EAGLE DISTRIBUTING OF SHREVEPORT, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan EAGLE DISTRIBUTING CO. OF SHREVEPORT, INC. HEALTH & WELFARE PLAN
401k plan membership statisitcs for EAGLE DISTRIBUTING CO. OF SHREVEPORT, INC. HEALTH & WELFARE PLAN
Measure | Date | Value |
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2022: EAGLE DISTRIBUTING CO. OF SHREVEPORT, INC. HEALTH & WELFARE PLAN 2022 401k membership |
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Total participants, beginning-of-year | 2022-08-01 | 85 |
Total number of active participants reported on line 7a of the Form 5500 | 2022-08-01 | 90 |
Number of retired or separated participants receiving benefits | 2022-08-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2022-08-01 | 0 |
Total of all active and inactive participants | 2022-08-01 | 90 |
2021: EAGLE DISTRIBUTING CO. OF SHREVEPORT, INC. HEALTH & WELFARE PLAN 2021 401k membership |
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Total participants, beginning-of-year | 2021-08-01 | 76 |
Total number of active participants reported on line 7a of the Form 5500 | 2021-08-01 | 85 |
Number of retired or separated participants receiving benefits | 2021-08-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2021-08-01 | 0 |
Total of all active and inactive participants | 2021-08-01 | 85 |
2020: EAGLE DISTRIBUTING CO. OF SHREVEPORT, INC. HEALTH & WELFARE PLAN 2020 401k membership |
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Total participants, beginning-of-year | 2020-08-01 | 85 |
Total number of active participants reported on line 7a of the Form 5500 | 2020-08-01 | 76 |
Number of retired or separated participants receiving benefits | 2020-08-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2020-08-01 | 0 |
Total of all active and inactive participants | 2020-08-01 | 76 |
2019: EAGLE DISTRIBUTING CO. OF SHREVEPORT, INC. HEALTH & WELFARE PLAN 2019 401k membership |
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Total participants, beginning-of-year | 2019-08-01 | 95 |
Total number of active participants reported on line 7a of the Form 5500 | 2019-08-01 | 85 |
Number of retired or separated participants receiving benefits | 2019-08-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2019-08-01 | 0 |
Total of all active and inactive participants | 2019-08-01 | 85 |
2018: EAGLE DISTRIBUTING CO. OF SHREVEPORT, INC. HEALTH & WELFARE PLAN 2018 401k membership |
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Total participants, beginning-of-year | 2018-08-01 | 97 |
Total number of active participants reported on line 7a of the Form 5500 | 2018-08-01 | 95 |
Number of retired or separated participants receiving benefits | 2018-08-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2018-08-01 | 0 |
Total of all active and inactive participants | 2018-08-01 | 95 |
2017: EAGLE DISTRIBUTING CO. OF SHREVEPORT, INC. HEALTH & WELFARE PLAN 2017 401k membership |
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Total participants, beginning-of-year | 2017-08-01 | 116 |
Total number of active participants reported on line 7a of the Form 5500 | 2017-08-01 | 97 |
Number of retired or separated participants receiving benefits | 2017-08-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2017-08-01 | 0 |
Total of all active and inactive participants | 2017-08-01 | 97 |
2016: EAGLE DISTRIBUTING CO. OF SHREVEPORT, INC. HEALTH & WELFARE PLAN 2016 401k membership |
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Total participants, beginning-of-year | 2016-08-01 | 110 |
Total number of active participants reported on line 7a of the Form 5500 | 2016-08-01 | 116 |
Number of retired or separated participants receiving benefits | 2016-08-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2016-08-01 | 0 |
Total of all active and inactive participants | 2016-08-01 | 116 |
2015: EAGLE DISTRIBUTING CO. OF SHREVEPORT, INC. HEALTH & WELFARE PLAN 2015 401k membership |
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Total participants, beginning-of-year | 2015-08-01 | 108 |
Total number of active participants reported on line 7a of the Form 5500 | 2015-08-01 | 110 |
Number of retired or separated participants receiving benefits | 2015-08-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2015-08-01 | 0 |
Total of all active and inactive participants | 2015-08-01 | 110 |
2014: EAGLE DISTRIBUTING CO. OF SHREVEPORT, INC. HEALTH & WELFARE PLAN 2014 401k membership |
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Total participants, beginning-of-year | 2014-08-01 | 113 |
Total number of active participants reported on line 7a of the Form 5500 | 2014-08-01 | 108 |
Number of retired or separated participants receiving benefits | 2014-08-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2014-08-01 | 0 |
Total of all active and inactive participants | 2014-08-01 | 108 |
2013: EAGLE DISTRIBUTING CO. OF SHREVEPORT, INC. HEALTH & WELFARE PLAN 2013 401k membership |
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Total participants, beginning-of-year | 2013-08-01 | 0 |
Total number of active participants reported on line 7a of the Form 5500 | 2013-08-01 | 113 |
Number of retired or separated participants receiving benefits | 2013-08-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2013-08-01 | 0 |
Total of all active and inactive participants | 2013-08-01 | 113 |
Measure | Date | Value |
