401k Plan data: T & R ELECTRIC SUPPLY COMPANY, INC. HEALTHCARE PLAN plan

T & R ELECTRIC SUPPLY COMPANY, INC. HEALTHCARE PLAN 401k Plan overview

Plan Name	T & R ELECTRIC SUPPLY COMPANY, INC. HEALTHCARE PLAN
Plan identification number	502

T & R ELECTRIC SUPPLY COMPANY, INC. HEALTHCARE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental

401k Sponsoring company profile

T & R ELECTRIC SUPPLY CO., INC. has sponsored the creation of one or more 401k plans.

Company Name: T & R ELECTRIC SUPPLY CO., INC.

Employer identification number (EIN): 460283047

NAIC Classification: 335310

Form 5500 Filing Information

Submission information for form 5500 for 401k plan T & R ELECTRIC SUPPLY COMPANY, INC. HEALTHCARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2023-01-01
502 2022-01-01
502 2021-01-01
502 2020-07-01
502 2019-07-01
502 2018-07-01
502 2017-07-01 CHRIS THOMPSON
502 2016-07-01 CHRIS THOMPSON
502 2015-07-01 CHRIS THOMPSON
502 2014-07-01 CHRIS THOMPSON
502 2013-07-01 CHRIS THOMPSON
502 2012-07-01 CHRIS THOMPSON

Plan Statistics for T & R ELECTRIC SUPPLY COMPANY, INC. HEALTHCARE PLAN

401k plan membership statisitcs for T & R ELECTRIC SUPPLY COMPANY, INC. HEALTHCARE PLAN

Measure Date Value
2023: T & R ELECTRIC SUPPLY COMPANY, INC. HEALTHCARE PLAN 2023 401k membership
Total participants, beginning-of-year 2023-01-01 109
Total number of active participants reported on line 7a of the Form 5500 2023-01-01 118
Number of retired or separated participants receiving benefits 2023-01-01 0
Number of other retired or separated participants entitled to future benefits 2023-01-01 0
Total of all active and inactive participants 2023-01-01 118
2022: T & R ELECTRIC SUPPLY COMPANY, INC. HEALTHCARE PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 236
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 109
Number of retired or separated participants receiving benefits 2022-01-01 0
Number of other retired or separated participants entitled to future benefits 2022-01-01 0
Total of all active and inactive participants 2022-01-01 109
2021: T & R ELECTRIC SUPPLY COMPANY, INC. HEALTHCARE PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 258
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 236
Number of retired or separated participants receiving benefits 2021-01-01 0
Number of other retired or separated participants entitled to future benefits 2021-01-01 0
Total of all active and inactive participants 2021-01-01 236
2020: T & R ELECTRIC SUPPLY COMPANY, INC. HEALTHCARE PLAN 2020 401k membership
Total participants, beginning-of-year 2020-07-01 254
Total number of active participants reported on line 7a of the Form 5500 2020-07-01 258
Number of retired or separated participants receiving benefits 2020-07-01 0
Number of other retired or separated participants entitled to future benefits 2020-07-01 0
Total of all active and inactive participants 2020-07-01 258
2019: T & R ELECTRIC SUPPLY COMPANY, INC. HEALTHCARE PLAN 2019 401k membership
Total participants, beginning-of-year 2019-07-01 258
Total number of active participants reported on line 7a of the Form 5500 2019-07-01 254
