XCALIBER INTERNATIONAL has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan XCALIBER INTERNATIONAL WELFARE BENEFITS PLAN
| Measure | Date | Value |
|---|
| 2023: XCALIBER INTERNATIONAL WELFARE BENEFITS PLAN 2023 401k membership |
|---|
| Total participants, beginning-of-year | 2023-12-01 | 271 |
| Total number of active participants reported on line 7a of the Form 5500 | 2023-12-01 | 276 |
| Number of retired or separated participants receiving benefits | 2023-12-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2023-12-01 | 0 |
| Total of all active and inactive participants | 2023-12-01 | 276 |
| Number of employers contributing to the scheme | 2023-12-01 | 0 |
| 2022: XCALIBER INTERNATIONAL WELFARE BENEFITS PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-12-01 | 266 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-12-01 | 271 |
| Number of retired or separated participants receiving benefits | 2022-12-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2022-12-01 | 0 |
| Total of all active and inactive participants | 2022-12-01 | 271 |
| Number of employers contributing to the scheme | 2022-12-01 | 0 |
| 2021: XCALIBER INTERNATIONAL WELFARE BENEFITS PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-12-01 | 205 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-12-01 | 266 |
| Total of all active and inactive participants | 2021-12-01 | 266 |
| 2020: XCALIBER INTERNATIONAL WELFARE BENEFITS PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-12-01 | 191 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-12-01 | 205 |
| Total of all active and inactive participants | 2020-12-01 | 205 |
| 2019: XCALIBER INTERNATIONAL WELFARE BENEFITS PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-12-01 | 155 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-12-01 | 191 |
| Total of all active and inactive participants | 2019-12-01 | 191 |
| Total participants | 2019-12-01 | 191 |
| 2018: XCALIBER INTERNATIONAL WELFARE BENEFITS PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-12-01 | 133 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-12-01 | 155 |
| Total of all active and inactive participants | 2018-12-01 | 155 |
| Total participants | 2018-12-01 | 155 |
| 2017: XCALIBER INTERNATIONAL WELFARE BENEFITS PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-12-01 | 106 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-12-01 | 133 |
| Total of all active and inactive participants | 2017-12-01 | 133 |
| Total participants | 2017-12-01 | 133 |
| 2016: XCALIBER INTERNATIONAL WELFARE BENEFITS PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-12-01 | 106 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-12-01 | 106 |
| Total of all active and inactive participants | 2016-12-01 | 106 |
| Total participants | 2016-12-01 | 106 |
| 2023: XCALIBER INTERNATIONAL WELFARE BENEFITS PLAN 2023 form 5500 responses |
|---|
| 2023-12-01 | Type of plan entity | Single employer plan |
| 2023-12-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2023-12-01 | Plan funding arrangement – Insurance | Yes |
| 2023-12-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2023-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2023-12-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2022: XCALIBER INTERNATIONAL WELFARE BENEFITS PLAN 2022 form 5500 responses |
|---|
| 2022-12-01 | Type of plan entity | Single employer plan |
| 2022-12-01 | Plan funding arrangement – Insurance | Yes |
| 2022-12-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-12-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: XCALIBER INTERNATIONAL WELFARE BENEFITS PLAN 2021 form 5500 responses |
|---|
| 2021-12-01 | Type of plan entity | Single employer plan |
| 2021-12-01 | Plan funding arrangement – Insurance | Yes |
| 2021-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: XCALIBER INTERNATIONAL WELFARE BENEFITS PLAN 2020 form 5500 responses |
|---|
| 2020-12-01 | Type of plan entity | Single employer plan |
| 2020-12-01 | Plan funding arrangement – Insurance | Yes |
| 2020-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: XCALIBER INTERNATIONAL WELFARE BENEFITS PLAN 2019 form 5500 responses |
|---|
| 2019-12-01 | Type of plan entity | Single employer plan |
| 2019-12-01 | Plan funding arrangement – Insurance | Yes |
| 2019-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: XCALIBER INTERNATIONAL WELFARE BENEFITS PLAN 2018 form 5500 responses |
|---|
| 2018-12-01 | Type of plan entity | Single employer plan |
| 2018-12-01 | Plan funding arrangement – Insurance | Yes |
| 2018-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: XCALIBER INTERNATIONAL WELFARE BENEFITS PLAN 2017 form 5500 responses |
|---|
| 2017-12-01 | Type of plan entity | Single employer plan |
| 2017-12-01 | Plan funding arrangement – Insurance | Yes |
| 2017-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: XCALIBER INTERNATIONAL WELFARE BENEFITS PLAN 2016 form 5500 responses |
|---|
| 2016-12-01 | Type of plan entity | Single employer plan |
| 2016-12-01 | First time form 5500 has been submitted | Yes |
| 2016-12-01 | Submission has been amended | No |
| 2016-12-01 | This submission is the final filing | No |
| 2016-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-12-01 | Plan is a collectively bargained plan | No |
| 2016-12-01 | Plan funding arrangement – Insurance | Yes |
| 2016-12-01 | Plan benefit arrangement – Insurance | Yes |
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG0AYD3 |
| Policy instance | 5 |
| Insurance contract or identification number | GLUG0AYD3 | | Number of Individuals Covered | 276 | | Insurance policy start date | 2023-12-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $2,470 | | Total amount of fees paid to insurance company | USD $0 | | 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 | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT,EMPLOYEE ASSISTANCE PROGRAM | | Welfare Benefit Premiums Paid to Carrier | USD $16,467 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 299608 |
