insurance Commissioners NAIC id number: 95204 )
Policy contract number7681
Policy instance 3
Insurance contract or identification number7681
Number of Individuals Covered228
Insurance policy start date2012-08-01
Insurance policy end date2013-07-31
Total amount of commissions paid to insurance brokerUSD $39,838
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $873,801
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $39,838
Insurance broker organization code?3
Insurance broker nameCORPORATE PLAN INC
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberDV564
Policy instance 1
Insurance contract or identification numberDV564
Number of Individuals Covered3
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $280
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,634
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $162
Insurance broker organization code?3
Insurance broker nameWRONA INSURANCE INC
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberDU434
Policy instance 1
Insurance contract or identification numberDU434
Number of Individuals Covered68
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $16,400
Total amount of fees paid to insurance companyUSD $28
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $63,153
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,228
Amount paid for insurance broker fees18
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
Insurance broker nameFRANIKA FLORES
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberDV564
Policy instance 2
Insurance contract or identification numberDV564
Number of Individuals Covered3
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $918
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,539
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $566
Insurance broker organization code?3
Insurance broker nameWRONA INSURANCE INC
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract numberAD469
Policy instance 6
Insurance contract or identification numberAD469
Number of Individuals Covered16
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $1,802
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,050
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $132
Insurance broker organization code?3
Insurance broker nameCHRISTOPHER J CONLEY
C.M. LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93432 )
Policy contract number71636360
Policy instance 5
Insurance contract or identification number71636360
Number of Individuals Covered1
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $166
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MEDICAL MUTUAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 29076 )
Policy contract number
Policy instance 3
Number of Individuals Covered139
Insurance policy start date2011-08-01
Insurance policy end date2012-07-31
Total amount of commissions paid to insurance brokerUSD $38,600
Total amount of fees paid to insurance companyUSD $20,735
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 $26,941
Amount paid for insurance broker fees14638
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
Insurance broker nameTALUS BROKERAGE SERVICES LLC
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00302254
Policy instance 4
Insurance contract or identification number00302254
Number of Individuals Covered174
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $8,106
Total amount of fees paid to insurance companyUSD $4,610
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $107,449
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5
Insurance broker organization code?3
Amount paid for insurance broker fees4610
Additional information about fees paid to insurance brokerFEES
Insurance broker nameEXPRESSLINK GENERAL AGENCY LLC
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberDV564
Policy instance 3
Insurance contract or identification numberDV564
Number of Individuals Covered3
Insurance policy start date2010-08-01
Insurance policy end date2011-07-31
Total amount of commissions paid to insurance brokerUSD $243
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,162
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract numberG# 4037915
Policy instance 6
Insurance contract or identification numberG# 4037915
Number of Individuals Covered147
Insurance policy start date2010-08-01
Insurance policy end date2011-07-31
Total amount of commissions paid to insurance brokerUSD $572
Total amount of fees paid to insurance companyUSD $153
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,814
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF OHIO (National Association of Insurance Commissioners NAIC id number: 95204 )
Policy contract number7681
Policy instance 5
Insurance contract or identification number7681
Number of Individuals Covered148
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $48,651
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,049,201
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00302254
Policy instance 4
Insurance contract or identification number00302254
Number of Individuals Covered130
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $6,059
Total amount of fees paid to insurance companyUSD $4,809
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $114,552
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
C.M. LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93432 )
Policy contract number71771280
Policy instance 2
Insurance contract or identification number71771280
Number of Individuals Covered3
Insurance policy start date2011-03-01
Insurance policy end date2012-02-29
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $52
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberDU434
Policy instance 1
Insurance contract or identification numberDU434
Number of Individuals Covered77
Insurance policy start date2010-08-01
Insurance policy end date2011-07-31
Total amount of commissions paid to insurance brokerUSD $8,702
Total amount of fees paid to insurance companyUSD $208
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $44,032
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract numberG# 4037915
Policy instance 2
Insurance contract or identification numberG# 4037915
Number of Individuals Covered136
Insurance policy start date2009-08-01
Insurance policy end date2010-07-31
Total amount of commissions paid to insurance brokerUSD $1,323
Total amount of fees paid to insurance companyUSD $573
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $8,818
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees573
Additional information about fees paid to insurance brokerSERVICE FEE PRODUCER PROGRAM PAYMENT
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $1,323
Insurance broker nameENTERPRISE GROUP PLANNING INC.