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2017 : EAGLE DISTRIBUTING CO. OF SHREVEPORT, INC. HEALTH & WELFARE PLAN 2017 401k financial data |
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Total unrealized appreciation/depreciation of assets | 2017-07-31 | $0 |
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2017-07-31 | $0 |
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2017-07-31 | $0 |
Total income from all sources (including contributions) | 2017-07-31 | $673,397 |
Total loss/gain on sale of assets | 2017-07-31 | $0 |
Total of all expenses incurred | 2017-07-31 | $673,397 |
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2017-07-31 | $564,393 |
Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2017-07-31 | $673,397 |
Value of total assets at end of year | 2017-07-31 | $0 |
Value of total assets at beginning of year | 2017-07-31 | $0 |
Total of administrative expenses incurred including professional, contract, advisory and management fees | 2017-07-31 | $109,004 |
Total interest from all sources | 2017-07-31 | $0 |
Total dividends received (eg from common stock, registered investment company shares) | 2017-07-31 | $0 |
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2017-07-31 | No |
Was this plan covered by a fidelity bond | 2017-07-31 | No |
If this is an individual account plan, was there a blackout period | 2017-07-31 | No |
Were there any nonexempt tranactions with any party-in-interest | 2017-07-31 | No |
Contributions received from participants | 2017-07-31 | $327,604 |
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2017-07-31 | No |
Value of net income/loss | 2017-07-31 | $0 |
Value of net assets at end of year (total assets less liabilities) | 2017-07-31 | $0 |
Value of net assets at beginning of year (total assets less liabilities) | 2017-07-31 | $0 |
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2017-07-31 | No |
Were any loans by the plan or fixed income obligations due to the plan in default | 2017-07-31 | No |
Were any leases to which the plan was party in default or uncollectible | 2017-07-31 | No |
Expenses. Payments to insurance carriers foe the provision of benefits | 2017-07-31 | $564,393 |
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2017-07-31 | No |
Was there a failure to transmit to the plan any participant contributions | 2017-07-31 | No |
Has the plan failed to provide any benefit when due under the plan | 2017-07-31 | No |
Contributions received in cash from employer | 2017-07-31 | $345,793 |
Contract administrator fees | 2017-07-31 | $109,004 |
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2017-07-31 | No |
Did the plan have assets held for investment | 2017-07-31 | No |
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2017-07-31 | No |
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2017-07-31 | No |
2016 : EAGLE DISTRIBUTING CO. OF SHREVEPORT, INC. HEALTH & WELFARE PLAN 2016 401k financial data |
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Total income from all sources | 2016-07-31 | $1,017,046 |
Expenses. Total of all expenses incurred | 2016-07-31 | $1,017,046 |
Benefits paid (including direct rollovers) | 2016-07-31 | $1,017,046 |
Total plan assets at beginning of year | 2016-07-31 | $0 |
Net income (gross income less expenses) | 2016-07-31 | $0 |
Net plan assets at end of year (total assets less liabilities) | 2016-07-31 | $0 |
Net plan assets at beginning of year (total assets less liabilities) | 2016-07-31 | $0 |
Total contributions received or receivable from employer(s) | 2016-07-31 | $1,017,046 |
2015 : EAGLE DISTRIBUTING CO. OF SHREVEPORT, INC. HEALTH & WELFARE PLAN 2015 401k financial data |
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Total income from all sources | 2015-07-31 | $1,031,306 |
Expenses. Total of all expenses incurred | 2015-07-31 | $1,031,306 |
Benefits paid (including direct rollovers) | 2015-07-31 | $1,031,306 |
Total plan assets at end of year | 2015-07-31 | $0 |
Total plan assets at beginning of year | 2015-07-31 | $0 |
Net income (gross income less expenses) | 2015-07-31 | $0 |
Net plan assets at end of year (total assets less liabilities) | 2015-07-31 | $0 |
Net plan assets at beginning of year (total assets less liabilities) | 2015-07-31 | $0 |
Total contributions received or receivable from employer(s) | 2015-07-31 | $1,031,306 |
2022: EAGLE DISTRIBUTING CO. OF SHREVEPORT, INC. HEALTH & WELFARE PLAN 2022 form 5500 responses |
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2022-08-01 | Type of plan entity | Single employer plan |
2022-08-01 | Submission has been amended | No |
2022-08-01 | This submission is the final filing | No |
2022-08-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2022-08-01 | Plan is a collectively bargained plan | No |
2022-08-01 | Plan funding arrangement – Insurance | Yes |
2022-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2022-08-01 | Plan benefit arrangement – Insurance | Yes |
2022-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2021: EAGLE DISTRIBUTING CO. OF SHREVEPORT, INC. HEALTH & WELFARE PLAN 2021 form 5500 responses |
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2021-08-01 | Type of plan entity | Single employer plan |
2021-08-01 | Submission has been amended | No |
2021-08-01 | This submission is the final filing | No |
2021-08-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2021-08-01 | Plan is a collectively bargained plan | No |
