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PEPPERMILL CASINO, INC. GROUP INSURANCE PLAN 401k Plan overview

Plan NamePEPPERMILL CASINO, INC. GROUP INSURANCE PLAN
Plan identification number 504

PEPPERMILL CASINO, INC. GROUP INSURANCE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

PEPPERMILL CASINOS, INC. has sponsored the creation of one or more 401k plans.

Company Name:PEPPERMILL CASINOS, INC.
Employer identification number (EIN):880302737
NAIC Classification:721120
NAIC Description:Casino Hotels

Additional information about PEPPERMILL CASINOS, INC.

Jurisdiction of Incorporation: Nevada Department of State
Incorporation Date: 1993-05-27
Company Identification Number: 19931050930
Legal Registered Office Address: 4785 CAUGHLIN PARKWAY

RENO
United States of America (USA)
89519

More information about PEPPERMILL CASINOS, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PEPPERMILL CASINO, INC. GROUP INSURANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5042022-05-01DENISE VESSIE2023-09-19
5042021-05-01DENISE VESSIE2022-09-09
5042020-05-01DENISE VESSIE2021-09-09
5042019-05-01DENISE VESSIE2020-10-22
5042018-05-01DENISE VESSIE2019-10-25
5042017-05-01
5042016-05-01
5042015-05-01DENISE VESSIE
5042014-05-01DENISE VESSIE
5042013-05-01DENISE VESSIE
5042012-05-01DENISE VESSIE
5042011-05-01DENISE VESSIE
5042009-05-01DENISE VESSIE

