JOHANNESON'S, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan JOHANNESONS INC. - HEALTH & SUPPLEMENTAL PLAN
401k plan membership statisitcs for JOHANNESONS INC. - HEALTH & SUPPLEMENTAL PLAN
| Measure | Date | Value |
|---|
| 2021: JOHANNESONS INC. - HEALTH & SUPPLEMENTAL PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 297 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 276 |
| Total of all active and inactive participants | 2021-01-01 | 276 |
| 2020: JOHANNESONS INC. - HEALTH & SUPPLEMENTAL PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 312 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 297 |
| Total of all active and inactive participants | 2020-01-01 | 297 |
| 2019: JOHANNESONS INC. - HEALTH & SUPPLEMENTAL PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 291 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 312 |
| Total of all active and inactive participants | 2019-01-01 | 312 |
| 2018: JOHANNESONS INC. - HEALTH & SUPPLEMENTAL PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 317 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 291 |
| Total of all active and inactive participants | 2018-01-01 | 291 |
| 2017: JOHANNESONS INC. - HEALTH & SUPPLEMENTAL PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 336 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 317 |
| Total of all active and inactive participants | 2017-01-01 | 317 |
| 2016: JOHANNESONS INC. - HEALTH & SUPPLEMENTAL PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 343 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 336 |
| Total of all active and inactive participants | 2016-01-01 | 336 |
| 2015: JOHANNESONS INC. - HEALTH & SUPPLEMENTAL PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 307 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 343 |
| Total of all active and inactive participants | 2015-01-01 | 343 |
| 2014: JOHANNESONS INC. - HEALTH & SUPPLEMENTAL PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 308 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 307 |
| Total of all active and inactive participants | 2014-01-01 | 307 |
| 2013: JOHANNESONS INC. - HEALTH & SUPPLEMENTAL PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 291 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 308 |
| Total of all active and inactive participants | 2013-01-01 | 308 |
| 2012: JOHANNESONS INC. - HEALTH & SUPPLEMENTAL PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 257 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 291 |
| Total of all active and inactive participants | 2012-01-01 | 291 |
| 2011: JOHANNESONS INC. - HEALTH & SUPPLEMENTAL PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-02-01 | 261 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-02-01 | 257 |
| Total of all active and inactive participants | 2011-02-01 | 257 |
| 2010: JOHANNESONS INC. - HEALTH & SUPPLEMENTAL PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-02-01 | 292 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-02-01 | 261 |
| Total of all active and inactive participants | 2010-02-01 | 261 |
| 2009: JOHANNESONS INC. - HEALTH & SUPPLEMENTAL PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-02-01 | 322 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-02-01 | 292 |
| Total of all active and inactive participants | 2009-02-01 | 292 |
| 2006: JOHANNESONS INC. - HEALTH & SUPPLEMENTAL PLAN 2006 401k membership |
|---|
| Total participants, beginning-of-year | 2006-02-01 | 245 |
| Total number of active participants reported on line 7a of the Form 5500 | 2006-02-01 | 275 |
| Total of all active and inactive participants | 2006-02-01 | 275 |
| 2021: JOHANNESONS INC. - HEALTH & SUPPLEMENTAL 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: JOHANNESONS INC. - HEALTH & SUPPLEMENTAL PLAN 2020 form 5500 responses |
|---|
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: JOHANNESONS INC. - HEALTH & SUPPLEMENTAL PLAN 2019 form 5500 responses |
|---|
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: JOHANNESONS INC. - HEALTH & SUPPLEMENTAL PLAN 2018 form 5500 responses |
|---|
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: JOHANNESONS INC. - HEALTH & SUPPLEMENTAL PLAN 2017 form 5500 responses |
|---|
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: JOHANNESONS INC. - HEALTH & SUPPLEMENTAL PLAN 2016 form 5500 responses |
|---|
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: JOHANNESONS INC. - HEALTH & SUPPLEMENTAL PLAN 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: JOHANNESONS INC. - HEALTH & SUPPLEMENTAL PLAN 2014 form 5500 responses |
|---|
| 2014-01-01 | Type of plan entity | Single employer plan |
| 2014-01-01 | Plan funding arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: JOHANNESONS INC. - HEALTH & SUPPLEMENTAL PLAN 2013 form 5500 responses |
|---|
| 2013-01-01 | Type of plan entity | Single employer plan |
| 2013-01-01 | Plan funding arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: JOHANNESONS INC. - HEALTH & SUPPLEMENTAL PLAN 2012 form 5500 responses |
|---|
| 2012-01-01 | Type of plan entity | Single employer plan |
| 2012-01-01 | Plan funding arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: JOHANNESONS INC. - HEALTH & SUPPLEMENTAL PLAN 2011 form 5500 responses |