Number of retired or separated participants receiving benefits 2019-07-01 0
Number of other retired or separated participants entitled to future benefits 2019-07-01 0
Total of all active and inactive participants 2019-07-01 254
2018: T & R ELECTRIC SUPPLY COMPANY, INC. HEALTHCARE PLAN 2018 401k membership
Total participants, beginning-of-year 2018-07-01 256
Total number of active participants reported on line 7a of the Form 5500 2018-07-01 258
Number of retired or separated participants receiving benefits 2018-07-01 0
Number of other retired or separated participants entitled to future benefits 2018-07-01 0
Total of all active and inactive participants 2018-07-01 258
2017: T & R ELECTRIC SUPPLY COMPANY, INC. HEALTHCARE PLAN 2017 401k membership
Total participants, beginning-of-year 2017-07-01 0
Total number of active participants reported on line 7a of the Form 5500 2017-07-01 256
Number of retired or separated participants receiving benefits 2017-07-01 0
Number of other retired or separated participants entitled to future benefits 2017-07-01 0
Total of all active and inactive participants 2017-07-01 256
2016: T & R ELECTRIC SUPPLY COMPANY, INC. HEALTHCARE PLAN 2016 401k membership
Total participants, beginning-of-year 2016-07-01 231
Total number of active participants reported on line 7a of the Form 5500 2016-07-01 238
Number of retired or separated participants receiving benefits 2016-07-01 0
Number of other retired or separated participants entitled to future benefits 2016-07-01 0
Total of all active and inactive participants 2016-07-01 238
2015: T & R ELECTRIC SUPPLY COMPANY, INC. HEALTHCARE PLAN 2015 401k membership
Total participants, beginning-of-year 2015-07-01 118
Total number of active participants reported on line 7a of the Form 5500 2015-07-01 231
Number of retired or separated participants receiving benefits 2015-07-01 0
Number of other retired or separated participants entitled to future benefits 2015-07-01 0
Total of all active and inactive participants 2015-07-01 231
2014: T & R ELECTRIC SUPPLY COMPANY, INC. HEALTHCARE PLAN 2014 401k membership
Total participants, beginning-of-year 2014-07-01 110
Total number of active participants reported on line 7a of the Form 5500 2014-07-01 118
Number of retired or separated participants receiving benefits 2014-07-01 0
Number of other retired or separated participants entitled to future benefits 2014-07-01 0
Total of all active and inactive participants 2014-07-01 118
2013: T & R ELECTRIC SUPPLY COMPANY, INC. HEALTHCARE PLAN 2013 401k membership
Total participants, beginning-of-year 2013-07-01 111
Total number of active participants reported on line 7a of the Form 5500 2013-07-01 110
Total of all active and inactive participants 2013-07-01 110
2012: T & R ELECTRIC SUPPLY COMPANY, INC. HEALTHCARE PLAN 2012 401k membership
Total participants, beginning-of-year 2012-07-01 95
Total number of active participants reported on line 7a of the Form 5500 2012-07-01 111
Total of all active and inactive participants 2012-07-01 111
Total participants 2012-07-01 0