2021-08-01 | Plan funding arrangement – Insurance | Yes |
2021-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2021-08-01 | Plan benefit arrangement – Insurance | Yes |
2021-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2020: EAGLE DISTRIBUTING CO. OF SHREVEPORT, INC. HEALTH & WELFARE PLAN 2020 form 5500 responses |
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2020-08-01 | Type of plan entity | Single employer plan |
2020-08-01 | Submission has been amended | No |
2020-08-01 | This submission is the final filing | No |
2020-08-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2020-08-01 | Plan is a collectively bargained plan | No |
2020-08-01 | Plan funding arrangement – Insurance | Yes |
2020-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2020-08-01 | Plan benefit arrangement – Insurance | Yes |
2020-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2019: EAGLE DISTRIBUTING CO. OF SHREVEPORT, INC. HEALTH & WELFARE PLAN 2019 form 5500 responses |
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2019-08-01 | Type of plan entity | Single employer plan |
2019-08-01 | Submission has been amended | No |
2019-08-01 | This submission is the final filing | No |
2019-08-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2019-08-01 | Plan is a collectively bargained plan | No |
2019-08-01 | Plan funding arrangement – Insurance | Yes |
2019-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2019-08-01 | Plan benefit arrangement – Insurance | Yes |
2019-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2018: EAGLE DISTRIBUTING CO. OF SHREVEPORT, INC. HEALTH & WELFARE PLAN 2018 form 5500 responses |
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2018-08-01 | Type of plan entity | Single employer plan |
2018-08-01 | Submission has been amended | No |
2018-08-01 | This submission is the final filing | No |
2018-08-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2018-08-01 | Plan is a collectively bargained plan | No |
2018-08-01 | Plan funding arrangement – Insurance | Yes |
2018-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2018-08-01 | Plan benefit arrangement – Insurance | Yes |
2018-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2017: EAGLE DISTRIBUTING CO. OF SHREVEPORT, INC. HEALTH & WELFARE PLAN 2017 form 5500 responses |
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2017-08-01 | Type of plan entity | Single employer plan |
2017-08-01 | Submission has been amended | No |
2017-08-01 | This submission is the final filing | No |
2017-08-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2017-08-01 | Plan is a collectively bargained plan | No |
2017-08-01 | Plan funding arrangement – Insurance | Yes |
2017-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2017-08-01 | Plan benefit arrangement – Insurance | Yes |
2017-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2016: EAGLE DISTRIBUTING CO. OF SHREVEPORT, INC. HEALTH & WELFARE PLAN 2016 form 5500 responses |
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2016-08-01 | Type of plan entity | Single employer plan |
2016-08-01 | Submission has been amended | No |
2016-08-01 | This submission is the final filing | No |
2016-08-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2016-08-01 | Plan is a collectively bargained plan | No |
2016-08-01 | Plan funding arrangement – Insurance | Yes |
2016-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2016-08-01 | Plan benefit arrangement – Insurance | Yes |
2016-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2015: EAGLE DISTRIBUTING CO. OF SHREVEPORT, INC. HEALTH & WELFARE PLAN 2015 form 5500 responses |
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2015-08-01 | Type of plan entity | Single employer plan |
2015-08-01 | Submission has been amended | No |
2015-08-01 | This submission is the final filing | No |
2015-08-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2015-08-01 | Plan is a collectively bargained plan | No |
2015-08-01 | Plan funding arrangement – Insurance | Yes |
2015-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2015-08-01 | Plan benefit arrangement – Insurance | Yes |
2015-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2014: EAGLE DISTRIBUTING CO. OF SHREVEPORT, INC. HEALTH & WELFARE PLAN 2014 form 5500 responses |
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2014-08-01 | Type of plan entity | Single employer plan |
2014-08-01 | Submission has been amended | No |
2014-08-01 | This submission is the final filing | No |
2014-08-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2014-08-01 | Plan is a collectively bargained plan | No |
2014-08-01 | Plan funding arrangement – Insurance | Yes |
2014-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2014-08-01 | Plan benefit arrangement – Insurance | Yes |
2014-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2013: EAGLE DISTRIBUTING CO. OF SHREVEPORT, INC. HEALTH & WELFARE PLAN 2013 form 5500 responses |
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2013-08-01 | Type of plan entity | Single employer plan |
2013-08-01 | First time form 5500 has been submitted | Yes |
2013-08-01 | Submission has been amended | No |
2013-08-01 | This submission is the final filing | No |
2013-08-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2013-08-01 | Plan is a collectively bargained plan | No |
2013-08-01 | Plan funding arrangement – Insurance | Yes |
2013-08-01 | Plan benefit arrangement – Insurance | Yes |
