EVENTIDE LUTHERAN HOME OF MOORHEAD has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan EVENTIDE LUTHERAN HOME EMPLOYEE BENEFIT PLAN AND TRUST
401k plan membership statisitcs for EVENTIDE LUTHERAN HOME EMPLOYEE BENEFIT PLAN AND TRUST
Measure | Date | Value |
---|
2022 : EVENTIDE LUTHERAN HOME EMPLOYEE BENEFIT PLAN AND TRUST 2022 401k financial data |
---|
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2022-09-30 | No |
Was this plan covered by a fidelity bond | 2022-09-30 | No |
If this is an individual account plan, was there a blackout period | 2022-09-30 | No |
Were there any nonexempt tranactions with any party-in-interest | 2022-09-30 | No |
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2022-09-30 | No |
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2022-09-30 | No |
Were any loans by the plan or fixed income obligations due to the plan in default | 2022-09-30 | No |
Were any leases to which the plan was party in default or uncollectible | 2022-09-30 | No |
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2022-09-30 | No |
Was there a failure to transmit to the plan any participant contributions | 2022-09-30 | No |
Has the plan failed to provide any benefit when due under the plan | 2022-09-30 | No |
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2022-09-30 | No |
Did the plan have assets held for investment | 2022-09-30 | No |
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2022-09-30 | No |
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2022-09-30 | No |
2021 : EVENTIDE LUTHERAN HOME EMPLOYEE BENEFIT PLAN AND TRUST 2021 401k financial data |
---|
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2021-09-30 | No |
Was this plan covered by a fidelity bond | 2021-09-30 | No |
If this is an individual account plan, was there a blackout period | 2021-09-30 | No |
Were there any nonexempt tranactions with any party-in-interest | 2021-09-30 | No |
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2021-09-30 | No |
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2021-09-30 | No |
Were any loans by the plan or fixed income obligations due to the plan in default | 2021-09-30 | No |
Were any leases to which the plan was party in default or uncollectible | 2021-09-30 | No |
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2021-09-30 | No |
Was there a failure to transmit to the plan any participant contributions | 2021-09-30 | No |
Has the plan failed to provide any benefit when due under the plan | 2021-09-30 | No |
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2021-09-30 | No |
Did the plan have assets held for investment | 2021-09-30 | No |
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2021-09-30 | No |
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2021-09-30 | No |
2020 : EVENTIDE LUTHERAN HOME EMPLOYEE BENEFIT PLAN AND TRUST 2020 401k financial data |
---|
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2020-09-30 | No |
Was this plan covered by a fidelity bond | 2020-09-30 | No |
If this is an individual account plan, was there a blackout period | 2020-09-30 | No |
Were there any nonexempt tranactions with any party-in-interest | 2020-09-30 | No |
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-09-30 | No |
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2020-09-30 | No |
Were any loans by the plan or fixed income obligations due to the plan in default | 2020-09-30 | No |
Were any leases to which the plan was party in default or uncollectible | 2020-09-30 | No |
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2020-09-30 | No |
Was there a failure to transmit to the plan any participant contributions | 2020-09-30 | No |
Has the plan failed to provide any benefit when due under the plan | 2020-09-30 | No |
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2020-09-30 | No |
Did the plan have assets held for investment | 2020-09-30 | No |
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-09-30 | No |
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2020-09-30 | No |
2019 : EVENTIDE LUTHERAN HOME EMPLOYEE BENEFIT PLAN AND TRUST 2019 401k financial data |
---|
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2019-09-30 | No |
Was this plan covered by a fidelity bond | 2019-09-30 | No |
If this is an individual account plan, was there a blackout period | 2019-09-30 | No |
Were there any nonexempt tranactions with any party-in-interest | 2019-09-30 | No |
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-09-30 | No |
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2019-09-30 | No |
Were any loans by the plan or fixed income obligations due to the plan in default | 2019-09-30 | No |
Were any leases to which the plan was party in default or uncollectible | 2019-09-30 | No |
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2019-09-30 | No |
Was there a failure to transmit to the plan any participant contributions | 2019-09-30 | No |
Has the plan failed to provide any benefit when due under the plan | 2019-09-30 | No |
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2019-09-30 | No |
Did the plan have assets held for investment | 2019-09-30 | No |
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-09-30 | No |
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2019-09-30 | No |
2018 : EVENTIDE LUTHERAN HOME EMPLOYEE BENEFIT PLAN AND TRUST 2018 401k financial data |
---|
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2018-09-30 | No |
Was this plan covered by a fidelity bond | 2018-09-30 | No |
If this is an individual account plan, was there a blackout period | 2018-09-30 | No |
Were there any nonexempt tranactions with any party-in-interest | 2018-09-30 | No |
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-09-30 | No |
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2018-09-30 | No |
Were any loans by the plan or fixed income obligations due to the plan in default | 2018-09-30 | No |
Were any leases to which the plan was party in default or uncollectible | 2018-09-30 | No |
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2018-09-30 | No |
Was there a failure to transmit to the plan any participant contributions | 2018-09-30 | No |
Has the plan failed to provide any benefit when due under the plan | 2018-09-30 | No |
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2018-09-30 | No |
Did the plan have assets held for investment | 2018-09-30 | No |
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-09-30 | No |
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2018-09-30 | No |
2017 : EVENTIDE LUTHERAN HOME EMPLOYEE BENEFIT PLAN AND TRUST 2017 401k financial data |
---|
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2017-09-30 | No |
Was this plan covered by a fidelity bond | 2017-09-30 | No |
If this is an individual account plan, was there a blackout period | 2017-09-30 | No |
Were there any nonexempt tranactions with any party-in-interest | 2017-09-30 | No |