Measure	Date	Value
2023: T & R ELECTRIC SUPPLY COMPANY, INC. HEALTHCARE PLAN 2023 401k membership
Total participants, beginning-of-year	2023-01-01	109
Total number of active participants reported on line 7a of the Form 5500	2023-01-01	118
Number of retired or separated participants receiving benefits	2023-01-01	0
Number of other retired or separated participants entitled to future benefits	2023-01-01	0
Total of all active and inactive participants	2023-01-01	118
2022: T & R ELECTRIC SUPPLY COMPANY, INC. HEALTHCARE PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	236
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	109
Number of retired or separated participants receiving benefits	2022-01-01	0
Number of other retired or separated participants entitled to future benefits	2022-01-01	0
Total of all active and inactive participants	2022-01-01	109
2021: T & R ELECTRIC SUPPLY COMPANY, INC. HEALTHCARE PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	258
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	236
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	0
Total of all active and inactive participants	2021-01-01	236
2020: T & R ELECTRIC SUPPLY COMPANY, INC. HEALTHCARE PLAN 2020 401k membership
Total participants, beginning-of-year	2020-07-01	254
Total number of active participants reported on line 7a of the Form 5500	2020-07-01	258
Number of retired or separated participants receiving benefits	2020-07-01	0
Number of other retired or separated participants entitled to future benefits	2020-07-01	0
Total of all active and inactive participants	2020-07-01	258
2019: T & R ELECTRIC SUPPLY COMPANY, INC. HEALTHCARE PLAN 2019 401k membership
Total participants, beginning-of-year	2019-07-01	258
Total number of active participants reported on line 7a of the Form 5500	2019-07-01	254
Number of retired or separated participants receiving benefits	2019-07-01	0
Number of other retired or separated participants entitled to future benefits	2019-07-01	0
Total of all active and inactive participants	2019-07-01	254
2018: T & R ELECTRIC SUPPLY COMPANY, INC. HEALTHCARE PLAN 2018 401k membership
Total participants, beginning-of-year	2018-07-01	256
Total number of active participants reported on line 7a of the Form 5500	2018-07-01	258
Number of retired or separated participants receiving benefits	2018-07-01	0
Number of other retired or separated participants entitled to future benefits	2018-07-01	0
Total of all active and inactive participants	2018-07-01	258
2017: T & R ELECTRIC SUPPLY COMPANY, INC. HEALTHCARE PLAN 2017 401k membership
Total participants, beginning-of-year	2017-07-01	0
Total number of active participants reported on line 7a of the Form 5500	2017-07-01	256
Number of retired or separated participants receiving benefits	2017-07-01	0
Number of other retired or separated participants entitled to future benefits	2017-07-01	0
Total of all active and inactive participants	2017-07-01	256
2016: T & R ELECTRIC SUPPLY COMPANY, INC. HEALTHCARE PLAN 2016 401k membership
Total participants, beginning-of-year	2016-07-01	231
Total number of active participants reported on line 7a of the Form 5500	2016-07-01	238
Number of retired or separated participants receiving benefits	2016-07-01	0
Number of other retired or separated participants entitled to future benefits	2016-07-01	0
Total of all active and inactive participants	2016-07-01	238
2015: T & R ELECTRIC SUPPLY COMPANY, INC. HEALTHCARE PLAN 2015 401k membership
Total participants, beginning-of-year	2015-07-01	118
Total number of active participants reported on line 7a of the Form 5500	2015-07-01	231
Number of retired or separated participants receiving benefits	2015-07-01	0
Number of other retired or separated participants entitled to future benefits	2015-07-01	0
Total of all active and inactive participants	2015-07-01	231
2014: T & R ELECTRIC SUPPLY COMPANY, INC. HEALTHCARE PLAN 2014 401k membership
Total participants, beginning-of-year	2014-07-01	110
Total number of active participants reported on line 7a of the Form 5500	2014-07-01	118
Number of retired or separated participants receiving benefits	2014-07-01	0
Number of other retired or separated participants entitled to future benefits	2014-07-01	0
Total of all active and inactive participants	2014-07-01	118
2013: T & R ELECTRIC SUPPLY COMPANY, INC. HEALTHCARE PLAN 2013 401k membership
Total participants, beginning-of-year	2013-07-01	111
Total number of active participants reported on line 7a of the Form 5500	2013-07-01	110
Total of all active and inactive participants	2013-07-01	110
2012: T & R ELECTRIC SUPPLY COMPANY, INC. HEALTHCARE PLAN 2012 401k membership
Total participants, beginning-of-year	2012-07-01	95
Total number of active participants reported on line 7a of the Form 5500	2012-07-01	111
Total of all active and inactive participants	2012-07-01	111
Total participants	2012-07-01	0