RXBENEFITS (National Association of Insurance Commissioners NAIC id number: 52429 ) |
Policy contract number | EAGLE DISTRIBUT |
Policy instance | 8 |
Insurance contract or identification number | EAGLE DISTRIBUT | Number of Individuals Covered | 82 | Insurance policy start date | 2022-09-01 | Insurance policy end date | 2023-08-31 | 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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | 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 Carrier | USD $0 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GLLVOBL2B |
Policy instance | 1 |
Insurance contract or identification number | GLLVOBL2B | Number of Individuals Covered | 69 | Insurance policy start date | 2022-08-01 | Insurance policy end date | 2023-07-31 | Total amount of commissions paid to insurance broker | USD $641 | Total amount of fees paid to insurance company | USD $565 | 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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | 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 Carrier | USD $6,408 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $641 | Amount paid for insurance broker fees | 377 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
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SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
Policy contract number | 245429 |
Policy instance | 2 |
Insurance contract or identification number | 245429 | Number of Individuals Covered | 90 | Insurance policy start date | 2022-08-01 | Insurance policy end date | 2023-07-31 | 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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | SHORT TERM DISABILITY | 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 Carrier | USD $426,961 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GLUGOBL2B |
Policy instance | 3 |
Insurance contract or identification number | GLUGOBL2B | Number of Individuals Covered | 81 | Insurance policy start date | 2022-08-01 | Insurance policy end date | 2023-07-31 | Total amount of commissions paid to insurance broker | USD $679 | Total amount of fees paid to insurance company | USD $388 | 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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | 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 Carrier | USD $4,528 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $679 | Amount paid for insurance broker fees | 259 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GUC OBL2B |
Policy instance | 4 |
Insurance contract or identification number | GUC OBL2B | Number of Individuals Covered | 42 | Insurance policy start date | 2022-08-01 | Insurance policy end date | 2023-07-31 | Total amount of commissions paid to insurance broker | USD $2,018 | Total amount of fees paid to insurance company | USD $1,113 | 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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | SHORT TERM DISABILITY VOLUNTARY | 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 Carrier | USD $13,455 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,018 | Amount paid for insurance broker fees | 742 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GUDEOBL2B |
Policy instance | 5 |
Insurance contract or identification number | GUDEOBL2B | Number of Individuals Covered | 29 | Insurance policy start date | 2022-08-01 | Insurance policy end date | 2023-07-31 | Total amount of commissions paid to insurance broker | USD $1,667 | Total amount of fees paid to insurance company | USD $944 | 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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | CRITICAL ILLNESS VOLUNTARY | 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 Carrier | USD $11,110 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,667 | Amount paid for insurance broker fees | 629 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GUDHOBL2B |
Policy instance | 6 |
Insurance contract or identification number | GUDHOBL2B | Number of Individuals Covered | 44 | Insurance policy start date | 2022-08-01 | Insurance policy end date | 2023-07-31 | Total amount of commissions paid to insurance broker | USD $1,375 | Total amount of fees paid to insurance company | USD $748 | 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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENT ONLY VOLUNTARY | 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 Carrier | USD $9,165 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,375 | Amount paid for insurance broker fees | 499 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GVTLOBL2B |
Policy instance | 7 |
Insurance contract or identification number | GVTLOBL2B | Number of Individuals Covered | 53 | Insurance policy start date | 2022-08-01 | Insurance policy end date | 2023-07-31 | Total amount of commissions paid to insurance broker | USD $3,474 | Total amount of fees paid to insurance company | USD $2,019 | 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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | TERM LIFE VOLUNTARY | 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 Carrier | USD $23,161 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,474 | Amount paid for insurance broker fees | 1346 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GLLVOBL2B |
Policy instance | 1 |