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2017-09-30 | No |
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2017-09-30 | No |
Were any loans by the plan or fixed income obligations due to the plan in default | 2017-09-30 | No |
Were any leases to which the plan was party in default or uncollectible | 2017-09-30 | No |
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2017-09-30 | No |
Was there a failure to transmit to the plan any participant contributions | 2017-09-30 | No |
Has the plan failed to provide any benefit when due under the plan | 2017-09-30 | No |
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2017-09-30 | No |
Did the plan have assets held for investment | 2017-09-30 | No |
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2017-09-30 | No |
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2017-09-30 | No |
2016 : EVENTIDE LUTHERAN HOME EMPLOYEE BENEFIT PLAN AND TRUST 2016 401k financial data |
---|
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2016-09-30 | No |
Was this plan covered by a fidelity bond | 2016-09-30 | No |
If this is an individual account plan, was there a blackout period | 2016-09-30 | No |
Were there any nonexempt tranactions with any party-in-interest | 2016-09-30 | No |
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-09-30 | No |
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2016-09-30 | No |
Were any loans by the plan or fixed income obligations due to the plan in default | 2016-09-30 | No |
Were any leases to which the plan was party in default or uncollectible | 2016-09-30 | No |
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2016-09-30 | No |
Was there a failure to transmit to the plan any participant contributions | 2016-09-30 | No |
Has the plan failed to provide any benefit when due under the plan | 2016-09-30 | No |
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2016-09-30 | No |
Did the plan have assets held for investment | 2016-09-30 | No |
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-09-30 | No |
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2016-09-30 | No |
2015 : EVENTIDE LUTHERAN HOME EMPLOYEE BENEFIT PLAN AND TRUST 2015 401k financial data |
---|
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2015-09-30 | No |
Was this plan covered by a fidelity bond | 2015-09-30 | No |
If this is an individual account plan, was there a blackout period | 2015-09-30 | No |
Were there any nonexempt tranactions with any party-in-interest | 2015-09-30 | No |
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-09-30 | No |
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2015-09-30 | No |
Were any loans by the plan or fixed income obligations due to the plan in default | 2015-09-30 | No |
Were any leases to which the plan was party in default or uncollectible | 2015-09-30 | No |
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2015-09-30 | No |
Was there a failure to transmit to the plan any participant contributions | 2015-09-30 | No |
Has the plan failed to provide any benefit when due under the plan | 2015-09-30 | No |
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2015-09-30 | No |
Did the plan have assets held for investment | 2015-09-30 | No |
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-09-30 | No |
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2015-09-30 | No |
2014 : EVENTIDE LUTHERAN HOME EMPLOYEE BENEFIT PLAN AND TRUST 2014 401k financial data |
---|
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2014-09-30 | No |
Was this plan covered by a fidelity bond | 2014-09-30 | No |
If this is an individual account plan, was there a blackout period | 2014-09-30 | No |
Were there any nonexempt tranactions with any party-in-interest | 2014-09-30 | No |
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-09-30 | No |
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2014-09-30 | No |
Were any loans by the plan or fixed income obligations due to the plan in default | 2014-09-30 | No |
Were any leases to which the plan was party in default or uncollectible | 2014-09-30 | No |
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2014-09-30 | No |
Was there a failure to transmit to the plan any participant contributions | 2014-09-30 | No |
Has the plan failed to provide any benefit when due under the plan | 2014-09-30 | No |
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2014-09-30 | No |
Did the plan have assets held for investment | 2014-09-30 | No |
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-09-30 | No |
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2014-09-30 | No |
2013 : EVENTIDE LUTHERAN HOME EMPLOYEE BENEFIT PLAN AND TRUST 2013 401k financial data |
---|
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2013-09-30 | No |
Was this plan covered by a fidelity bond | 2013-09-30 | No |
If this is an individual account plan, was there a blackout period | 2013-09-30 | No |
Were there any nonexempt tranactions with any party-in-interest | 2013-09-30 | No |
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-09-30 | No |
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2013-09-30 | No |
Were any loans by the plan or fixed income obligations due to the plan in default | 2013-09-30 | No |
Were any leases to which the plan was party in default or uncollectible | 2013-09-30 | No |
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2013-09-30 | No |
Was there a failure to transmit to the plan any participant contributions | 2013-09-30 | No |
Has the plan failed to provide any benefit when due under the plan | 2013-09-30 | No |
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2013-09-30 | No |
Did the plan have assets held for investment | 2013-09-30 | No |
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-09-30 | No |
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2013-09-30 | No |
2012 : EVENTIDE LUTHERAN HOME EMPLOYEE BENEFIT PLAN AND TRUST 2012 401k financial data |
---|
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2012-09-30 | No |
Was this plan covered by a fidelity bond | 2012-09-30 | No |
If this is an individual account plan, was there a blackout period | 2012-09-30 | No |
Were there any nonexempt tranactions with any party-in-interest | 2012-09-30 | No |
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-09-30 | No |
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2012-09-30 | No |
Were any loans by the plan or fixed income obligations due to the plan in default | 2012-09-30 | No |
Were any leases to which the plan was party in default or uncollectible | 2012-09-30 | No |
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2012-09-30 | No |
Was there a failure to transmit to the plan any participant contributions | 2012-09-30 | No |
Has the plan failed to provide any benefit when due under the plan | 2012-09-30 | No |
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2012-09-30 | No |
Did the plan have assets held for investment | 2012-09-30 | No |