Plan Statistics for PEPPERMILL CASINO, INC. GROUP INSURANCE PLAN

401k plan membership statisitcs for PEPPERMILL CASINO, INC. GROUP INSURANCE PLAN

Measure Date Value
2022: PEPPERMILL CASINO, INC. GROUP INSURANCE PLAN 2022 401k membership
Total participants, beginning-of-year2022-05-012,157
Total number of active participants reported on line 7a of the Form 55002022-05-012,165
Number of retired or separated participants receiving benefits2022-05-010
Number of other retired or separated participants entitled to future benefits2022-05-010
Total of all active and inactive participants2022-05-012,165
Number of employers contributing to the scheme2022-05-010
2021: PEPPERMILL CASINO, INC. GROUP INSURANCE PLAN 2021 401k membership
Total participants, beginning-of-year2021-05-012,576
Total number of active participants reported on line 7a of the Form 55002021-05-012,157
Number of retired or separated participants receiving benefits2021-05-010
Number of other retired or separated participants entitled to future benefits2021-05-010
Total of all active and inactive participants2021-05-012,157
Number of employers contributing to the scheme2021-05-010
2020: PEPPERMILL CASINO, INC. GROUP INSURANCE PLAN 2020 401k membership
Total participants, beginning-of-year2020-05-012,582
Total number of active participants reported on line 7a of the Form 55002020-05-012,576
Number of retired or separated participants receiving benefits2020-05-010
Number of other retired or separated participants entitled to future benefits2020-05-010
Total of all active and inactive participants2020-05-012,576
Number of employers contributing to the scheme2020-05-010
2019: PEPPERMILL CASINO, INC. GROUP INSURANCE PLAN 2019 401k membership
Total participants, beginning-of-year2019-05-012,529
Total number of active participants reported on line 7a of the Form 55002019-05-012,582
Number of retired or separated participants receiving benefits2019-05-010
Number of other retired or separated participants entitled to future benefits2019-05-010
Total of all active and inactive participants2019-05-012,582
Number of employers contributing to the scheme2019-05-010
2018: PEPPERMILL CASINO, INC. GROUP INSURANCE PLAN 2018 401k membership
Total participants, beginning-of-year2018-05-012,571
Total number of active participants reported on line 7a of the Form 55002018-05-012,526
Number of retired or separated participants receiving benefits2018-05-013
Number of other retired or separated participants entitled to future benefits2018-05-010
Total of all active and inactive participants2018-05-012,529
Number of employers contributing to the scheme2018-05-010
2017: PEPPERMILL CASINO, INC. GROUP INSURANCE PLAN 2017 401k membership
Total participants, beginning-of-year2017-05-012,278
Total number of active participants reported on line 7a of the Form 55002017-05-012,681
Number of retired or separated participants receiving benefits2017-05-019
Number of other retired or separated participants entitled to future benefits2017-05-0132
Total of all active and inactive participants2017-05-012,722
2016: PEPPERMILL CASINO, INC. GROUP INSURANCE PLAN 2016 401k membership
Total participants, beginning-of-year2016-05-012,364
Total number of active participants reported on line 7a of the Form 55002016-05-012,278
Number of retired or separated participants receiving benefits2016-05-010
Number of other retired or separated participants entitled to future benefits2016-05-010
Total of all active and inactive participants2016-05-012,278
2015: PEPPERMILL CASINO, INC. GROUP INSURANCE PLAN 2015 401k membership
Total participants, beginning-of-year2015-05-012,359
Total number of active participants reported on line 7a of the Form 55002015-05-012,364
Number of retired or separated participants receiving benefits2015-05-010
Number of other retired or separated participants entitled to future benefits2015-05-010
Total of all active and inactive participants2015-05-012,364
2014: PEPPERMILL CASINO, INC. GROUP INSURANCE PLAN 2014 401k membership
Total participants, beginning-of-year2014-05-012,244
Total number of active participants reported on line 7a of the Form 55002014-05-012,341
Number of retired or separated participants receiving benefits2014-05-0118
Number of other retired or separated participants entitled to future benefits2014-05-010
Total of all active and inactive participants2014-05-012,359
2013: PEPPERMILL CASINO, INC. GROUP INSURANCE PLAN 2013 401k membership
Total participants, beginning-of-year2013-05-012,410
Total number of active participants reported on line 7a of the Form 55002013-05-012,344
Number of retired or separated participants receiving benefits2013-05-010
Number of other retired or separated participants entitled to future benefits2013-05-010
Total of all active and inactive participants2013-05-012,344
2012: PEPPERMILL CASINO, INC. GROUP INSURANCE PLAN 2012 401k membership
Total participants, beginning-of-year2012-05-012,586
Total number of active participants reported on line 7a of the Form 55002012-05-012,410
Number of retired or separated participants receiving benefits2012-05-010
Number of other retired or separated participants entitled to future benefits2012-05-010
Total of all active and inactive participants2012-05-012,410
2011: PEPPERMILL CASINO, INC. GROUP INSURANCE PLAN 2011 401k membership
Total participants, beginning-of-year2011-05-012,753
Total number of active participants reported on line 7a of the Form 55002011-05-012,586
Number of retired or separated participants receiving benefits2011-05-010
Number of other retired or separated participants entitled to future benefits2011-05-010
Total of all active and inactive participants2011-05-012,586
2009: PEPPERMILL CASINO, INC. GROUP INSURANCE PLAN 2009 401k membership
Total participants, beginning-of-year2009-05-012,685
Total number of active participants reported on line 7a of the Form 55002009-05-012,735
Number of retired or separated participants receiving benefits2009-05-010
Number of other retired or separated participants entitled to future benefits2009-05-010
Total of all active and inactive participants2009-05-012,735