Financial Data on T & R ELECTRIC SUPPLY COMPANY, INC. HEALTHCARE PLAN

Measure	Date	Value
2014 : T & R ELECTRIC SUPPLY COMPANY, INC. HEALTHCARE PLAN 2014 401k financial data
Total income from all sources	2014-06-30	$0
Total plan assets at end of year	2014-06-30	$0
Total plan assets at beginning of year	2014-06-30	$0
Net plan assets at end of year (total assets less liabilities)	2014-06-30	$0
Net plan assets at beginning of year (total assets less liabilities)	2014-06-30	$0

Form 5500 Responses for T & R ELECTRIC SUPPLY COMPANY, INC. HEALTHCARE PLAN

2023: T & R ELECTRIC SUPPLY COMPANY, INC. HEALTHCARE PLAN 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
2023-01-01	Plan funding arrangement – Insurance	Yes
2023-01-01	Plan benefit arrangement – Insurance	Yes
2022: T & R ELECTRIC SUPPLY COMPANY, INC. HEALTHCARE PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2021: T & R ELECTRIC SUPPLY COMPANY, INC. HEALTHCARE PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2020: T & R ELECTRIC SUPPLY COMPANY, INC. HEALTHCARE PLAN 2020 form 5500 responses
2020-07-01	Type of plan entity	Single employer plan
2020-07-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2020-07-01	Plan funding arrangement – Insurance	Yes
2020-07-01	Plan benefit arrangement – Insurance	Yes
2019: T & R ELECTRIC SUPPLY COMPANY, INC. HEALTHCARE PLAN 2019 form 5500 responses
2019-07-01	Type of plan entity	Single employer plan
2019-07-01	Plan funding arrangement – Insurance	Yes
2019-07-01	Plan benefit arrangement – Insurance	Yes
2018: T & R ELECTRIC SUPPLY COMPANY, INC. HEALTHCARE PLAN 2018 form 5500 responses
2018-07-01	Type of plan entity	Single employer plan
2018-07-01	Plan funding arrangement – Insurance	Yes
2018-07-01	Plan benefit arrangement – Insurance	Yes
2017: T & R ELECTRIC SUPPLY COMPANY, INC. HEALTHCARE PLAN 2017 form 5500 responses
2017-07-01	Type of plan entity	Single employer plan
2017-07-01	Plan funding arrangement – Insurance	Yes
2017-07-01	Plan benefit arrangement – Insurance	Yes
2016: T & R ELECTRIC SUPPLY COMPANY, INC. HEALTHCARE PLAN 2016 form 5500 responses
2016-07-01	Type of plan entity	Single employer plan
2016-07-01	Plan funding arrangement – Insurance	Yes
2016-07-01	Plan benefit arrangement – Insurance	Yes
2015: T & R ELECTRIC SUPPLY COMPANY, INC. HEALTHCARE PLAN 2015 form 5500 responses
2015-07-01	Type of plan entity	Single employer plan
2015-07-01	Plan funding arrangement – Insurance	Yes
2015-07-01	Plan benefit arrangement – Insurance	Yes
2014: T & R ELECTRIC SUPPLY COMPANY, INC. HEALTHCARE PLAN 2014 form 5500 responses
2014-07-01	Type of plan entity	Single employer plan
2014-07-01	Plan funding arrangement – Insurance	Yes
2014-07-01	Plan benefit arrangement – Insurance	Yes
2013: T & R ELECTRIC SUPPLY COMPANY, INC. HEALTHCARE PLAN 2013 form 5500 responses
2013-07-01	Type of plan entity	Single employer plan
2013-07-01	Plan funding arrangement – Insurance	Yes
2013-07-01	Plan benefit arrangement – Insurance	Yes
2012: T & R ELECTRIC SUPPLY COMPANY, INC. HEALTHCARE PLAN 2012 form 5500 responses
2012-07-01	Type of plan entity	Single employer plan
2012-07-01	Plan funding arrangement – Insurance	Yes
2012-07-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

AVERA HEALTH PLANS, INC. (National Association of Insurance Commissioners NAIC id number: 95839 )

Policy contract number

A0000265

Policy instance

Insurance contract or identification number	A0000265
Number of Individuals Covered	118
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 54097 )

Policy contract number

2238

Policy instance

Insurance contract or identification number	2238
Number of Individuals Covered	114
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $1,718
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000010161549

Policy instance

Insurance contract or identification number	000010161549
Number of Individuals Covered	115
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $835
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $10,380
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AVERA HEALTH PLANS, INC. (National Association of Insurance Commissioners NAIC id number: 95839 )

Policy contract number

A0000265

Policy instance

Insurance contract or identification number	A0000265
Number of Individuals Covered	109
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 54097 )

Policy contract number

2238

Policy instance

Insurance contract or identification number	2238
Number of Individuals Covered	115
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $1,614
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 $1,614
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000010161549