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-09-30 | No |
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2012-09-30 | No |
2011 : EVENTIDE LUTHERAN HOME EMPLOYEE BENEFIT PLAN AND TRUST 2011 401k financial data |
---|
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2011-09-30 | No |
Was this plan covered by a fidelity bond | 2011-09-30 | No |
If this is an individual account plan, was there a blackout period | 2011-09-30 | No |
Were there any nonexempt tranactions with any party-in-interest | 2011-09-30 | No |
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-09-30 | No |
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2011-09-30 | No |
Were any loans by the plan or fixed income obligations due to the plan in default | 2011-09-30 | No |
Were any leases to which the plan was party in default or uncollectible | 2011-09-30 | No |
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2011-09-30 | No |
Was there a failure to transmit to the plan any participant contributions | 2011-09-30 | No |
Has the plan failed to provide any benefit when due under the plan | 2011-09-30 | No |
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2011-09-30 | No |
Did the plan have assets held for investment | 2011-09-30 | No |
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-09-30 | No |
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2011-09-30 | No |
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
Policy contract number | 62444 |
Policy instance | 3 |
Insurance contract or identification number | 62444 | Number of Individuals Covered | 97 | Insurance policy start date | 2021-10-01 | Insurance policy end date | 2022-09-30 | Total amount of commissions paid to insurance broker | USD $6,652 | Total amount of fees paid to insurance company | USD $0 | Temporary Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENT | Welfare Benefit Premiums Paid to Carrier | USD $34,900 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,640 | Insurance broker organization code? | 3 |
|
HEALTHPARTNERS INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 44547 ) |
Policy contract number | 36557 |
Policy instance | 8 |
Insurance contract or identification number | 36557 | Number of Individuals Covered | 702 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-09-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $45,825 | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $4,895,959 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 26924 |
|
BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 ) |
Policy contract number | 250804 |
Policy instance | 1 |
Insurance contract or identification number | 250804 | Insurance policy start date | 2021-10-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,737,558 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 ) |
Policy contract number | 36776 |
Policy instance | 2 |
Insurance contract or identification number | 36776 | Number of Individuals Covered | 292 | Insurance policy start date | 2021-10-01 | Insurance policy end date | 2022-09-30 | Total amount of commissions paid to insurance broker | USD $4,350 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $64,011 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,350 | Insurance broker organization code? | 3 |
|
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GLUG0ASQX |
Policy instance | 4 |
Insurance contract or identification number | GLUG0ASQX | Number of Individuals Covered | 525 | Insurance policy start date | 2021-10-01 | Insurance policy end date | 2022-09-30 | Total amount of commissions paid to insurance broker | USD $2,424 | Total amount of fees paid to insurance company | USD $1,006 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | LIFE & AD&D | Welfare Benefit Premiums Paid to Carrier | USD $24,243 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,408 | Amount paid for insurance broker fees | 1006 | Insurance broker organization code? | 3 |
|
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GLTD0ASQX |
Policy instance | 5 |
Insurance contract or identification number | GLTD0ASQX | Number of Individuals Covered | 525 | Insurance policy start date | 2021-10-01 | Insurance policy end date | 2022-09-30 | Total amount of commissions paid to insurance broker | USD $12,562 | Total amount of fees paid to insurance company | USD $6,806 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $167,495 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,289 | Amount paid for insurance broker fees | 6806 | Insurance broker organization code? | 3 |
|
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GVTL0ASQX |
Policy instance | 6 |
Insurance contract or identification number | GVTL0ASQX | Number of Individuals Covered | 163 | Insurance policy start date | 2021-10-01 | Insurance policy end date | 2022-09-30 | Total amount of commissions paid to insurance broker | USD $9,431 | Total amount of fees paid to insurance company | USD $2,790 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | VOLUNTARY LIFE | Welfare Benefit Premiums Paid to Carrier | USD $62,870 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,477 | Amount paid for insurance broker fees | 2790 | Insurance broker organization code? | 3 |
|
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
Policy contract number | 62444 |
Policy instance | 7 |
Insurance contract or identification number | 62444 | Number of Individuals Covered | 92 | Insurance policy start date | 2021-10-01 | Insurance policy end date | 2022-09-30 | Total amount of commissions paid to insurance broker | USD $2,598 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | CANCER | Welfare Benefit Premiums Paid to Carrier | USD $21,437 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,598 |
|
BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 ) |
Policy contract number | 250804 |
Policy instance | 1 |
Insurance contract or identification number | 250804 | Insurance policy start date | 2020-10-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,839,026 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 ) |
Policy contract number | 36776 |
Policy instance | 2 |
Insurance contract or identification number | 36776 | Number of Individuals Covered | 318 | Insurance policy start date | 2020-10-01 | Insurance policy end date | 2021-09-30 | Total amount of commissions paid to insurance broker | USD $9,697 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $64,644 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $9,697 | Insurance broker organization code? | 3 |
|
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
Policy contract number | 62444 |
Policy instance | 3 |
Insurance contract or identification number | 62444 | Number of Individuals Covered | 119 | Insurance policy start date | 2020-10-01 | Insurance policy end date | 2021-09-30 | Total amount of commissions paid to insurance broker | USD $5,621 | Total amount of fees paid to insurance company | USD $0 | Temporary Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENT | Welfare Benefit Premiums Paid to Carrier | USD $33,730 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,585 | Insurance broker organization code? | 3 |
