LA PAZ REGIONAL HOSPITAL has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan LA PAZ REGIONAL HOSPITAL BENEFIT PLAN-LIFE
Measure | Date | Value |
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2022: LA PAZ REGIONAL HOSPITAL BENEFIT PLAN-LIFE 2022 401k membership |
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Total participants, beginning-of-year | 2022-01-01 | 166 |
Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 166 |
Total of all active and inactive participants | 2022-01-01 | 166 |
Total participants | 2022-01-01 | 166 |
2019: LA PAZ REGIONAL HOSPITAL BENEFIT PLAN-LIFE 2019 401k membership |
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Total participants, beginning-of-year | 2019-07-01 | 174 |
Total number of active participants reported on line 7a of the Form 5500 | 2019-07-01 | 174 |
Total of all active and inactive participants | 2019-07-01 | 174 |
Total participants | 2019-07-01 | 174 |
2018: LA PAZ REGIONAL HOSPITAL BENEFIT PLAN-LIFE 2018 401k membership |
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Total participants, beginning-of-year | 2018-06-01 | 176 |
Total number of active participants reported on line 7a of the Form 5500 | 2018-06-01 | 176 |
Total of all active and inactive participants | 2018-06-01 | 176 |
Total participants | 2018-06-01 | 176 |
Number of participants with account balances | 2018-06-01 | 0 |
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2018-06-01 | 0 |
Number of employers contributing to the scheme | 2018-06-01 | 0 |
Number of retired or separated participants receiving benefits | 2018-06-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2018-06-01 | 0 |
2017: LA PAZ REGIONAL HOSPITAL BENEFIT PLAN-LIFE 2017 401k membership |
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Total participants, beginning-of-year | 2017-06-30 | 204 |
Total number of active participants reported on line 7a of the Form 5500 | 2017-06-30 | 204 |
Total of all active and inactive participants | 2017-06-30 | 204 |
Total participants | 2017-06-30 | 204 |
2016: LA PAZ REGIONAL HOSPITAL BENEFIT PLAN-LIFE 2016 401k membership |
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Total participants, beginning-of-year | 2016-06-01 | 125 |
Total number of active participants reported on line 7a of the Form 5500 | 2016-06-01 | 125 |
Total of all active and inactive participants | 2016-06-01 | 125 |
Total participants | 2016-06-01 | 125 |
2015: LA PAZ REGIONAL HOSPITAL BENEFIT PLAN-LIFE 2015 401k membership |
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Total participants, beginning-of-year | 2015-06-01 | 140 |
Total number of active participants reported on line 7a of the Form 5500 | 2015-06-01 | 140 |
Total of all active and inactive participants | 2015-06-01 | 140 |
Total participants | 2015-06-01 | 140 |
2014: LA PAZ REGIONAL HOSPITAL BENEFIT PLAN-LIFE 2014 401k membership |
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Total participants, beginning-of-year | 2014-07-01 | 77 |
Total number of active participants reported on line 7a of the Form 5500 | 2014-07-01 | 77 |
Total of all active and inactive participants | 2014-07-01 | 77 |
Total participants | 2014-07-01 | 77 |
2013: LA PAZ REGIONAL HOSPITAL BENEFIT PLAN-LIFE 2013 401k membership |
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Total participants, beginning-of-year | 2013-07-01 | 105 |
Total number of active participants reported on line 7a of the Form 5500 | 2013-07-01 | 105 |
Total of all active and inactive participants | 2013-07-01 | 105 |
Total participants | 2013-07-01 | 105 |
2012: LA PAZ REGIONAL HOSPITAL BENEFIT PLAN-LIFE 2012 401k membership |
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Total participants, beginning-of-year | 2012-07-01 | 110 |
Total number of active participants reported on line 7a of the Form 5500 | 2012-07-01 | 110 |
Total of all active and inactive participants | 2012-07-01 | 110 |
Total participants | 2012-07-01 | 110 |
2011: LA PAZ REGIONAL HOSPITAL BENEFIT PLAN-LIFE 2011 401k membership |
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Total participants, beginning-of-year | 2011-07-01 | 105 |
Total number of active participants reported on line 7a of the Form 5500 | 2011-07-01 | 105 |
Total of all active and inactive participants | 2011-07-01 | 105 |
Total participants | 2011-07-01 | 105 |
2010: LA PAZ REGIONAL HOSPITAL BENEFIT PLAN-LIFE 2010 401k membership |
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Total participants, beginning-of-year | 2010-06-01 | 131 |
Total number of active participants reported on line 7a of the Form 5500 | 2010-06-01 | 131 |
Total of all active and inactive participants | 2010-06-01 | 131 |
Total participants | 2010-06-01 | 131 |
2009: LA PAZ REGIONAL HOSPITAL BENEFIT PLAN-LIFE 2009 401k membership |
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Total participants, beginning-of-year | 2009-06-01 | 126 |
Total number of active participants reported on line 7a of the Form 5500 | 2009-06-01 | 126 |
Total of all active and inactive participants | 2009-06-01 | 126 |
Total participants | 2009-06-01 | 126 |
2022: LA PAZ REGIONAL HOSPITAL BENEFIT PLAN-LIFE 2022 form 5500 responses |
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2022-01-01 | Type of plan entity | Single employer plan |
2022-01-01 | Submission has been amended | No |
2022-01-01 | This submission is the final filing | No |