Insurance contract or identification number | GLLVOBL2B | Number of Individuals Covered | 63 | Insurance policy start date | 2021-08-01 | Insurance policy end date | 2022-07-31 | Total amount of commissions paid to insurance broker | USD $624 | Total amount of fees paid to insurance company | USD $322 | 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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | 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 Carrier | USD $6,244 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $624 | Amount paid for insurance broker fees | 322 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
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SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
Policy contract number | 245429 |
Policy instance | 2 |
Insurance contract or identification number | 245429 | Number of Individuals Covered | 85 | Insurance policy start date | 2021-08-01 | Insurance policy end date | 2022-07-31 | 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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | SHORT TERM DISABILITY | 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 Carrier | USD $388,189 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GLUGOBL2B |
Policy instance | 3 |
Insurance contract or identification number | GLUGOBL2B | Number of Individuals Covered | 75 | Insurance policy start date | 2021-08-01 | Insurance policy end date | 2022-07-31 | Total amount of commissions paid to insurance broker | USD $626 | Total amount of fees paid to insurance company | USD $221 | 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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | 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 Carrier | USD $4,176 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $626 | Amount paid for insurance broker fees | 221 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GUC OBL2B |
Policy instance | 4 |
Insurance contract or identification number | GUC OBL2B | Number of Individuals Covered | 34 | Insurance policy start date | 2021-08-01 | Insurance policy end date | 2022-07-31 | Total amount of commissions paid to insurance broker | USD $1,677 | Total amount of fees paid to insurance company | USD $547 | 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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | SHORT TERM DISABILITY VOLUNTARY | 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 Carrier | USD $11,180 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,677 | Amount paid for insurance broker fees | 547 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GUDEOBL2B |
Policy instance | 5 |
Insurance contract or identification number | GUDEOBL2B | Number of Individuals Covered | 27 | Insurance policy start date | 2021-08-01 | Insurance policy end date | 2022-07-31 | Total amount of commissions paid to insurance broker | USD $1,481 | Total amount of fees paid to insurance company | USD $409 | 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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | CRITICAL ILLNESS VOLUNTARY | 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 Carrier | USD $9,872 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,481 | Amount paid for insurance broker fees | 409 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GUDHOBL2B |
Policy instance | 6 |
Insurance contract or identification number | GUDHOBL2B | Number of Individuals Covered | 35 | Insurance policy start date | 2021-08-01 | Insurance policy end date | 2022-07-31 | Total amount of commissions paid to insurance broker | USD $1,138 | Total amount of fees paid to insurance company | USD $383 | 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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENT ONLY VOLUNTARY | 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 Carrier | USD $7,590 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,138 | Amount paid for insurance broker fees | 383 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GVTLOBL2B |
Policy instance | 7 |
Insurance contract or identification number | GVTLOBL2B | Number of Individuals Covered | 52 | Insurance policy start date | 2021-08-01 | Insurance policy end date | 2022-07-31 | Total amount of commissions paid to insurance broker | USD $3,296 | Total amount of fees paid to insurance company | USD $1,124 | 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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | TERM LIFE VOLUNTARY | 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 Carrier | USD $21,974 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,296 | Amount paid for insurance broker fees | 1124 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GVTLOBL2B |
Policy instance | 7 |
Insurance contract or identification number | GVTLOBL2B | Number of Individuals Covered | 53 | Insurance policy start date | 2020-08-01 | Insurance policy end date | 2021-07-31 | Total amount of commissions paid to insurance broker | USD $2,921 | Total amount of fees paid to insurance company | USD $950 | 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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | TERM LIFE VOLUNTARY | 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 Carrier | USD $19,473 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,921 | Amount paid for insurance broker fees | 950 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GUDHOBL2B |
Policy instance | 6 |