|---|
| 2011-02-01 | Type of plan entity | Single employer plan |
| 2011-02-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2011-02-01 | Plan funding arrangement – Insurance | Yes |
| 2011-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2010: JOHANNESONS INC. - HEALTH & SUPPLEMENTAL PLAN 2010 form 5500 responses |
|---|
| 2010-02-01 | Type of plan entity | Single employer plan |
| 2010-02-01 | Plan funding arrangement – Insurance | Yes |
| 2010-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: JOHANNESONS INC. - HEALTH & SUPPLEMENTAL PLAN 2009 form 5500 responses |
|---|
| 2009-02-01 | Type of plan entity | Single employer plan |
| 2009-02-01 | Plan funding arrangement – Insurance | Yes |
| 2009-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2006: JOHANNESONS INC. - HEALTH & SUPPLEMENTAL PLAN 2006 form 5500 responses |
|---|
| 2006-02-01 | Type of plan entity | Single employer plan |
| 2006-02-01 | First time form 5500 has been submitted | Yes |
| 2006-02-01 | Plan funding arrangement – Insurance | Yes |
| 2006-02-01 | Plan benefit arrangement – Insurance | Yes |
| BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 ) |
| Policy contract number | 250954 |
| Policy instance | 1 |
| Insurance contract or identification number | 250954 | | Number of Individuals Covered | 276 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $11,235 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $11,235 | | Insurance broker organization code? | 3 |
|
| BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 ) |
| Policy contract number | 250954 |
| Policy instance | 1 |
| Insurance contract or identification number | 250954 | | Number of Individuals Covered | 297 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $11,315 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $11,315 | | Insurance broker organization code? | 3 |
|
| BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 ) |
| Policy contract number | 75845 |
| Policy instance | 1 |
| Insurance contract or identification number | 75845 | | Number of Individuals Covered | 312 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $7,200 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $7,200 | | Insurance broker organization code? | 3 |
|
| BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 ) |
| Policy contract number | 75845 |
| Policy instance | 1 |
| Insurance contract or identification number | 75845 | | Number of Individuals Covered | 291 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $9,428 | | Total amount of fees paid to insurance company | USD $0 | | 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 $9,428 | | Insurance broker organization code? | 3 |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 101365201 |
| Policy instance | 2 |
| Insurance contract or identification number | 101365201 | | Number of Individuals Covered | 59 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $2,923 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $19,304 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,923 | | Insurance broker organization code? | 3 | | Insurance broker name | NORIDIAN INSURANCE SERVICES INC |
|
| BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 ) |
| Policy contract number | 78068 |
| Policy instance | 1 |
| Insurance contract or identification number | 78068 | | Number of Individuals Covered | 317 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $9,913 | | Total amount of fees paid to insurance company | USD $0 | | 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 $9,913 | | Insurance broker organization code? | 3 | | Insurance broker name | PICKETT AGENCY, INC. |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 101718101 |
| Policy instance | 2 |
| Insurance contract or identification number | 101718101 | | Number of Individuals Covered | 69 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $4,572 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $22,097 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,572 | | Insurance broker organization code? | 3 | | Insurance broker name | NORIDIAN INSURANCE SERVICES INC |
|
| BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 ) |
| Policy contract number | 75845 |
| Policy instance | 1 |
| Insurance contract or identification number | 75845 | | Number of Individuals Covered | 343 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $34,983 | | Total amount of fees paid to insurance company | USD $0 | | 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 $34,983 | | Insurance broker organization code? | 3 | | Insurance broker name | PICKETT AGENCY, INC. |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 101718101 |
| Policy instance | 2 |
| Insurance contract or identification number | 101718101 | | Number of Individuals Covered | 75 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $3,874 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $21,967 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,874 | | Insurance broker organization code? | 3 | | Insurance broker name | NORIDIAN INSURANCE SERVICES INC |
|
| BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 ) |
| Policy contract number | 75845 |