Form 5500 Responses for PEPPERMILL CASINO, INC. GROUP INSURANCE PLAN

2022: PEPPERMILL CASINO, INC. GROUP INSURANCE PLAN 2022 form 5500 responses
2022-05-01Type of plan entitySingle employer plan
2022-05-01Plan funding arrangement – InsuranceYes
2022-05-01Plan funding arrangement – General assets of the sponsorYes
2022-05-01Plan benefit arrangement – InsuranceYes
2022-05-01Plan benefit arrangement – General assets of the sponsorYes
2021: PEPPERMILL CASINO, INC. GROUP INSURANCE PLAN 2021 form 5500 responses
2021-05-01Type of plan entitySingle employer plan
2021-05-01Plan funding arrangement – InsuranceYes
2021-05-01Plan funding arrangement – General assets of the sponsorYes
2021-05-01Plan benefit arrangement – InsuranceYes
2021-05-01Plan benefit arrangement – General assets of the sponsorYes
2020: PEPPERMILL CASINO, INC. GROUP INSURANCE PLAN 2020 form 5500 responses
2020-05-01Type of plan entitySingle employer plan
2020-05-01Plan funding arrangement – InsuranceYes
2020-05-01Plan funding arrangement – General assets of the sponsorYes
2020-05-01Plan benefit arrangement – InsuranceYes
2020-05-01Plan benefit arrangement – General assets of the sponsorYes
2019: PEPPERMILL CASINO, INC. GROUP INSURANCE PLAN 2019 form 5500 responses
2019-05-01Type of plan entitySingle employer plan
2019-05-01Plan funding arrangement – InsuranceYes
2019-05-01Plan funding arrangement – General assets of the sponsorYes
2019-05-01Plan benefit arrangement – InsuranceYes
2019-05-01Plan benefit arrangement – General assets of the sponsorYes
2018: PEPPERMILL CASINO, INC. GROUP INSURANCE PLAN 2018 form 5500 responses
2018-05-01Type of plan entitySingle employer plan
2018-05-01Plan funding arrangement – InsuranceYes
2018-05-01Plan funding arrangement – General assets of the sponsorYes
2018-05-01Plan benefit arrangement – InsuranceYes
2018-05-01Plan benefit arrangement – General assets of the sponsorYes
2017: PEPPERMILL CASINO, INC. GROUP INSURANCE PLAN 2017 form 5500 responses
2017-05-01Type of plan entitySingle employer plan
2017-05-01Plan funding arrangement – InsuranceYes
2017-05-01Plan funding arrangement – General assets of the sponsorYes
2017-05-01Plan benefit arrangement – InsuranceYes
2017-05-01Plan benefit arrangement – General assets of the sponsorYes
2016: PEPPERMILL CASINO, INC. GROUP INSURANCE PLAN 2016 form 5500 responses
2016-05-01Type of plan entitySingle employer plan
2016-05-01Submission has been amendedNo
2016-05-01This submission is the final filingNo
2016-05-01This return/report is a short plan year return/report (less than 12 months)No
2016-05-01Plan is a collectively bargained planNo
2016-05-01Plan funding arrangement – InsuranceYes
2016-05-01Plan funding arrangement – General assets of the sponsorYes
2016-05-01Plan benefit arrangement – InsuranceYes
2016-05-01Plan benefit arrangement – General assets of the sponsorYes
2015: PEPPERMILL CASINO, INC. GROUP INSURANCE PLAN 2015 form 5500 responses
2015-05-01Type of plan entitySingle employer plan
2015-05-01Submission has been amendedNo
2015-05-01This submission is the final filingNo
2015-05-01This return/report is a short plan year return/report (less than 12 months)No
2015-05-01Plan is a collectively bargained planNo
2015-05-01Plan funding arrangement – InsuranceYes
2015-05-01Plan funding arrangement – General assets of the sponsorYes
2015-05-01Plan benefit arrangement – InsuranceYes
2015-05-01Plan benefit arrangement – General assets of the sponsorYes
2014: PEPPERMILL CASINO, INC. GROUP INSURANCE PLAN 2014 form 5500 responses
2014-05-01Type of plan entitySingle employer plan
2014-05-01Submission has been amendedNo
2014-05-01This submission is the final filingNo
2014-05-01This return/report is a short plan year return/report (less than 12 months)No
2014-05-01Plan is a collectively bargained planNo
2014-05-01Plan funding arrangement – InsuranceYes
2014-05-01Plan funding arrangement – General assets of the sponsorYes
2014-05-01Plan benefit arrangement – InsuranceYes
2014-05-01Plan benefit arrangement – General assets of the sponsorYes
2013: PEPPERMILL CASINO, INC. GROUP INSURANCE PLAN 2013 form 5500 responses
2013-05-01Type of plan entitySingle employer plan
2013-05-01Submission has been amendedNo
2013-05-01This submission is the final filingNo
2013-05-01This return/report is a short plan year return/report (less than 12 months)No
2013-05-01Plan is a collectively bargained planNo
2013-05-01Plan funding arrangement – InsuranceYes
2013-05-01Plan funding arrangement – General assets of the sponsorYes
2013-05-01Plan benefit arrangement – InsuranceYes
2013-05-01Plan benefit arrangement – General assets of the sponsorYes
2012: PEPPERMILL CASINO, INC. GROUP INSURANCE PLAN 2012 form 5500 responses
2012-05-01Type of plan entitySingle employer plan
2012-05-01Submission has been amendedNo
2012-05-01This submission is the final filingNo
2012-05-01This return/report is a short plan year return/report (less than 12 months)No
2012-05-01Plan is a collectively bargained planNo
2012-05-01Plan funding arrangement – InsuranceYes
2012-05-01Plan funding arrangement – General assets of the sponsorYes
2012-05-01Plan benefit arrangement – InsuranceYes
2012-05-01Plan benefit arrangement – General assets of the sponsorYes
2011: PEPPERMILL CASINO, INC. GROUP INSURANCE PLAN 2011 form 5500 responses
2011-05-01Type of plan entitySingle employer plan
2011-05-01Submission has been amendedNo
2011-05-01This submission is the final filingNo
2011-05-01This return/report is a short plan year return/report (less than 12 months)No
2011-05-01Plan is a collectively bargained planNo
2011-05-01Plan funding arrangement – InsuranceYes
2011-05-01Plan funding arrangement – General assets of the sponsorYes
2011-05-01Plan benefit arrangement – InsuranceYes
2011-05-01Plan benefit arrangement – General assets of the sponsorYes