Insurance contract or identification number | GUDHOBL2B | Number of Individuals Covered | 31 | Insurance policy start date | 2020-08-01 | Insurance policy end date | 2021-07-31 | Total amount of commissions paid to insurance broker | USD $1,056 | Total amount of fees paid to insurance company | USD $348 | 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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENT ONLY VOLUNTARY | 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 Carrier | USD $7,042 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,056 | Amount paid for insurance broker fees | 348 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GUDEOBL2B |
Policy instance | 5 |
Insurance contract or identification number | GUDEOBL2B | Number of Individuals Covered | 25 | Insurance policy start date | 2020-08-01 | Insurance policy end date | 2021-07-31 | Total amount of commissions paid to insurance broker | USD $946 | Total amount of fees paid to insurance company | USD $313 | 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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | CRITICAL ILLNESS VOLUNTARY | 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 Carrier | USD $6,307 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $946 | Amount paid for insurance broker fees | 313 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GUC OBL2B |
Policy instance | 4 |
Insurance contract or identification number | GUC OBL2B | Number of Individuals Covered | 34 | Insurance policy start date | 2020-08-01 | Insurance policy end date | 2021-07-31 | Total amount of commissions paid to insurance broker | USD $1,446 | Total amount of fees paid to insurance company | USD $469 | 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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | SHORT TERM DISABILITY VOLUNTARY | 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 Carrier | USD $9,639 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,446 | Amount paid for insurance broker fees | 469 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GLUGOBL2B |
Policy instance | 3 |
Insurance contract or identification number | GLUGOBL2B | Number of Individuals Covered | 74 | Insurance policy start date | 2020-08-01 | Insurance policy end date | 2021-07-31 | Total amount of commissions paid to insurance broker | USD $637 | Total amount of fees paid to insurance company | USD $221 | 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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | 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 Carrier | USD $4,249 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $637 | Amount paid for insurance broker fees | 221 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
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SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
Policy contract number | 245429 |
Policy instance | 2 |
Insurance contract or identification number | 245429 | Number of Individuals Covered | 76 | Insurance policy start date | 2020-08-01 | Insurance policy end date | 2021-07-31 | 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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | SHORT TERM DISABILITY | 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 Carrier | USD $403,413 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GLLVOBL2B |
Policy instance | 1 |
Insurance contract or identification number | GLLVOBL2B | Number of Individuals Covered | 59 | Insurance policy start date | 2020-08-01 | Insurance policy end date | 2021-07-31 | Total amount of commissions paid to insurance broker | USD $591 | Total amount of fees paid to insurance company | USD $296 | 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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | 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 Carrier | USD $5,914 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $591 | Amount paid for insurance broker fees | 296 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GLLVOBL2B |
Policy instance | 1 |
Insurance contract or identification number | GLLVOBL2B | Number of Individuals Covered | 63 | Insurance policy start date | 2019-08-01 | Insurance policy end date | 2020-07-31 | Total amount of commissions paid to insurance broker | USD $648 | Total amount of fees paid to insurance company | USD $68 | 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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | 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 Carrier | USD $6,475 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $648 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 68 | Additional information about fees paid to insurance broker | OTHER COMPENSATION |
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SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
Policy contract number | 245429 |
Policy instance | 2 |
Insurance contract or identification number | 245429 | Number of Individuals Covered | 84 | Insurance policy start date | 2019-08-01 | Insurance policy end date | 2020-07-31 | 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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | SHORT TERM DISABILITY | 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 Carrier | USD $342,154 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GLUGOBL2B |
Policy instance | 3 |