| Policy instance | 1 |
| Insurance contract or identification number | 75845 | | Number of Individuals Covered | 307 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $32,463 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 $32,463 | | Insurance broker organization code? | 3 | | Insurance broker name | PICKETT AGENCY, INC. |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 101718101 |
| Policy instance | 2 |
| Insurance contract or identification number | 101718101 | | Number of Individuals Covered | 80 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $3,927 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $21,755 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,927 | | Insurance broker organization code? | 3 | | Insurance broker name | NORIDIAN INSURANCE SERVICES INC |
|
| BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 ) |
| Policy contract number | 75845 |
| Policy instance | 1 |
| Insurance contract or identification number | 75845 | | Number of Individuals Covered | 308 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $30,365 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 $30,365 | | Insurance broker organization code? | 3 | | Insurance broker name | PICKETT AGENCY, INC. |
|
| BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 ) |
| Policy contract number | 75845 |
| Policy instance | 1 |
| Insurance contract or identification number | 75845 | | Number of Individuals Covered | 291 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $24,746 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 $24,746 | | Insurance broker organization code? | 3 | | Insurance broker name | PICKETT AGENCY, INC. |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 101718101 |
| Policy instance | 2 |
| Insurance contract or identification number | 101718101 | | Number of Individuals Covered | 87 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $4,953 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $21,812 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,953 | | Insurance broker organization code? | 3 | | Insurance broker name | NORIDIAN INSURANCE SERVICES INC |
|
| BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 ) |
| Policy contract number | 75845 |
| Policy instance | 1 |
| Insurance contract or identification number | 75845 | | Number of Individuals Covered | 257 | | Insurance policy start date | 2011-02-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $23,151 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 ) |
| Policy contract number | 75845 |
| Policy instance | 1 |
| Insurance contract or identification number | 75845 | | Number of Individuals Covered | 261 | | Insurance policy start date | 2010-02-01 | | Insurance policy end date | 2011-01-31 | | Total amount of commissions paid to insurance broker | USD $28,180 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 $28,180 | | Insurance broker organization code? | 3 | | Insurance broker name | PICKETT AGENCY, INC. |
|
| BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 ) |
| Policy contract number | 75845 |
| Policy instance | 1 |
| Insurance contract or identification number | 75845 | | Number of Individuals Covered | 292 | | Insurance policy start date | 2009-02-01 | | Insurance policy end date | 2010-01-31 | | Total amount of commissions paid to insurance broker | USD $28,430 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 $28,430 | | Insurance broker organization code? | 3 | | Insurance broker name | PICKETT AGENCY, INC. |
|
| BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 ) |
| Policy contract number | 75845 |
| Policy instance | 1 |
| Insurance contract or identification number | 75845 | | Number of Individuals Covered | 322 | | Insurance policy start date | 2008-02-01 | | Insurance policy end date | 2009-01-31 | | Total amount of commissions paid to insurance broker | USD $34,879 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 $34,879 | | Insurance broker organization code? | 3 | | Insurance broker name | PICKETT AGENCY INC. |
|
| BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 ) |
| Policy contract number | 75845,75673 |
| Policy instance | 1 |
| Insurance contract or identification number | 75845,75673 | | Number of Individuals Covered | 313 | | Insurance policy start date | 2007-02-01 | | Insurance policy end date | 2008-01-31 | | Total amount of commissions paid to insurance broker | USD $32,724 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 $32,724 | | Insurance broker organization code? | 3 | | Insurance broker name | PICKETT AGENCY, INC. |
|
| BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 ) |
| Policy contract number | 75845, 75673 |
| Policy instance | 1 |
| Insurance contract or identification number | 75845, 75673 | | Number of Individuals Covered | 275 | | Insurance policy start date | 2006-02-01 | | Insurance policy end date | 2007-01-31 | | Total amount of commissions paid to insurance broker | USD $28,751 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,102,750 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $28,751 | | Insurance broker organization code? | 3 | | Insurance broker name | PICKETT AGENCY INC. |
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