2022-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2022-01-01 | Plan is a collectively bargained plan | No |
2022-01-01 | Plan funding arrangement – Insurance | Yes |
2022-01-01 | Plan benefit arrangement – Insurance | Yes |
2019: LA PAZ REGIONAL HOSPITAL BENEFIT PLAN-LIFE 2019 form 5500 responses |
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2019-07-01 | Type of plan entity | Single employer plan |
2019-07-01 | Submission has been amended | No |
2019-07-01 | This submission is the final filing | No |
2019-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2019-07-01 | Plan is a collectively bargained plan | No |
2019-07-01 | Plan funding arrangement – Insurance | Yes |
2019-07-01 | Plan benefit arrangement – Insurance | Yes |
2018: LA PAZ REGIONAL HOSPITAL BENEFIT PLAN-LIFE 2018 form 5500 responses |
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2018-06-01 | Type of plan entity | Single employer plan |
2018-06-01 | Submission has been amended | No |
2018-06-01 | This submission is the final filing | No |
2018-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2018-06-01 | Plan is a collectively bargained plan | No |
2018-06-01 | Plan funding arrangement – Insurance | Yes |
2018-06-01 | Plan benefit arrangement – Insurance | Yes |
2017: LA PAZ REGIONAL HOSPITAL BENEFIT PLAN-LIFE 2017 form 5500 responses |
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2017-06-30 | Type of plan entity | Single employer plan |
2017-06-30 | Submission has been amended | No |
2017-06-30 | This submission is the final filing | No |
2017-06-30 | This return/report is a short plan year return/report (less than 12 months) | No |
2017-06-30 | Plan is a collectively bargained plan | No |
2017-06-30 | Plan funding arrangement – Insurance | Yes |
2017-06-30 | Plan benefit arrangement – Insurance | Yes |
2016: LA PAZ REGIONAL HOSPITAL BENEFIT PLAN-LIFE 2016 form 5500 responses |
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2016-06-01 | Type of plan entity | Single employer plan |
2016-06-01 | Submission has been amended | No |
2016-06-01 | This submission is the final filing | No |
2016-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2016-06-01 | Plan is a collectively bargained plan | No |
2016-06-01 | Plan funding arrangement – Insurance | Yes |
2016-06-01 | Plan benefit arrangement – Insurance | Yes |
2015: LA PAZ REGIONAL HOSPITAL BENEFIT PLAN-LIFE 2015 form 5500 responses |
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2015-06-01 | Type of plan entity | Single employer plan |
2015-06-01 | Submission has been amended | No |
2015-06-01 | This submission is the final filing | No |
2015-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2015-06-01 | Plan is a collectively bargained plan | No |
2015-06-01 | Plan funding arrangement – Insurance | Yes |
2015-06-01 | Plan benefit arrangement – Insurance | Yes |
2014: LA PAZ REGIONAL HOSPITAL BENEFIT PLAN-LIFE 2014 form 5500 responses |
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2014-07-01 | Type of plan entity | Single employer plan |
2014-07-01 | Submission has been amended | No |
2014-07-01 | This submission is the final filing | No |
2014-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2014-07-01 | Plan is a collectively bargained plan | No |
2014-07-01 | Plan funding arrangement – Insurance | Yes |
2014-07-01 | Plan benefit arrangement – Insurance | Yes |
2013: LA PAZ REGIONAL HOSPITAL BENEFIT PLAN-LIFE 2013 form 5500 responses |
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2013-07-01 | Type of plan entity | Mulitple employer plan |
2013-07-01 | Submission has been amended | No |
2013-07-01 | This submission is the final filing | No |
2013-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2013-07-01 | Plan is a collectively bargained plan | No |
2013-07-01 | Plan funding arrangement – Insurance | Yes |
2013-07-01 | Plan benefit arrangement – Insurance | Yes |
2012: LA PAZ REGIONAL HOSPITAL BENEFIT PLAN-LIFE 2012 form 5500 responses |
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2012-07-01 | Type of plan entity | Single employer plan |
2012-07-01 | Submission has been amended | No |
2012-07-01 | This submission is the final filing | No |
2012-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2012-07-01 | Plan is a collectively bargained plan | No |
2012-07-01 | Plan funding arrangement – Insurance | Yes |
2012-07-01 | Plan benefit arrangement – Insurance | Yes |
2011: LA PAZ REGIONAL HOSPITAL BENEFIT PLAN-LIFE 2011 form 5500 responses |
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2011-07-01 | Type of plan entity | Single employer plan |
2011-07-01 | Submission has been amended | No |
2011-07-01 | This submission is the final filing | No |
2011-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2011-07-01 | Plan is a collectively bargained plan | No |
2011-07-01 | Plan funding arrangement – Insurance | Yes |
2011-07-01 | Plan benefit arrangement – Insurance | Yes |
2010: LA PAZ REGIONAL HOSPITAL BENEFIT PLAN-LIFE 2010 form 5500 responses |
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2010-06-01 | Type of plan entity | Single employer plan |
2010-06-01 | Submission has been amended | No |
2010-06-01 | This submission is the final filing | No |
2010-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2010-06-01 | Plan is a collectively bargained plan | No |
2010-06-01 | Plan funding arrangement – Insurance | Yes |