|
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GLUG0ASQX |
Policy instance | 4 |
Insurance contract or identification number | GLUG0ASQX | Number of Individuals Covered | 600 | Insurance policy start date | 2020-10-01 | Insurance policy end date | 2021-09-30 | Total amount of commissions paid to insurance broker | USD $2,564 | Total amount of fees paid to insurance company | USD $2,419 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | LIFE & AD&D | Welfare Benefit Premiums Paid to Carrier | USD $25,630 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $663 | Amount paid for insurance broker fees | 1613 | Insurance broker organization code? | 3 |
|
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GLTD0ASQX |
Policy instance | 5 |
Insurance contract or identification number | GLTD0ASQX | Number of Individuals Covered | 600 | Insurance policy start date | 2020-10-01 | Insurance policy end date | 2021-09-30 | Total amount of commissions paid to insurance broker | USD $12,962 | Total amount of fees paid to insurance company | USD $16,157 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $172,827 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,318 | Amount paid for insurance broker fees | 10771 | Insurance broker organization code? | 3 |
|
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
Policy contract number | 62444 |
Policy instance | 7 |
Insurance contract or identification number | 62444 | Number of Individuals Covered | 94 | Insurance policy start date | 2020-10-01 | Insurance policy end date | 2021-09-30 | Total amount of commissions paid to insurance broker | USD $2,275 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | CANCER | Welfare Benefit Premiums Paid to Carrier | USD $19,815 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,275 |
|
HEALTHPARTNERS INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 44547 ) |
Policy contract number | 36557 |
Policy instance | 8 |
Insurance contract or identification number | 36557 | Number of Individuals Covered | 783 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-09-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $47,051 | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $5,439,059 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 42761 | Insurance broker organization code? | 3 |
|
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GVTL0ASQX |
Policy instance | 6 |
Insurance contract or identification number | GVTL0ASQX | Number of Individuals Covered | 194 | Insurance policy start date | 2020-10-01 | Insurance policy end date | 2021-09-30 | Total amount of commissions paid to insurance broker | USD $10,690 | Total amount of fees paid to insurance company | USD $6,437 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | VOLUNTARY LIFE | Welfare Benefit Premiums Paid to Carrier | USD $71,269 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8,013 | Amount paid for insurance broker fees | 4291 | Insurance broker organization code? | 3 |
|
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
Policy contract number | 62444 |
Policy instance | 3 |
Insurance contract or identification number | 62444 | Number of Individuals Covered | 120 | Insurance policy start date | 2019-10-01 | Insurance policy end date | 2020-09-30 | Total amount of commissions paid to insurance broker | USD $6,527 | Total amount of fees paid to insurance company | USD $0 | Temporary Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENT | Welfare Benefit Premiums Paid to Carrier | USD $79,671 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,479 |
|
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 ) |
Policy contract number | 36776 |
Policy instance | 2 |
Insurance contract or identification number | 36776 | Number of Individuals Covered | 741 | Insurance policy start date | 2019-10-01 | Insurance policy end date | 2020-09-30 | Total amount of commissions paid to insurance broker | USD $10,609 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $70,724 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $10,609 | Insurance broker organization code? | 3 |
|
BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 ) |
Policy contract number | 250804 |
Policy instance | 1 |
Insurance contract or identification number | 250804 | Number of Individuals Covered | 0 | Insurance policy start date | 2019-10-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $22,067 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,812,751 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $22,067 |
|
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GLUG0ASQX |
Policy instance | 4 |
Insurance contract or identification number | GLUG0ASQX | Number of Individuals Covered | 1338 | Insurance policy start date | 2019-10-01 | Insurance policy end date | 2020-09-30 | Total amount of commissions paid to insurance broker | USD $2,684 | Total amount of fees paid to insurance company | USD $2,334 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | LIFE & AD&D | Welfare Benefit Premiums Paid to Carrier | USD $26,837 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,684 | Amount paid for insurance broker fees | 1556 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
|
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GLTD0ASQX |
Policy instance | 5 |
Insurance contract or identification number | GLTD0ASQX | Number of Individuals Covered | 1338 | Insurance policy start date | 2019-10-01 | Insurance policy end date | 2020-09-30 | Total amount of commissions paid to insurance broker | USD $13,419 | Total amount of fees paid to insurance company | USD $15,498 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $178,919 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $13,419 | Amount paid for insurance broker fees | 10332 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
|
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GVTL0ASQX |
Policy instance | 6 |
Insurance contract or identification number | GVTL0ASQX | Number of Individuals Covered | 448 | Insurance policy start date | 2019-10-01 | Insurance policy end date | 2020-09-30 | Total amount of commissions paid to insurance broker | USD $10,678 | Total amount of fees paid to insurance company | USD $6,329 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | VOLUNTARY LIFE | Welfare Benefit Premiums Paid to Carrier | USD $71,184 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $10,678 | Amount paid for insurance broker fees | 4219 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
|
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
Policy contract number | 62444 |
Policy instance | 8 |
