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MENARD INC. HEALTH INSURANCE PLAN 401k Plan overview

Plan NameMENARD INC. HEALTH INSURANCE PLAN
Plan identification number 501

MENARD INC. HEALTH INSURANCE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Temporary disability (accident and sickness)

401k Sponsoring company profile

MENARD INC. has sponsored the creation of one or more 401k plans.

Company Name:MENARD INC.
Employer identification number (EIN):390989248
NAIC Classification:444110
NAIC Description:Home Centers

Additional information about MENARD INC.

Jurisdiction of Incorporation: State of Delaware Division of Corporations
Incorporation Date:
Company Identification Number: 0778065

More information about MENARD INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MENARD INC. HEALTH INSURANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01
5012021-01-01
5012020-01-01
5012019-01-01
5012019-01-01
5012018-01-01
5012017-01-01JEFF SACIA
5012016-01-01JEFF SACIA
5012015-01-01JEFF SACIA
5012014-01-01JEFF SACIA
5012013-01-01JEFF SACIA
5012012-01-01JEFF SACIA
5012011-01-01JEFF SACIA JEFF SACIA2012-09-07
5012010-01-01JEFF SACIA
5012009-01-01JEFF SACIA

Plan Statistics for MENARD INC. HEALTH INSURANCE PLAN

401k plan membership statisitcs for MENARD INC. HEALTH INSURANCE PLAN

Measure Date Value
2022: MENARD INC. HEALTH INSURANCE PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-0112,644
Total number of active participants reported on line 7a of the Form 55002022-01-0112,324
Number of retired or separated participants receiving benefits2022-01-01101
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-0112,425
2021: MENARD INC. HEALTH INSURANCE PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-0113,183
Total number of active participants reported on line 7a of the Form 55002021-01-0112,475
Number of retired or separated participants receiving benefits2021-01-01169
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-0112,644
2020: MENARD INC. HEALTH INSURANCE PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-0112,982
Total number of active participants reported on line 7a of the Form 55002020-01-0112,979
Number of retired or separated participants receiving benefits2020-01-01204
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-0113,183
2019: MENARD INC. HEALTH INSURANCE PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-0112,982
Total number of active participants reported on line 7a of the Form 55002019-01-0112,790
Number of retired or separated participants receiving benefits2019-01-01192
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-0112,982
2018: MENARD INC. HEALTH INSURANCE PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-0111,953
Total number of active participants reported on line 7a of the Form 55002018-01-0112,788
Number of retired or separated participants receiving benefits2018-01-01194
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-0112,982
2017: MENARD INC. HEALTH INSURANCE PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-019,620
Total number of active participants reported on line 7a of the Form 55002017-01-0111,832
Number of retired or separated participants receiving benefits2017-01-01121
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-0111,953
2016: MENARD INC. HEALTH INSURANCE PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-019,111
Total number of active participants reported on line 7a of the Form 55002016-01-019,214
Number of retired or separated participants receiving benefits2016-01-0125
Number of other retired or separated participants entitled to future benefits2016-01-01381
Total of all active and inactive participants2016-01-019,620
2015: MENARD INC. HEALTH INSURANCE PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-018,748
Total number of active participants reported on line 7a of the Form 55002015-01-018,711
Number of retired or separated participants receiving benefits2015-01-0143
Number of other retired or separated participants entitled to future benefits2015-01-01357
Total of all active and inactive participants2015-01-019,111
2014: MENARD INC. HEALTH INSURANCE PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-018,528
Total number of active participants reported on line 7a of the Form 55002014-01-018,267
Number of retired or separated participants receiving benefits2014-01-0134
Number of other retired or separated participants entitled to future benefits2014-01-01343
Total of all active and inactive participants2014-01-018,644
2013: MENARD INC. HEALTH INSURANCE PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-017,320
Total number of active participants reported on line 7a of the Form 55002013-01-016,990
Number of retired or separated participants receiving benefits2013-01-0136
Number of other retired or separated participants entitled to future benefits2013-01-0196
Total of all active and inactive participants2013-01-017,122
2012: MENARD INC. HEALTH INSURANCE PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-017,415
Total number of active participants reported on line 7a of the Form 55002012-01-017,008
Number of retired or separated participants receiving benefits2012-01-0144
Number of other retired or separated participants entitled to future benefits2012-01-010
Total of all active and inactive participants2012-01-017,052
2011: MENARD INC. HEALTH INSURANCE PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-017,547
Total number of active participants reported on line 7a of the Form 55002011-01-0135,746
Number of retired or separated participants receiving benefits2011-01-0151
Total of all active and inactive participants2011-01-0135,797
2010: MENARD INC. HEALTH INSURANCE PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-017,903
Total number of active participants reported on line 7a of the Form 55002010-01-017,470
Number of retired or separated participants receiving benefits2010-01-0177
Number of other retired or separated participants entitled to future benefits2010-01-010
Total of all active and inactive participants2010-01-017,547
2009: MENARD INC. HEALTH INSURANCE PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-017,327
Total number of active participants reported on line 7a of the Form 55002009-01-017,843
Number of retired or separated participants receiving benefits2009-01-0160
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-017,903