2009: PEPPERMILL CASINO, INC. GROUP INSURANCE PLAN 2009 form 5500 responses
2009-05-01Type of plan entitySingle employer plan
2009-05-01Submission has been amendedNo
2009-05-01This submission is the final filingNo
2009-05-01This return/report is a short plan year return/report (less than 12 months)No
2009-05-01Plan is a collectively bargained planNo
2009-05-01Plan funding arrangement – InsuranceYes
2009-05-01Plan funding arrangement – General assets of the sponsorYes
2009-05-01Plan benefit arrangement – InsuranceYes
2009-05-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number641604
Policy instance 2
Insurance contract or identification number641604
Number of Individuals Covered2276
Insurance policy start date2021-06-01
Insurance policy end date2022-05-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $2,431
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees2431
Additional information about fees paid to insurance brokerCONTINGENT COMPENSATION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUC0814H
Policy instance 1
Insurance contract or identification numberGUC0814H
Number of Individuals Covered624
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $48,249
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $321,658
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $48,249
Amount paid for insurance broker fees0
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number641604
Policy instance 2
Insurance contract or identification number641604
Number of Individuals Covered2269
Insurance policy start date2020-06-01
Insurance policy end date2021-05-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $1,840
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees1840
Additional information about fees paid to insurance brokerCONTINGENT COMPENSATION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUC0814H
Policy instance 1
Insurance contract or identification numberGUC0814H
Number of Individuals Covered657
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $43,075
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $287,168
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $43,075
Amount paid for insurance broker fees0
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number641604
Policy instance 2
Insurance contract or identification number641604
Number of Individuals Covered2576
Insurance policy start date2019-06-01
Insurance policy end date2020-05-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $2,796
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees2796
Additional information about fees paid to insurance brokerCONTINGENT COMPENSATION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUC0814H
Policy instance 1
Insurance contract or identification numberGUC0814H
Number of Individuals Covered696
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $46,354
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $309,026
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $46,354
Amount paid for insurance broker fees0
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number641604
Policy instance 2
Insurance contract or identification number641604
Number of Individuals Covered2584
Insurance policy start date2018-06-01
Insurance policy end date2019-05-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $3,647
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees3647
Additional information about fees paid to insurance brokerCONTINGENT COMPENSATION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUC0814H
Policy instance 1
Insurance contract or identification numberGUC0814H
Number of Individuals Covered797
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $49,967
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $333,114
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $49,967
Amount paid for insurance broker fees0
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number641604
Policy instance 2
Insurance contract or identification number641604
Number of Individuals Covered2729
Insurance policy start date2017-06-01
Insurance policy end date2018-05-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $1,035
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees1035
Additional information about fees paid to insurance brokerCONTINGENT COMPENSATION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUC0814H
Policy instance 1
Insurance contract or identification numberGUC0814H
Number of Individuals Covered1655
Insurance policy start date2018-03-31
Insurance policy end date2019-02-28
Total amount of commissions paid to insurance brokerUSD $48,201
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $321,339
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $48,201
Amount paid for insurance broker fees0
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number641604
Policy instance 2
Insurance contract or identification number641604
Number of Individuals Covered2587
Insurance policy start date2016-06-01
Insurance policy end date2017-05-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $1,758
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees1758
Additional information about fees paid to insurance brokerCONTINGENT COMPENSATION
Insurance broker organization code?3
Insurance broker nameLOCKTON COMPANIES, LLC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUC0814H
Policy instance 1
Insurance contract or identification numberGUC0814H
Number of Individuals Covered843
Insurance policy start date2017-03-01
Insurance policy end date2018-02-28
Total amount of commissions paid to insurance brokerUSD $45,782
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $311,425
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $45,782
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameLOCKTON COMPANIES, LLC

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