| Policy instance | 1 |
| Insurance contract or identification number | 299608 | | Number of Individuals Covered | 279 | | Insurance policy start date | 2023-12-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $5,943 | | Total amount of fees paid to insurance company | USD $15,065 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $199,165 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 ) |
| Policy contract number | 5110 |
| Policy instance | 2 |
| Insurance contract or identification number | 5110 | | Number of Individuals Covered | 209 | | Insurance policy start date | 2023-12-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $859 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30061993 |
| Policy instance | 3 |
| Insurance contract or identification number | 30061993 | | Number of Individuals Covered | 210 | | Insurance policy start date | 2023-12-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $231 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,188 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E5170873 |
| Policy instance | 4 |
| Insurance contract or identification number | E5170873 | | Number of Individuals Covered | 32 | | Insurance policy start date | 2023-12-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $726 | | Total amount of fees paid to insurance company | USD $204 | | Other welfare benefits provided | ACCIDENT, CRITICAL ILLNESS, HOSPITAL, CANCER | | Welfare Benefit Premiums Paid to Carrier | USD $1,940 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUG0AYD3 |
| Policy instance | 5 |
| Insurance contract or identification number | GUG0AYD3 | | Number of Individuals Covered | 272 | | Insurance policy start date | 2022-12-01 | | Insurance policy end date | 2023-11-30 | | Total amount of commissions paid to insurance broker | USD $28,733 | | Total amount of fees paid to insurance company | USD $12,088 | | 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 | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT,EMPLOYEE ASSISTANCE PROGRAM | | Welfare Benefit Premiums Paid to Carrier | USD $191,555 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $28,733 | | Amount paid for insurance broker fees | 12088 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 923265 |
| Policy instance | 1 |
| Insurance contract or identification number | 923265 | | Number of Individuals Covered | 187 | | Insurance policy start date | 2022-12-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $7,589 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $152,075 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $0 | | Amount paid for insurance broker fees | 7589 | | Additional information about fees paid to insurance broker | SERVICE FEE AGREEMENT | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 ) |
| Policy contract number | 5110 |
| Policy instance | 2 |
| Insurance contract or identification number | 5110 | | Number of Individuals Covered | 208 | | Insurance policy start date | 2022-12-01 | | Insurance policy end date | 2023-11-30 | | Total amount of commissions paid to insurance broker | USD $10,328 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,328 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30061993 |
| Policy instance | 3 |
| Insurance contract or identification number | 30061993 | | Number of Individuals Covered | 209 | | Insurance policy start date | 2022-12-01 | | Insurance policy end date | 2023-11-30 | | Total amount of commissions paid to insurance broker | USD $1,415 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $25,997 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,285 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E5170873 |
| Policy instance | 4 |
| Insurance contract or identification number | E5170873 | | Number of Individuals Covered | 31 | | Insurance policy start date | 2022-12-01 | | Insurance policy end date | 2023-11-30 | | Total amount of commissions paid to insurance broker | USD $6,193 | | Total amount of fees paid to insurance company | USD $246 | | Other welfare benefits provided | ACCIDENT, CRITICAL ILLNESS, HOSPITAL, CANCER | | Welfare Benefit Premiums Paid to Carrier | USD $20,333 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,839 | | Amount paid for insurance broker fees | 31 | | Additional information about fees paid to insurance broker | FEES | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 ) |
| Policy contract number | 5110 |
| Policy instance | 5 |
| Insurance contract or identification number | 5110 | | Number of Individuals Covered | 202 | | Insurance policy start date | 2021-12-01 | | Insurance policy end date | 2021-11-30 | | Total amount of commissions paid to insurance broker | USD $9,802 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $122,523 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,802 |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 0923265 |
| Policy instance | 4 |
| Insurance contract or identification number | 0923265 | | Number of Individuals Covered | 188 | | Insurance policy start date | 2021-12-01 | | Insurance policy end date | 2022-11-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $85,033 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,704,078 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $0 | | Amount paid for insurance broker fees | 85033 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30061933 |
| Policy instance | 3 |
| Insurance contract or identification number | 30061933 | | Number of Individuals Covered | 194 | | Insurance policy start date | 2021-12-01 | | Insurance policy end date | 2022-11-30 | | Total amount of commissions paid to insurance broker | USD $1,348 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $23,984 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,225 |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E5170873 |