Insurance contract or identification number | 62444 | Number of Individuals Covered | 101 | Insurance policy start date | 2019-10-01 | Insurance policy end date | 2020-09-30 | Total amount of commissions paid to insurance broker | USD $3,037 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | CANCER | Welfare Benefit Premiums Paid to Carrier | USD $25,281 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,037 |
|
HEALTHPARTNERS INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 44547 ) |
Policy contract number | 36557 |
Policy instance | 9 |
Insurance contract or identification number | 36557 | Number of Individuals Covered | 991 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-09-30 | Total amount of commissions paid to insurance broker | USD $84,202 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $4,522,581 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $84,202 | Insurance broker organization code? | 3 |
|
121 BENEFITS (National Association of Insurance Commissioners NAIC id number: 52429 ) |
Policy contract number | 90165 |
Policy instance | 7 |
Insurance contract or identification number | 90165 | Number of Individuals Covered | 68 | Insurance policy start date | 2020-10-01 | Insurance policy end date | 2021-09-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 ) |
Policy contract number | 36776 |
Policy instance | 2 |
Insurance contract or identification number | 36776 | Number of Individuals Covered | 349 | Insurance policy start date | 2018-10-01 | Insurance policy end date | 2019-09-30 | Total amount of commissions paid to insurance broker | USD $10,187 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $67,916 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $10,187 | Insurance broker organization code? | 3 |
|
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
Policy contract number | 62444 |
Policy instance | 3 |
Insurance contract or identification number | 62444 | Number of Individuals Covered | 134 | Insurance policy start date | 2018-10-01 | Insurance policy end date | 2019-09-30 | Total amount of commissions paid to insurance broker | USD $7,875 | Total amount of fees paid to insurance company | USD $0 | Temporary Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENT | Welfare Benefit Premiums Paid to Carrier | USD $46,897 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,819 |
|
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
Policy contract number | 62444 |
Policy instance | 8 |
Insurance contract or identification number | 62444 | Number of Individuals Covered | 120 | Insurance policy start date | 2018-10-01 | Insurance policy end date | 2019-09-30 | Total amount of commissions paid to insurance broker | USD $4,026 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | CANCER | Welfare Benefit Premiums Paid to Carrier | USD $30,589 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,026 |
|
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GVTL0ASQX |
Policy instance | 6 |
Insurance contract or identification number | GVTL0ASQX | Number of Individuals Covered | 229 | Insurance policy start date | 2018-10-01 | Insurance policy end date | 2019-09-30 | Total amount of commissions paid to insurance broker | USD $10,636 | Total amount of fees paid to insurance company | USD $6,621 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | VOLUNTARY LIFE | Welfare Benefit Premiums Paid to Carrier | USD $71,089 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $10,636 | Amount paid for insurance broker fees | 4414 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
|
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GLUG0ASQX |
Policy instance | 4 |
Insurance contract or identification number | GLUG0ASQX | Number of Individuals Covered | 639 | Insurance policy start date | 2018-10-01 | Insurance policy end date | 2019-09-30 | Total amount of commissions paid to insurance broker | USD $2,543 | Total amount of fees paid to insurance company | USD $2,304 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | LIFE & AD&D | Welfare Benefit Premiums Paid to Carrier | USD $25,496 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,543 | Amount paid for insurance broker fees | 1536 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
|
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GLTD0ASQX |
Policy instance | 5 |
Insurance contract or identification number | GLTD0ASQX | Number of Individuals Covered | 639 | Insurance policy start date | 2018-10-01 | Insurance policy end date | 2019-09-30 | Total amount of commissions paid to insurance broker | USD $12,595 | Total amount of fees paid to insurance company | USD $15,165 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $168,376 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $12,595 | Amount paid for insurance broker fees | 10110 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
|
121 BENEFITS (National Association of Insurance Commissioners NAIC id number: 52429 ) |
Policy contract number | 90165 |
Policy instance | 7 |
Insurance contract or identification number | 90165 | Number of Individuals Covered | 68 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $7,832 | Total amount of fees paid to insurance company | USD $0 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,832 |
|
BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 ) |
Policy contract number | 10258 |
Policy instance | 1 |
Insurance contract or identification number | 10258 | Number of Individuals Covered | 919 | Insurance policy start date | 2018-10-01 | Insurance policy end date | 2019-09-30 | Total amount of commissions paid to insurance broker | USD $11,596 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,620,299 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,798 |
|
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 ) |
Policy contract number | 36776 |
Policy instance | 2 |
Insurance contract or identification number | 36776 | Number of Individuals Covered | 667 | Insurance policy start date | 2017-10-01 | Insurance policy end date | 2018-09-30 | Total amount of commissions paid to insurance broker | USD $6,695 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $44,631 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 50790-1611 |
Policy instance | 3 |
Insurance contract or identification number | 50790-1611 | Number of Individuals Covered | 438 | Insurance policy start date | 2017-10-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $1,448 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $9,580 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
Policy contract number | 62444 |
Policy instance | 4 |
Insurance contract or identification number | 62444 | Number of Individuals Covered | 149 | Insurance policy start date | 2017-10-01 | Insurance policy end date | 2018-09-30 | Total amount of commissions paid to insurance broker | USD $13,561 | Total amount of fees paid to insurance company | USD $0 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $48,358 | 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 | GLTD0ASQX |