2010-06-01 | Plan benefit arrangement – Insurance | Yes |
2009: LA PAZ REGIONAL HOSPITAL BENEFIT PLAN-LIFE 2009 form 5500 responses |
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2009-06-01 | Type of plan entity | Single employer plan |
2009-06-01 | First time form 5500 has been submitted | Yes |
2009-06-01 | Submission has been amended | Yes |
2009-06-01 | This submission is the final filing | No |
2009-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2009-06-01 | Plan is a collectively bargained plan | No |
2009-06-01 | Plan funding arrangement – Insurance | Yes |
2009-06-01 | Plan benefit arrangement – Insurance | Yes |
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GVTL0430I |
Policy instance | 3 |
Insurance contract or identification number | GVTL0430I | Number of Individuals Covered | 81 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2023-01-01 | Total amount of commissions paid to insurance broker | USD $5,613 | Total amount of fees paid to insurance company | USD $2,251 | Are there contracts with allocated funds for individual policies? | 1 | 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 | 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 $37,421 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,613 | Amount paid for insurance broker fees | 2251 | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GLUG0430I |
Policy instance | 2 |
Insurance contract or identification number | GLUG0430I | Number of Individuals Covered | 166 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2023-01-01 | Total amount of commissions paid to insurance broker | USD $3,129 | Total amount of fees paid to insurance company | USD $1,535 | Are there contracts with allocated funds for individual policies? | 1 | 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 | 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 $32,737 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,129 | Amount paid for insurance broker fees | 1535 | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GTL0403I |
Policy instance | 1 |
Insurance contract or identification number | GTL0403I | Number of Individuals Covered | 166 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2023-01-01 | Total amount of commissions paid to insurance broker | USD $3,833 | Total amount of fees paid to insurance company | USD $2,349 | Are there contracts with allocated funds for individual policies? | 1 | 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 | Yes | 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 $47,170 | 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 | GLTD0403I |
Policy instance | 1 |
Insurance contract or identification number | GLTD0403I | Number of Individuals Covered | 174 | Insurance policy start date | 2019-07-01 | Insurance policy end date | 2020-07-01 | Total amount of commissions paid to insurance broker | USD $3,999 | Total amount of fees paid to insurance company | USD $1,826 | Are there contracts with allocated funds for individual policies? | 1 | 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 | Yes | 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 $50,935 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,999 | Amount paid for insurance broker fees | 1826 | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GLUG0430I |
Policy instance | 2 |
Insurance contract or identification number | GLUG0430I | Number of Individuals Covered | 174 | Insurance policy start date | 2019-07-01 | Insurance policy end date | 2020-07-01 | Total amount of commissions paid to insurance broker | USD $3,287 | Total amount of fees paid to insurance company | USD $1,293 | Are there contracts with allocated funds for individual policies? | 1 | 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 | 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 $36,009 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,287 | Amount paid for insurance broker fees | 1293 | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GVTL0430I |
Policy instance | 3 |
Insurance contract or identification number | GVTL0430I | Number of Individuals Covered | 88 | Insurance policy start date | 2019-07-01 | Insurance policy end date | 2020-07-01 | Total amount of commissions paid to insurance broker | USD $7,209 | Total amount of fees paid to insurance company | USD $1,700 | Are there contracts with allocated funds for individual policies? | 1 | 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 | 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 $48,061 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,209 | Amount paid for insurance broker fees | 1700 | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GLTD0430I |
Policy instance | 1 |
Insurance contract or identification number | GLTD0430I | Number of Individuals Covered | 176 | Insurance policy start date | 2018-06-01 | Insurance policy end date | 2019-06-01 | Total amount of commissions paid to insurance broker | USD $3,990 | Total amount of fees paid to insurance company | USD $2,188 | Are there contracts with allocated funds for individual policies? | 1 | 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 | Yes | 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 $49,793 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,990 | Amount paid for insurance broker fees | 2188 | Additional information about fees paid to insurance broker | OTHER COMPENSATION TO AGENT OF RECORD | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GVTL0430I |