Policy instance

Insurance contract or identification number	000010161549
Number of Individuals Covered	115
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $723
Total amount of fees paid to insurance company	USD $249
Health Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $8,906
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $723
Amount paid for insurance broker fees	249
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000010161549

Policy instance

Insurance contract or identification number	000010161549
Number of Individuals Covered	118
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $733
Health Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $9,047
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $733
Insurance broker organization code?	3

DELTA DENTAL OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 54097 )

Policy contract number

2238

Policy instance

Insurance contract or identification number	2238
Number of Individuals Covered	119
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $1,611
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 $1,611
Insurance broker organization code?	3

AVERA HEALTH PLANS, INC. (National Association of Insurance Commissioners NAIC id number: 95839 )

Policy contract number

SD195

Policy instance

Insurance contract or identification number	SD195
Number of Individuals Covered	236
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

AVERA HEALTH PLANS, INC. (National Association of Insurance Commissioners NAIC id number: 95839 )

Policy contract number

SD195

Policy instance

Insurance contract or identification number	SD195
Number of Individuals Covered	241
Insurance policy start date	2020-07-01
Insurance policy end date	2020-12-31
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

DELTA DENTAL OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 54097 )

Policy contract number

2238

Policy instance

Insurance contract or identification number	2238
Number of Individuals Covered	258
Insurance policy start date	2020-07-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $862
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 $862
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000010161549

Policy instance

Insurance contract or identification number	000010161549
Number of Individuals Covered	123
Insurance policy start date	2020-07-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $324
Life 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 $324
Insurance broker organization code?	3

AVERA HEALTH PLANS, INC. (National Association of Insurance Commissioners NAIC id number: 95839 )

Policy contract number

SD195

Policy instance

Insurance contract or identification number	SD195
Number of Individuals Covered	240
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $23,022
Health 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 $23,022
Insurance broker organization code?	3

DELTA DENTAL OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 54097 )

Policy contract number

2238

Policy instance

Insurance contract or identification number	2238
Number of Individuals Covered	254
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $1,610
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 $1,213
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000010161549

Policy instance

Insurance contract or identification number	000010161549
Number of Individuals Covered	124
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $831
Total amount of fees paid to insurance company	USD $377
Life Insurance Welfare Benefit	Yes
Temporary Disability 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 $643
Insurance broker organization code?	3
Amount paid for insurance broker fees	377
Additional information about fees paid to insurance broker	BROKER BONUS

AVERA HEALTH PLANS, INC. (National Association of Insurance Commissioners NAIC id number: 95839 )

Policy contract number

SD195

Policy instance

Insurance contract or identification number	SD195
Number of Individuals Covered	247
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $26,496
Health 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 $26,496
Insurance broker organization code?	3

DELTA DENTAL OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 54097 )

Policy contract number

2238

Policy instance

Insurance contract or identification number	2238
Number of Individuals Covered	123
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $1,618
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 $1,618
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000010161549

Policy instance

Insurance contract or identification number	000010161549
Number of Individuals Covered	122
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $704
Total amount of fees paid to insurance company	USD $46
Life Insurance Welfare Benefit	Yes
Temporary Disability 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 $704
Amount paid for insurance broker fees	46
Insurance broker organization code?	3

AVERA HEALTH PLANS, INC. (National Association of Insurance Commissioners NAIC id number: 95839 )

Policy contract number

SD195

Policy instance

Insurance contract or identification number	SD195
Number of Individuals Covered	238
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $25,866
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $25,866
Insurance broker organization code?	3
Insurance broker name	HOLMES MURPHY & ASSOCAIATES

DELTA DENTAL OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 54097 )

Policy contract number

2238

Policy instance

Insurance contract or identification number	2238
Number of Individuals Covered	250
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $1,509
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,509
Insurance broker organization code?	3
Insurance broker name	HOLMES MURPHY & ASSOC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000010161549

Policy instance

Insurance contract or identification number	000010161549
Number of Individuals Covered	121
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $692
Total amount of fees paid to insurance company	USD $123
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $692
Amount paid for insurance broker fees	123
Insurance broker organization code?	3
Insurance broker name	HOLMES MURPHY & ASSOC INC