Insurance contract or identification number | GLUGOBL2B | Number of Individuals Covered | 85 | Insurance policy start date | 2019-08-01 | Insurance policy end date | 2020-07-31 | Total amount of commissions paid to insurance broker | USD $705 | Total amount of fees paid to insurance company | USD $52 | 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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | 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 Carrier | USD $4,700 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $705 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 52 | Additional information about fees paid to insurance broker | OTHER COMPENSATION |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GUC OBL2B |
Policy instance | 4 |
Insurance contract or identification number | GUC OBL2B | Number of Individuals Covered | 39 | Insurance policy start date | 2019-08-01 | Insurance policy end date | 2020-07-31 | Total amount of commissions paid to insurance broker | USD $1,509 | Total amount of fees paid to insurance company | USD $109 | 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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | SHORT TERM DISABILITY VOLUNTARY | 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 Carrier | USD $10,063 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,509 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 109 | Additional information about fees paid to insurance broker | OTHER COMPENSATION |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GUDEOBL2B |
Policy instance | 5 |
Insurance contract or identification number | GUDEOBL2B | Number of Individuals Covered | 28 | Insurance policy start date | 2019-08-01 | Insurance policy end date | 2020-07-31 | Total amount of commissions paid to insurance broker | USD $1,003 | Total amount of fees paid to insurance company | USD $75 | 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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | CRITICAL ILLNESS VOLUNTARY | 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 Carrier | USD $6,684 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,003 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 75 | Additional information about fees paid to insurance broker | OTHER COMPENSATION |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GUDHOBL2B |
Policy instance | 6 |
Insurance contract or identification number | GUDHOBL2B | Number of Individuals Covered | 31 | Insurance policy start date | 2019-08-01 | Insurance policy end date | 2020-07-31 | Total amount of commissions paid to insurance broker | USD $1,123 | Total amount of fees paid to insurance company | USD $82 | 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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENT ONLY VOLUNTARY | 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 Carrier | USD $7,490 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,123 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 82 | Additional information about fees paid to insurance broker | OTHER COMPENSATION |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GVTLOBL2B |
Policy instance | 7 |
Insurance contract or identification number | GVTLOBL2B | Number of Individuals Covered | 64 | Insurance policy start date | 2019-08-01 | Insurance policy end date | 2020-07-31 | Total amount of commissions paid to insurance broker | USD $3,291 | Total amount of fees paid to insurance company | USD $244 | 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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | TERM LIFE VOLUNTARY | 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 Carrier | USD $21,938 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,291 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 244 | Additional information about fees paid to insurance broker | OTHER COMPENSATION |
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THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00472243 |
Policy instance | 1 |
Insurance contract or identification number | 00472243 | Number of Individuals Covered | 90 | Insurance policy start date | 2018-08-01 | Insurance policy end date | 2019-07-31 | Total amount of commissions paid to insurance broker | USD $12,071 | Total amount of fees paid to insurance company | USD $0 | 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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D, OPTIONAL LIFE, VOLUNTARY CRITICAL ILLNESS | 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 Carrier | USD $96,048 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $11,951 | Insurance broker organization code? | 3 |
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SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
Policy contract number | 245429 |
Policy instance | 2 |
Insurance contract or identification number | 245429 | Number of Individuals Covered | 95 | Insurance policy start date | 2018-08-01 | Insurance policy end date | 2019-07-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $1,447 | 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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | SHORT TERM DISABILITY | 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 Carrier | USD $234,261 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 1447 | Additional information about fees paid to insurance broker | BROKER BONUS | Insurance broker organization code? | 3 |
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SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