Form 5500 Responses for MENARD INC. HEALTH INSURANCE PLAN

2022: MENARD INC. HEALTH INSURANCE PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: MENARD INC. HEALTH INSURANCE PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: MENARD INC. HEALTH INSURANCE PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: MENARD INC. HEALTH INSURANCE PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – General assets of the sponsorYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – General assets of the sponsorYes
2018: MENARD INC. HEALTH INSURANCE PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: MENARD INC. HEALTH INSURANCE PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: MENARD INC. HEALTH INSURANCE PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – General assets of the sponsorYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – General assets of the sponsorYes
2015: MENARD INC. HEALTH INSURANCE PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – General assets of the sponsorYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – General assets of the sponsorYes
2014: MENARD INC. HEALTH INSURANCE PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – General assets of the sponsorYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – General assets of the sponsorYes
2013: MENARD INC. HEALTH INSURANCE PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – General assets of the sponsorYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – General assets of the sponsorYes
2012: MENARD INC. HEALTH INSURANCE PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: MENARD INC. HEALTH INSURANCE PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – InsuranceYes
2010: MENARD INC. HEALTH INSURANCE PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedNo
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan benefit arrangement – InsuranceYes
2009: MENARD INC. HEALTH INSURANCE PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0213952
Policy instance 3
Insurance contract or identification number0213952
Number of Individuals Covered12324
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $2,000
Total amount of fees paid to insurance companyUSD $953
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $49,020
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,000
Amount paid for insurance broker fees953
Additional information about fees paid to insurance brokerNON-MONETARY/SUPPLEMENTAL COMP. MARKETING FEES
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0213951
Policy instance 2
Insurance contract or identification number0213951
Number of Individuals Covered12324
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $8,000
Total amount of fees paid to insurance companyUSD $3,474
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $191,486
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,000
Amount paid for insurance broker fees3474
Additional information about fees paid to insurance brokerNON-MONETARY/SUPPLEMENTAL COMP. MARKETING FEES
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54003 )
Policy contract number210023
Policy instance 1
Insurance contract or identification number210023
Number of Individuals Covered22716
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $472,366
Total amount of fees paid to insurance companyUSD $28,341
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $112,705,642
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $472,366
Amount paid for insurance broker fees28341
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0213952
Policy instance 3
Insurance contract or identification number0213952
Number of Individuals Covered12475
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $2,000
Total amount of fees paid to insurance companyUSD $698
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $50,001
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,000
Amount paid for insurance broker fees698
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION NON-MONETARY COMPENSATION
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0213951
Policy instance 2
Insurance contract or identification number0213951
Number of Individuals Covered12475
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $8,000
Total amount of fees paid to insurance companyUSD $2,520
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $195,318
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,000
Amount paid for insurance broker fees2520
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION NON-MONETARY COMPENSATION
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54003 )
Policy contract number210023
Policy instance 1
Insurance contract or identification number210023
Number of Individuals Covered23198
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $499,176
Total amount of fees paid to insurance companyUSD $31,293
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $111,186,827
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $499,176
Amount paid for insurance broker fees31293
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54003 )
Policy contract number210023
Policy instance 1
Insurance contract or identification number210023
Number of Individuals Covered25154
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $440,347
Total amount of fees paid to insurance companyUSD $50,000
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $105,592,955
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $440,347
Amount paid for insurance broker fees50000
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0213951
Policy instance 2
Insurance contract or identification number0213951
Number of Individuals Covered12979
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of fees paid to insurance companyUSD $10,518
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $196,942
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees10518
Additional information about fees paid to insurance brokerSUPPLEMENTAL/NON-MONETARY COMP. SERVICE FEES AND MARKETING FEES
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0213952
Policy instance 3
Insurance contract or identification number0213952
Number of Individuals Covered12979
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of fees paid to insurance companyUSD $2,683
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $50,423
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees2683
Additional information about fees paid to insurance brokerSUPPLEMENTAL/NON-MONETARY COMP. ADDITIONAL COMP. AND MARKETING FEES
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54003 )
Policy contract number210023
Policy instance 1
Insurance contract or identification number210023
Number of Individuals Covered26887
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $409,489
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $103,257,930
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $409,489