SANFORD HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95683 )

Policy contract number

HP000714

Policy instance

Insurance contract or identification number	HP000714
Number of Individuals Covered	248
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Total amount of commissions paid to insurance broker	USD $18,549
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,549
Insurance broker organization code?	3
Insurance broker name	HOLMES MURPHY & ASSOCAIATES

DELTA DENTAL OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 54097 )

Policy contract number

2238

Policy instance

Insurance contract or identification number	2238
Number of Individuals Covered	232
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Total amount of commissions paid to insurance broker	USD $1,498
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,498
Insurance broker organization code?	3
Insurance broker name	HOLMES MURPHY & ASSOC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000010161549

Policy instance

Insurance contract or identification number	000010161549
Number of Individuals Covered	118
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Total amount of commissions paid to insurance broker	USD $567
Total amount of fees paid to insurance company	USD $34
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $567
Amount paid for insurance broker fees	34
Insurance broker organization code?	3
Insurance broker name	HOLMES MURPHY & ASSOC INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000010161549

Policy instance

Insurance contract or identification number	000010161549
Number of Individuals Covered	118
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $583
Total amount of fees paid to insurance company	USD $32
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $583
Amount paid for insurance broker fees	32
Insurance broker organization code?	3
Insurance broker name	HOLMES MURPHY & ASSOC INC

DELTA DENTAL OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 54097 )

Policy contract number

2238

Policy instance

Insurance contract or identification number	2238
Number of Individuals Covered	232
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $1,504
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,504
Insurance broker organization code?	3
Insurance broker name	HOLMES MURPHY & ASSOC

SANFORD HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95683 )

Policy contract number

HP000714

Policy instance

Insurance contract or identification number	HP000714
Number of Individuals Covered	248
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $18,190
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,190
Insurance broker organization code?	3
Insurance broker name	HOLMES MURPHY & ASSOCAIATES

SANFORD HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95683 )

Policy contract number

HP000714

Policy instance

Insurance contract or identification number	HP000714
Number of Individuals Covered	241
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Total amount of commissions paid to insurance broker	USD $16,724
Health 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 $16,724
Insurance broker organization code?	3
Insurance broker name	HOLMES MURPHY & ASSOCIATES

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000010161549

Policy instance

Insurance contract or identification number	000010161549
Number of Individuals Covered	110
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Total amount of commissions paid to insurance broker	USD $514
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $514
Insurance broker organization code?	3
Insurance broker name	HOLMES MURPHY AND ASSOC INC

AIG MEDICAL EXCESS (National Association of Insurance Commissioners NAIC id number: 19445 )

Policy contract number

63000

Policy instance

Insurance contract or identification number	63000
Number of Individuals Covered	111
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $1,708
Other welfare benefits provided	TRANSPLANT
Welfare Benefit Premiums Paid to Carrier	USD $17,031
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8
Insurance broker name	HOLMES MURPHY & ASSOCIATES

HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )

Policy contract number

93440

Policy instance

Insurance contract or identification number	93440
Number of Individuals Covered	111
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Welfare Benefit Premiums Paid to Carrier	USD $261,300
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

63000

Policy instance

Insurance contract or identification number	63000
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $4
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $30
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
Insurance broker name	FIRST ADMINISTRATORS INC

WELLMARK BLUE CROSS BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 88848 )

Policy contract number

63000

Policy instance

Insurance contract or identification number	63000
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $104
Welfare Benefit Premiums Paid to Carrier	USD $850
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $104
Insurance broker name	FIRST ADMINISTRATORS INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000010161549

Policy instance

Insurance contract or identification number	000010161549
Number of Individuals Covered	108
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $519
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $6,085
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $519
Insurance broker organization code?	3
Insurance broker name	HOLMES MURPHY AND ASSOCIATES INC

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Company Name:	T & R ELECTRIC SUPPLY CO., INC.
Employer identification number (EIN):	460283047
NAIC Classification:	335310