Policy instance | 6 |
Insurance contract or identification number | GLTD0ASQX | Number of Individuals Covered | 654 | Insurance policy start date | 2017-10-01 | Insurance policy end date | 2018-09-30 | Total amount of commissions paid to insurance broker | USD $12,673 | Total amount of fees paid to insurance company | USD $14,248 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $168,969 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
121 BENEFITS (National Association of Insurance Commissioners NAIC id number: 52429 ) |
Policy contract number | 90165 |
Policy instance | 8 |
Insurance contract or identification number | 90165 | Number of Individuals Covered | 85 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $8,444 | Total amount of fees paid to insurance company | USD $0 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 ) |
Policy contract number | 36776 |
Policy instance | 9 |
Insurance contract or identification number | 36776 | Number of Individuals Covered | 667 | Insurance policy start date | 2017-10-01 | Insurance policy end date | 2018-09-30 | Total amount of commissions paid to insurance broker | USD $6,695 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $44,631 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
Policy contract number | 62444 |
Policy instance | 10 |
Insurance contract or identification number | 62444 | Number of Individuals Covered | 107 | Insurance policy start date | 2017-10-01 | Insurance policy end date | 2018-09-30 | Total amount of commissions paid to insurance broker | USD $6,381 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | CANCER | Welfare Benefit Premiums Paid to Carrier | USD $3,757 | 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 | GLUG0ASQX |
Policy instance | 5 |
Insurance contract or identification number | GLUG0ASQX | Number of Individuals Covered | 654 | Insurance policy start date | 2017-10-01 | Insurance policy end date | 2018-09-30 | Total amount of commissions paid to insurance broker | USD $2,571 | Total amount of fees paid to insurance company | USD $2,182 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | LIFE & AD&D | Welfare Benefit Premiums Paid to Carrier | USD $25,172 | 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 | 10258 |
Policy instance | 1 |
Insurance contract or identification number | 10258 | Number of Individuals Covered | 812 | Insurance policy start date | 2017-10-01 | Insurance policy end date | 2018-09-30 | Total amount of commissions paid to insurance broker | USD $27,251 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,575,303 | 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 | GVTL0ASQX |
Policy instance | 7 |
Insurance contract or identification number | GVTL0ASQX | Number of Individuals Covered | 256 | Insurance policy start date | 2017-10-01 | Insurance policy end date | 2018-10-01 | Total amount of commissions paid to insurance broker | USD $10,839 | Total amount of fees paid to insurance company | USD $5,634 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | VOLUNTARY LIFE | Welfare Benefit Premiums Paid to Carrier | USD $72,261 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
Policy contract number | 753731 |
Policy instance | 2 |
Insurance contract or identification number | 753731 | Number of Individuals Covered | 54 | Insurance policy start date | 2016-01-01 | Insurance policy end date | 2016-12-31 | Total amount of commissions paid to insurance broker | USD $858 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $9,365 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $858 | Insurance broker organization code? | 3 | Insurance broker name | PREMIER BENEFITS GROUP, INC |
|
BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 ) |
Policy contract number | 10258 |
Policy instance | 1 |
Insurance contract or identification number | 10258 | Number of Individuals Covered | 752 | Insurance policy start date | 2015-10-01 | Insurance policy end date | 2016-09-30 | Total amount of commissions paid to insurance broker | USD $7,192 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,252,148 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,192 | Insurance broker name | WARNER & COMPANY |
|
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 50790-1611 |
Policy instance | 3 |
Insurance contract or identification number | 50790-1611 | Number of Individuals Covered | 395 | Insurance policy start date | 2015-10-01 | Insurance policy end date | 2016-09-30 | Total amount of commissions paid to insurance broker | USD $4,772 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $41,000 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,181 | Insurance broker name | EE DORSETT & ASSOCIATES |
|
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
Policy contract number | 62444 |
Policy instance | 4 |
Insurance contract or identification number | 62444 | Number of Individuals Covered | 175 | Insurance policy start date | 2015-10-01 | Insurance policy end date | 2016-09-30 | Total amount of commissions paid to insurance broker | USD $14,668 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $81,120 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $14,574 | Insurance broker name | WILLIAM FLICKINGER |
|
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GLUG0ASQX |
Policy instance | 5 |
Insurance contract or identification number | GLUG0ASQX | Number of Individuals Covered | 540 | Insurance policy start date | 2015-06-01 | Insurance policy end date | 2016-06-01 | Total amount of commissions paid to insurance broker | USD $1,884 | Total amount of fees paid to insurance company | USD $904 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | LIFE & AD&D | Welfare Benefit Premiums Paid to Carrier | USD $18,843 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,884 | Amount paid for insurance broker fees | 904 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | PREMIER BENEFITS GROUP INC. |
|
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GLTD0ASQX |
Policy instance | 6 |
Insurance contract or identification number | GLTD0ASQX | Number of Individuals Covered | 541 | Insurance policy start date | 2015-06-01 | Insurance policy end date | 2016-06-01 | Total amount of commissions paid to insurance broker | USD $8,655 | Total amount of fees paid to insurance company | USD $5,486 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $115,398 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8,655 | Amount paid for insurance broker fees | 5486 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | PREMIER BENEFITS GROUP INC. |
|
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GVTL0ASQX |
Policy instance | 7 |