Policy instance | 3 |
Insurance contract or identification number | GVTL0430I | Number of Individuals Covered | 87 | Insurance policy start date | 2018-06-01 | Insurance policy end date | 2019-06-01 | Total amount of commissions paid to insurance broker | USD $6,467 | Total amount of fees paid to insurance company | USD $1,776 | Are there contracts with allocated funds for individual policies? | 1 | 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 | 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 $43,115 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,467 | Amount paid for insurance broker fees | 1776 | Additional information about fees paid to insurance broker | OTHER COMPENSATION TO AGENT | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GLUG0430I |
Policy instance | 2 |
Insurance contract or identification number | GLUG0430I | Number of Individuals Covered | 176 | Insurance policy start date | 2018-06-01 | Insurance policy end date | 2019-06-01 | Total amount of commissions paid to insurance broker | USD $3,316 | Total amount of fees paid to insurance company | USD $1,869 | Are there contracts with allocated funds for individual policies? | 1 | 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 | 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 $36,318 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,316 | Amount paid for insurance broker fees | 1869 | Additional information about fees paid to insurance broker | OTHER COMPENSATION FOR AGENT | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GLTD430I |
Policy instance | 1 |
Insurance contract or identification number | GLTD430I | Number of Individuals Covered | 176 | Insurance policy start date | 2018-06-01 | Insurance policy end date | 2019-06-01 | Total amount of commissions paid to insurance broker | USD $3,990 | Total amount of fees paid to insurance company | USD $2,188 | Are there contracts with allocated funds for individual policies? | 1 | 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 | Yes | 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 $49,793 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,990 | Amount paid for insurance broker fees | 2188 | Additional information about fees paid to insurance broker | OTHER COMPENSATION TO AGENT OF RECORD | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GLUG0430I |
Policy instance | 3 |
Insurance contract or identification number | GLUG0430I | Number of Individuals Covered | 204 | Insurance policy start date | 2017-06-30 | Insurance policy end date | 2018-07-01 | Total amount of commissions paid to insurance broker | USD $3,265 | Total amount of fees paid to insurance company | USD $1,268 | Are there contracts with allocated funds for individual policies? | 1 | 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 | 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 $35,292 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,265 | Amount paid for insurance broker fees | 1268 | Insurance broker organization code? | 3 | Insurance broker name | CBIZ BENEFITS & INSURANCE SVS INC |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000430I |
Policy instance | 2 |
Insurance contract or identification number | G000430I | Number of Individuals Covered | 204 | Insurance policy start date | 2017-06-30 | Insurance policy end date | 2018-07-01 | Total amount of commissions paid to insurance broker | USD $3,265 | Total amount of fees paid to insurance company | USD $1,268 | Are there contracts with allocated funds for individual policies? | 1 | 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 | 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 $35,292 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,265 | Amount paid for insurance broker fees | 1268 | Insurance broker organization code? | 3 | Insurance broker name | CBIZ BENEFITS & INSURANCE SVS INC |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GVTL0430I |
Policy instance | 1 |
Insurance contract or identification number | GVTL0430I | Number of Individuals Covered | 204 | Insurance policy start date | 2017-06-30 | Insurance policy end date | 2018-07-01 | Total amount of commissions paid to insurance broker | USD $3,279 | Total amount of fees paid to insurance company | USD $1,484 | Are there contracts with allocated funds for individual policies? | 1 | 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 | Yes | 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 $35,575 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,279 | Amount paid for insurance broker fees | 1484 | Insurance broker organization code? | 3 | Insurance broker name | CBIZ BENEFITS & INSURANCE SVS INC |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GTLD04301 |
Policy instance | 1 |
Insurance contract or identification number | GTLD04301 | Number of Individuals Covered | 137 | Insurance policy start date | 2015-06-01 | Insurance policy end date | 2016-06-01 | Total amount of commissions paid to insurance broker | USD $3,762 | Total amount of fees paid to insurance company | USD $1,629 | Are there contracts with allocated funds for individual policies? | Yes | 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 | Yes | 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 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,762 | Amount paid for insurance broker fees | 1629 | Additional information about fees paid to insurance broker | AGNET OR BROKER OF RECORD OTHER COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | CBIZ BENEFITS & INSURANCE SVS INC |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G0004301 |