| Policy instance | 2 |
| Insurance contract or identification number | E5170873 | | Number of Individuals Covered | 22 | | Insurance policy end date | 2022-11-30 | | Total amount of commissions paid to insurance broker | USD $1,991 | | Total amount of fees paid to insurance company | USD $107 | | Other welfare benefits provided | LIFE & AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $13,574 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $846 | | Amount paid for insurance broker fees | 29 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AYD3 |
| Policy instance | 1 |
| Insurance contract or identification number | G000AYD3 | | Number of Individuals Covered | 266 | | Insurance policy start date | 2021-12-01 | | Insurance policy end date | 2022-11-30 | | Total amount of commissions paid to insurance broker | USD $25,572 | | Total amount of fees paid to insurance company | USD $10,133 | | Other welfare benefits provided | LIFE & AD&D, SHORT& LONG TERM DISAB | | Welfare Benefit Premiums Paid to Carrier | USD $170,471 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $25,572 | | Amount paid for insurance broker fees | 10133 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AYD3 |
| Policy instance | 1 |
| Insurance contract or identification number | G000AYD3 | | Number of Individuals Covered | 205 | | Insurance policy start date | 2020-12-01 | | Insurance policy end date | 2021-11-30 | | Total amount of commissions paid to insurance broker | USD $21,232 | | Total amount of fees paid to insurance company | USD $7,369 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | LIFE & AD&D, SHORT TERM DISAB | | Welfare Benefit Premiums Paid to Carrier | USD $143,356 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $21,232 | | Amount paid for insurance broker fees | 7369 | | Insurance broker organization code? | 3 |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E5170873 |
| Policy instance | 2 |
| Insurance contract or identification number | E5170873 | | Number of Individuals Covered | 24 | | Insurance policy end date | 2021-11-30 | | Total amount of commissions paid to insurance broker | USD $595 | | Total amount of fees paid to insurance company | USD $1 | | Other welfare benefits provided | LIFE & AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $13,822 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $595 | | Amount paid for insurance broker fees | 1 | | Insurance broker organization code? | 3 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30061933 |
| Policy instance | 3 |
| Insurance contract or identification number | 30061933 | | Number of Individuals Covered | 164 | | Insurance policy start date | 2020-12-01 | | Insurance policy end date | 2021-11-30 | | Total amount of commissions paid to insurance broker | USD $1,285 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $22,065 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,171 |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 0923265 |
| Policy instance | 4 |
| Insurance contract or identification number | 0923265 | | Number of Individuals Covered | 153 | | Insurance policy start date | 2020-12-01 | | Insurance policy end date | 2021-11-30 | | Total amount of commissions paid to insurance broker | USD $1,617 | | Total amount of fees paid to insurance company | USD $62,304 | | Welfare Benefit Premiums Paid to Carrier | USD $1,139,575 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 62304 | | Commission paid to Insurance Broker | USD $1,617 |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E5170873 |
| Policy instance | 2 |
| Insurance contract or identification number | E5170873 | | Number of Individuals Covered | 26 | | Insurance policy start date | 2019-12-01 | | Insurance policy end date | 2020-11-30 | | Total amount of commissions paid to insurance broker | USD $3,055 | | Total amount of fees paid to insurance company | USD $261 | | Other welfare benefits provided | LIFE & AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $16,080 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,339 | | Amount paid for insurance broker fees | 132 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AYD3 |
| Policy instance | 1 |
| Insurance contract or identification number | G000AYD3 | | Number of Individuals Covered | 191 | | Insurance policy start date | 2019-12-01 | | Insurance policy end date | 2020-11-30 | | Total amount of commissions paid to insurance broker | USD $19,670 | | Total amount of fees paid to insurance company | USD $8,155 | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | LIFE & AD&D, SHORT TERM DISAB | | Welfare Benefit Premiums Paid to Carrier | USD $131,136 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $19,670 | | Amount paid for insurance broker fees | 8155 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GOOOAYD3 |
| Policy instance | 1 |
| Insurance contract or identification number | GOOOAYD3 | | Number of Individuals Covered | 177 | | Insurance policy start date | 2018-12-01 | | Insurance policy end date | 2019-11-30 | | Total amount of commissions paid to insurance broker | USD $15,734 | | Total amount of fees paid to insurance company | USD $6,807 | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $104,894 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $15,734 | | Amount paid for insurance broker fees | 6807 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GOOOAYD3 |
| Policy instance | 1 |
| Insurance contract or identification number | GOOOAYD3 | | Number of Individuals Covered | 133 | | Insurance policy start date | 2017-12-01 | | Insurance policy end date | 2018-11-30 | | Total amount of commissions paid to insurance broker | USD $9,921 | | Total amount of fees paid to insurance company | USD $3,941 | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $66,139 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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