Insurance contract or identification number | GVTL0ASQX | Number of Individuals Covered | 210 | Insurance policy start date | 2015-06-01 | Insurance policy end date | 2016-06-01 | Total amount of commissions paid to insurance broker | USD $8,180 | Total amount of fees paid to insurance company | USD $2,765 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | VOLUNTARY LIFE | Welfare Benefit Premiums Paid to Carrier | USD $54,534 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8,180 | Amount paid for insurance broker fees | 2765 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | PREMIER BENEFITS GROUP INC. |
|
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G00ASQX |
Policy instance | 7 |
Insurance contract or identification number | G00ASQX | Number of Individuals Covered | 214 | Insurance policy start date | 2014-06-01 | Insurance policy end date | 2015-06-01 | Total amount of commissions paid to insurance broker | USD $8,202 | Total amount of fees paid to insurance company | USD $805 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | VOLUNTARY LIFE | Welfare Benefit Premiums Paid to Carrier | USD $54,680 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8,202 | Amount paid for insurance broker fees | 805 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | PRAIRIE BENEFITS INC. |
|
BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 ) |
Policy contract number | 10258 |
Policy instance | 1 |
Insurance contract or identification number | 10258 | Number of Individuals Covered | 309 | Insurance policy start date | 2014-10-01 | Insurance policy end date | 2015-09-30 | Total amount of commissions paid to insurance broker | USD $6,020 | 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 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,220,375 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,020 | Insurance broker name | WARNER & COMPANY |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 12273022 |
Policy instance | 2 |
Insurance contract or identification number | 12273022 | Number of Individuals Covered | 41 | Insurance policy start date | 2014-10-01 | Insurance policy end date | 2015-09-30 | Total amount of commissions paid to insurance broker | USD $696 | 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 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $41,195 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $696 | Insurance broker name | PRAIRIE BENEFITS INC. |
|
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 50790-1611 |
Policy instance | 3 |
Insurance contract or identification number | 50790-1611 | Number of Individuals Covered | 375 | Insurance policy start date | 2014-10-10 | Insurance policy end date | 2015-09-30 | Total amount of commissions paid to insurance broker | USD $4,451 | 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 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $32,318 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,967 | Insurance broker name | EE DORSETT & ASSOCIATES |
|
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
Policy contract number | 62444 |
Policy instance | 4 |
Insurance contract or identification number | 62444 | Number of Individuals Covered | 175 | Insurance policy start date | 2014-10-01 | Insurance policy end date | 2015-09-30 | Total amount of commissions paid to insurance broker | USD $27,716 | 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 $81,779 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $27,577 | Additional information about fees paid to insurance broker | N | Insurance broker name | KEELER & ASSOCIATES |
|
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G00ASQX |
Policy instance | 5 |
Insurance contract or identification number | G00ASQX | Number of Individuals Covered | 511 | Insurance policy start date | 2014-06-01 | Insurance policy end date | 2015-06-01 | Total amount of commissions paid to insurance broker | USD $1,757 | Total amount of fees paid to insurance company | USD $248 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | LIFE & AD&D | Welfare Benefit Premiums Paid to Carrier | USD $17,547 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,757 | Amount paid for insurance broker fees | 248 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | PRAIRIE BENEFITS INC. |
|
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G00ASQX |
Policy instance | 6 |
Insurance contract or identification number | G00ASQX | Number of Individuals Covered | 514 | Insurance policy start date | 2014-06-01 | Insurance policy end date | 2015-06-01 | Total amount of commissions paid to insurance broker | USD $7,972 | Total amount of fees paid to insurance company | USD $1,515 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $106,288 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,972 | Amount paid for insurance broker fees | 1515 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | PRAIRIE BENEFITS INC. |
|
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 50790-1611 |
Policy instance | 5 |
Insurance contract or identification number | 50790-1611 | Number of Individuals Covered | 325 | Insurance policy start date | 2013-10-10 | Insurance policy end date | 2014-09-30 | Total amount of commissions paid to insurance broker | USD $4,146 | 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 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $27,638 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,764 | Insurance broker name | EE DORSETT & ASSOCIATES |
|
MADISON NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65781 ) |
Policy contract number | 1184 |
Policy instance | 1 |
Insurance contract or identification number | 1184 | Number of Individuals Covered | 412 | Insurance policy start date | 2013-10-01 | Insurance policy end date | 2014-09-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $6,039 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $86,062 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 6039 | Additional information about fees paid to insurance broker | BROKER FEES | Insurance broker organization code? | 3 | Insurance broker name | PRAIRIE BENEFITS GROUP INC. |
|
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | GL146762 |
Policy instance | 2 |
Insurance contract or identification number | GL146762 | Number of Individuals Covered | 439 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-12-31 | Total amount of commissions paid to insurance broker | USD $1,914 | 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 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $105,737 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,914 | Insurance broker name | PREMIER BENEFITS GROUP, INC. |
|
BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 ) |
Policy contract number | 10258 |
Policy instance | 3 |
Insurance contract or identification number | 10258 | Number of Individuals Covered | 692 | Insurance policy start date | 2013-10-01 | Insurance policy end date | 2014-09-30 | Total amount of commissions paid to insurance broker | USD $19,130 | 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 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $945,566 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $19,130 | Insurance broker name | WARNER & COMPANY |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 12273022 |