Policy instance | 1 |
Insurance contract or identification number | G0004301 | Number of Individuals Covered | 77 | Insurance policy start date | 2014-07-01 | Insurance policy end date | 2015-06-30 | Total amount of commissions paid to insurance broker | USD $5,284 | Total amount of fees paid to insurance company | USD $1,795 | 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 | 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 | 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 $35,224 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,284 | Amount paid for insurance broker fees | 1795 | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD OTHER COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | CBIZ BENEFITS & INSURANCE SVS INC |
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UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
Policy contract number | 5428265 |
Policy instance | 1 |
Insurance contract or identification number | 5428265 | Number of Individuals Covered | 105 | Insurance policy start date | 2013-07-01 | Insurance policy end date | 2014-06-30 | Total amount of commissions paid to insurance broker | USD $5,158 | Total amount of fees paid to insurance company | USD $513 | 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 | 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 $31,124 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,158 | Amount paid for insurance broker fees | 513 | Additional information about fees paid to insurance broker | FEES & OTHER COMMISSIONS | Insurance broker organization code? | 3 | Insurance broker name | CBIZ BENEFITS & INS SERV |
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UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
Policy contract number | 5428265 |
Policy instance | 1 |
Insurance contract or identification number | 5428265 | Number of Individuals Covered | 110 | Insurance policy start date | 2012-07-01 | Insurance policy end date | 2013-06-30 | Total amount of commissions paid to insurance broker | USD $4,858 | Total amount of fees paid to insurance company | USD $482 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $48,606 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,858 | Amount paid for insurance broker fees | 482 | Additional information about fees paid to insurance broker | DENTAL INSURANCE | Insurance broker organization code? | 3 | Insurance broker name | CBIZ BENEFITS & INSURANCE SERV |
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UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
Policy contract number | 5428265 |
Policy instance | 1 |
Insurance contract or identification number | 5428265 | Number of Individuals Covered | 105 | Insurance policy start date | 2011-07-01 | Insurance policy end date | 2012-06-30 | Total amount of commissions paid to insurance broker | USD $4,963 | Total amount of fees paid to insurance company | USD $246 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $49,611 | 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 | G000430I |
Policy instance | 2 |
Insurance contract or identification number | G000430I | Number of Individuals Covered | 131 | Insurance policy start date | 2010-06-01 | Insurance policy end date | 2011-06-01 | Total amount of commissions paid to insurance broker | USD $4,595 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $38,245 | Commission paid to Insurance Broker | USD $3,049 | Amount paid for insurance broker fees | 0 | Additional information about fees paid to insurance broker | AGENT OR BROCKER OF RECORD | Insurance broker organization code? | 3 | Insurance broker name | ERIN P COLLINS AND ASSOCIATES INC |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000430I |
Policy instance | 3 |
Insurance contract or identification number | G000430I | Number of Individuals Covered | 69 | Insurance policy start date | 2010-06-01 | Insurance policy end date | 2011-06-01 | Total amount of commissions paid to insurance broker | USD $5,713 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | VOLUNTARY LIFE AND AD & D | Welfare Benefit Premiums Paid to Carrier | USD $31,635 | Commission paid to Insurance Broker | USD $3,799 | Amount paid for insurance broker fees | 0 | Additional information about fees paid to insurance broker | AGENT OR BROCKER OF RECORD | Insurance broker organization code? | 3 | Insurance broker name | ERIN P COLLINS AND ASSOCIATES INC |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000430I |
Policy instance | 1 |
Insurance contract or identification number | G000430I | Number of Individuals Covered | 131 | Insurance policy start date | 2010-06-01 | Insurance policy end date | 2011-06-01 | Total amount of commissions paid to insurance broker | USD $3,507 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $26,818 | Commission paid to Insurance Broker | USD $2,434 | Additional information about fees paid to insurance broker | AGENT OR BROCKER OF RECORD | Insurance broker organization code? | 3 | Insurance broker name | ERIN P COLLINS AND ASSOCIATES INC |
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