KAISER FOUNDATION HEALTH PLAN OF OHIO (National Association of Insurance Commissioners NAIC id number: 95204 )
Policy contract number7681
Policy instance 1
Insurance contract or identification number7681
Number of Individuals Covered154
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $46,335
Total amount of fees paid to insurance companyUSD $1
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $928,369
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $46,335
Insurance broker organization code?3
Amount paid for insurance broker fees1
Additional information about fees paid to insurance brokerENTERTAINMENT
Insurance broker nameENTERPRISE GROUP PLANNING, INC.
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberDV564
Policy instance 3
Insurance contract or identification numberDV564
Number of Individuals Covered3
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $264
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedMATERNITY LEAVE, CANCER
Welfare Benefit Premiums Paid to CarrierUSD $2,343
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $129
Insurance broker organization code?3
Insurance broker nameQUINN, MEYER & ASSOCIATES
C.M. LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93432 )
Policy contract number71771280
Policy instance 4
Insurance contract or identification number71771280
Number of Individuals Covered3
Insurance policy start date2010-03-01
Insurance policy end date2011-02-28
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $338
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
C.M. LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93432 )
Policy contract number71636360
Policy instance 5
Insurance contract or identification number71636360
Number of Individuals Covered1
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $284
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00302254
Policy instance 6
Insurance contract or identification number00302254
Number of Individuals Covered154
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $6,377
Total amount of fees paid to insurance companyUSD $4,728
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $125,248
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13
Insurance broker organization code?3
Amount paid for insurance broker fees4728
Insurance broker namePLANCORP INC
KAISER FOUNDATION HEALTH PLAN OF OHIO (National Association of Insurance Commissioners NAIC id number: 95204 )
Policy contract number7681
Policy instance 2
Insurance contract or identification number7681
Number of Individuals Covered126
Insurance policy start date2008-01-01
Insurance policy end date2008-12-31
Total amount of commissions paid to insurance brokerUSD $42,780
Total amount of fees paid to insurance companyUSD $35,699
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $711,843
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00302254
Policy instance 3
Insurance contract or identification number00302254
Number of Individuals Covered145
Insurance policy start date2008-01-01
Insurance policy end date2008-12-31
Total amount of commissions paid to insurance brokerUSD $5,639
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $91,579
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberDV564, DU434
Policy instance 1
Insurance contract or identification numberDV564, DU434
Number of Individuals Covered63
Insurance policy start date2008-01-01
Insurance policy end date2008-12-31
Total amount of commissions paid to insurance brokerUSD $9,576
Total amount of fees paid to insurance companyUSD $399
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedMATERNITY LEAVE, CANCER
Welfare Benefit Premiums Paid to CarrierUSD $49,526
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberDV564, DU434
Policy instance 2
Insurance contract or identification numberDV564, DU434
Number of Individuals Covered56
Insurance policy start date2007-01-01
Insurance policy end date2007-12-31
Total amount of commissions paid to insurance brokerUSD $9,711
Total amount of fees paid to insurance companyUSD $600
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedMATERNITY LEAVE, CANCER
Welfare Benefit Premiums Paid to CarrierUSD $51,610
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF OHIO (National Association of Insurance Commissioners NAIC id number: 95204 )
Policy contract number7681
Policy instance 3
Insurance contract or identification number7681
Number of Individuals Covered129
Insurance policy start date2006-08-01
Insurance policy end date2007-07-01
Total amount of commissions paid to insurance brokerUSD $39,124
Total amount of fees paid to insurance companyUSD $30,791
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $660,317
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
C.M. LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93432 )
Policy contract number71636330, ETC.