Policy instance | 4 |
Insurance contract or identification number | 12273022 | Number of Individuals Covered | 42 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-12-31 | Total amount of commissions paid to insurance broker | USD $816 | 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 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $11,841 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $816 | Insurance broker name | PRAIRIE BENEFITS INC. |
|
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
Policy contract number | HCL13816 |
Policy instance | 1 |
Insurance contract or identification number | HCL13816 | Insurance policy start date | 2012-10-01 | Insurance policy end date | 2013-09-30 | Total amount of commissions paid to insurance broker | USD $0 | 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 |
|
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | GL146762 |
Policy instance | 3 |
Insurance contract or identification number | GL146762 | Number of Individuals Covered | 439 | Insurance policy start date | 2013-02-01 | Insurance policy end date | 2014-01-31 | Total amount of commissions paid to insurance broker | USD $3,168 | 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 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $61,750 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,168 | Insurance broker name | |
|
BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 ) |
Policy contract number | 10258 |
Policy instance | 4 |
Insurance contract or identification number | 10258 | Number of Individuals Covered | 646 | Insurance policy start date | 2012-10-01 | Insurance policy end date | 2013-09-30 | Total amount of commissions paid to insurance broker | USD $18,613 | 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 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $747,194 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $18,613 | Insurance broker name | WARNER & COMPANY |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 12273022 |
Policy instance | 5 |
Insurance contract or identification number | 12273022 | Number of Individuals Covered | 62 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $934 | 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 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $15,159 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $934 | Insurance broker name | PRAIRIE BENEFITS INC. |
|
MADISON NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65781 ) |
Policy contract number | 1184 |
Policy instance | 2 |
Insurance contract or identification number | 1184 | Number of Individuals Covered | 421 | Insurance policy start date | 2012-10-01 | Insurance policy end date | 2013-09-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $8,688 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $86,876 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 8688 | Additional information about fees paid to insurance broker | BROKER FEES | Insurance broker organization code? | 3 | Insurance broker name | PRAIRIE BENEFITS GROUP INC. |
|
MADISON NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65781 ) |
Policy contract number | 1184 |
Policy instance | 2 |
Insurance contract or identification number | 1184 | Number of Individuals Covered | 433 | Insurance policy start date | 2011-10-01 | Insurance policy end date | 2012-09-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $8,241 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $82,407 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
Policy contract number | HCL13816 |
Policy instance | 1 |
Insurance contract or identification number | HCL13816 | Number of Individuals Covered | 205 | Insurance policy start date | 2011-10-01 | Insurance policy end date | 2012-09-30 | Total amount of commissions paid to insurance broker | USD $0 | 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 $25,644 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | GL146762 |
Policy instance | 3 |
Insurance contract or identification number | GL146762 | Number of Individuals Covered | 410 | Insurance policy start date | 2012-02-01 | Insurance policy end date | 2013-01-31 | Total amount of commissions paid to insurance broker | USD $3,395 | 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 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $57,390 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 12273022 |
Policy instance | 5 |
Insurance contract or identification number | 12273022 | Number of Individuals Covered | 63 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $996 | 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 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $16,917 | 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 | 10258 |
Policy instance | 4 |
Insurance contract or identification number | 10258 | Number of Individuals Covered | 431 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $16,952 | 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 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $587,590 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
Policy contract number | HCL13816 |
Policy instance | 1 |
Insurance contract or identification number | HCL13816 | Number of Individuals Covered | 205 | Insurance policy start date | 2010-10-01 | Insurance policy end date | 2011-09-30 | Total amount of commissions paid to insurance broker | USD $0 | 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 $128,860 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | GL146762 |
Policy instance | 3 |
Insurance contract or identification number | GL146762 | Number of Individuals Covered | 292 | Insurance policy start date | 2011-02-01 | Insurance policy end date | 2012-01-31 | Total amount of commissions paid to insurance broker | USD $1,919 | 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 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $23,382 | 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 | 10258 |
Policy instance | 4 |
Insurance contract or identification number | 10258 | Number of Individuals Covered | 358 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Total amount of commissions paid to insurance broker | USD $0 | 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 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $491,769 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
MADISON NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65781 ) |
Policy contract number | 1184 |
Policy instance | 2 |
Insurance contract or identification number | 1184 | Number of Individuals Covered | 417 | Insurance policy start date | 2010-10-01 | Insurance policy end date | 2011-09-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $7,636 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $76,356 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|