Policy contract number | 417005410992 |
Policy instance | 2 |
Insurance contract or identification number | 417005410992 | Number of Individuals Covered | 89 | Insurance policy start date | 2017-08-01 | Insurance policy end date | 2018-07-31 | 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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | SHORT TERM DISABILITY | 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 Carrier | USD $245,156 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00472243 |
Policy instance | 1 |
Insurance contract or identification number | 00472243 | Number of Individuals Covered | 97 | Insurance policy start date | 2017-08-01 | Insurance policy end date | 2018-07-31 | Total amount of commissions paid to insurance broker | USD $13,510 | Total amount of fees paid to insurance company | USD $4,536 | 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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D, OPTIONAL LIFE, VOLUNTARY CRITICAL ILLNESS | 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 Carrier | USD $108,133 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $13,510 | Amount paid for insurance broker fees | 4536 | Additional information about fees paid to insurance broker | BROKER FEES | Insurance broker organization code? | 3 | Insurance broker name | TFG FINANCIAL GROUP |
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THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 417004410992 |
Policy instance | 1 |
Insurance contract or identification number | 417004410992 | Number of Individuals Covered | 110 | Insurance policy start date | 2015-08-01 | Insurance policy end date | 2016-07-31 | Total amount of commissions paid to insurance broker | USD $3,016 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENT DEATH & DISMEMBER | 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 Carrier | USD $243,767 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,011 | Insurance broker organization code? | 3 | Insurance broker name | GALLAGHER BENEFIT SERVICES, INC. |
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STARMOUNT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68985 ) |
Policy contract number | EDOS814 |
Policy instance | 2 |
Insurance contract or identification number | EDOS814 | Number of Individuals Covered | 105 | Insurance policy start date | 2015-08-01 | Insurance policy end date | 2016-07-31 | Total amount of commissions paid to insurance broker | USD $6,421 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | 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 Carrier | USD $64,126 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,285 | Insurance broker organization code? | 3 | Insurance broker name | GALLAGHER BENEFIT SERVICES |
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ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 ) |
Policy contract number | 417002410992 |
Policy instance | 2 |
Insurance contract or identification number | 417002410992 | Number of Individuals Covered | 107 | Insurance policy start date | 2014-08-01 | Insurance policy end date | 2015-07-31 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | Yes | 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 Carrier | USD $272,811 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00472243 |
Policy instance | 1 |
Insurance contract or identification number | 00472243 | Number of Individuals Covered | 108 | Insurance policy start date | 2014-08-01 | Insurance policy end date | 2015-07-31 | Total amount of commissions paid to insurance broker | USD $3,261 | Total amount of fees paid to insurance company | USD $455 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENT DEATH & DISMEMBER | 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 Carrier | USD $24,147 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,746 | Amount paid for insurance broker fees | 455 | Additional information about fees paid to insurance broker | BROKER FEES | Insurance broker organization code? | 3 | Insurance broker name | TFG FINANCIAL GROUP |
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ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 ) |
Policy contract number | 417002410992 |
Policy instance | 2 |
Insurance contract or identification number | 417002410992 | Number of Individuals Covered | 97 | Insurance policy start date | 2013-08-01 | Insurance policy end date | 2014-07-31 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | Yes | 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 Carrier | USD $189,217 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00472243 |
Policy instance | 1 |
Insurance contract or identification number | 00472243 | Number of Individuals Covered | 113 | Insurance policy start date | 2013-08-01 | Insurance policy end date | 2014-07-31 | Total amount of commissions paid to insurance broker | USD $8,540 | Total amount of fees paid to insurance company | USD $1,906 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENT DEATH & DISMEMBER | 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 Carrier | USD $77,989 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8,540 | Amount paid for insurance broker fees | 1906 | Additional information about fees paid to insurance broker | BROKER FEES | Insurance broker organization code? | 3 | Insurance broker name | GALLAGHER BENEFIT SERVICES, INC. |
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