Policy instance 1
Insurance contract or identification number71636330, ETC.
Number of Individuals Covered5
Insurance policy start date2007-01-01
Insurance policy end date2007-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,764
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00302254
Policy instance 4
Insurance contract or identification number00302254
Number of Individuals Covered126
Insurance policy start date2007-01-01
Insurance policy end date2007-12-31
Total amount of commissions paid to insurance brokerUSD $4,192
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $72,279
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberDV564, DU434
Policy instance 1
Insurance contract or identification numberDV564, DU434
Number of Individuals Covered55
Insurance policy start date2006-01-01
Insurance policy end date2006-12-31
Total amount of commissions paid to insurance brokerUSD $8,426
Total amount of fees paid to insurance companyUSD $775
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedMATERNITY LEAVE, CANCER
Welfare Benefit Premiums Paid to CarrierUSD $38,898
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )
Policy contract number50109000197
Policy instance 4
Insurance contract or identification number50109000197
Number of Individuals Covered118
Insurance policy start date2005-08-01
Insurance policy end date2006-07-31
Total amount of commissions paid to insurance brokerUSD $26,377
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
C.M. LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93432 )
Policy contract number71636330, ETC.
Policy instance 3
Insurance contract or identification number71636330, ETC.
Number of Individuals Covered5
Insurance policy start date2006-01-01
Insurance policy end date2006-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,680
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00302254
Policy instance 2
Insurance contract or identification number00302254
Number of Individuals Covered112
Insurance policy start date2006-01-01
Insurance policy end date2006-12-31
Total amount of commissions paid to insurance brokerUSD $4,321
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $72,585
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
C.M. LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93432 )
Policy contract number71636330, ETC.
Policy instance 1
Insurance contract or identification number71636330, ETC.
Number of Individuals Covered6
Insurance policy start date2005-01-01
Insurance policy end date2005-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $4,063
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberDV564,DU434
Policy instance 2
Insurance contract or identification numberDV564,DU434
Number of Individuals Covered53
Insurance policy start date2005-01-01
Insurance policy end date2005-12-31
Total amount of commissions paid to insurance brokerUSD $6,841
Total amount of fees paid to insurance companyUSD $515
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedMATERNITY LEAVE, CANCER
Welfare Benefit Premiums Paid to CarrierUSD $32,846
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )
Policy contract number50109000197
Policy instance 3
Insurance contract or identification number50109000197
Number of Individuals Covered135
Insurance policy start date2004-08-01
Insurance policy end date2005-07-31
Total amount of commissions paid to insurance brokerUSD $21,291
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00302254
Policy instance 4
Insurance contract or identification number00302254
Number of Individuals Covered129
Insurance policy start date2005-01-01
Insurance policy end date2005-12-31
Total amount of commissions paid to insurance brokerUSD $2,968
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $62,523
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberDV564, DU434
Policy instance 1
Insurance contract or identification numberDV564, DU434
Number of Individuals Covered50
Insurance policy start date2004-01-01
Insurance policy end date2004-12-31
Total amount of commissions paid to insurance brokerUSD $1,691
Total amount of fees paid to insurance companyUSD $86
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedMATERNITY LEAVE, CANCER
Welfare Benefit Premiums Paid to CarrierUSD $8,274
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )
Policy contract number50109000197
Policy instance 2
Insurance contract or identification number50109000197
Number of Individuals Covered142
Insurance policy start date2003-08-01
Insurance policy end date2004-07-31
Total amount of commissions paid to insurance brokerUSD $21,626
Total amount of fees paid to insurance companyUSD $992
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00302254
Policy instance 3
Insurance contract or identification number00302254
Number of Individuals Covered119
Insurance policy start date2004-01-01
Insurance policy end date2004-12-31
Total amount of commissions paid to insurance brokerUSD $2,847
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $50,638
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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