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0213951
Policy instance 2
Insurance contract or identification number0213951
Number of Individuals Covered12906
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $88,000
Total amount of fees paid to insurance companyUSD $2,415
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $197,690
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $56,000
Amount paid for insurance broker fees73
Additional information about fees paid to insurance brokerNON-MONETARY COMPENSATION
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0213952
Policy instance 3
Insurance contract or identification number0213952
Number of Individuals Covered12906
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $22,000
Total amount of fees paid to insurance companyUSD $727
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $50,609
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,000
Amount paid for insurance broker fees73
Additional information about fees paid to insurance brokerNON-MONETARY COMPENSATION
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number681340G
Policy instance 4
Insurance contract or identification number681340G
Number of Individuals Covered12788
Insurance policy start date2018-04-01
Insurance policy end date2018-12-31
Temporary Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KANAWHA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65110 )
Policy contract number597821
Policy instance 3
Insurance contract or identification number597821
Number of Individuals Covered2
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $9,946
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $230,553
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,946
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54003 )
Policy contract number050290
Policy instance 2
Insurance contract or identification number050290
Number of Individuals Covered18320
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $89,955
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $4,461,284
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $89,955
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54003 )
Policy contract number00226741
Policy instance 1
Insurance contract or identification number00226741
Number of Individuals Covered17829
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $427,592
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $85,938,114
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $310,619
Insurance broker organization code?3
KANAWHA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65110 )
Policy contract number597821
Policy instance 3
Insurance contract or identification number597821
Number of Individuals Covered11890
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $13,169
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $270,212
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,169
Insurance broker organization code?3
Insurance broker nameEMPLOYERS BENEFIT GROUP LLC
BLUE CROSS BLUE SHIELD OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54003 )
Policy contract number050290
Policy instance 2
Insurance contract or identification number050290
Number of Individuals Covered17222
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $82,475
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $4,154,084
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $82,475
Insurance broker organization code?3
Insurance broker nameLOCKTON COMPANIES, LLC
BLUE CROSS BLUE SHIELD OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54003 )
Policy contract number00226741
Policy instance 1
Insurance contract or identification number00226741
Number of Individuals Covered16572
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $399,961
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $87,361,313
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $399,984
Insurance broker organization code?3
Insurance broker nameWILLIS OF MINNESOTA INC
BLUE CROSS BLUE SHIELD OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54003 )
Policy contract number226741
Policy instance 1
Insurance contract or identification number226741
Number of Individuals Covered14565
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $344,035
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $70,765,016
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $344,035
Insurance broker organization code?3
Insurance broker nameWILLIS MN INC.
BLUE CROSS BLUE SHIELD OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54003 )
Policy contract number226741
Policy instance 1
Insurance contract or identification number226741
Number of Individuals Covered14307
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $328,600
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $66,946,211
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $328,600
Insurance broker organization code?3
Insurance broker nameWILLIS MN INC.
BLUE CROSS BLUE SHIELD OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54003 )
Policy contract number226741
Policy instance 1
Insurance contract or identification number226741
Number of Individuals Covered7021
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $259,991
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $60,895,188
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $259,991
Insurance broker organization code?3
Insurance broker nameWILLIS MN INC.
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
Policy contract number597821
Policy instance 2
Insurance contract or identification number597821
Number of Individuals Covered7010
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $217,861
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $40,383,449
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $181,176
Insurance broker organization code?3
Insurance broker nameWILLIS CORROON CORP MN INC.
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
Policy contract number597821
Policy instance 1
Insurance contract or identification number597821
Number of Individuals Covered1321
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $49,422
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 BrokerUSD $41,382
Insurance broker organization code?3
Insurance broker nameWILLIS MN INC.
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number650355
Policy instance 1
Insurance contract or identification number650355
Number of Individuals Covered12994
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $288,015
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number620355
Policy instance 1
Insurance contract or identification number620355
Number of Individuals Covered7547
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $262,154
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $262,154
Insurance broker organization code?3
Insurance broker nameEMPLOYERS BENEFIT GROUP LLC

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