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SFM MUTUAL INSURANCE COMPANY FLEXIBLE BENEFITS PLAN 401k Plan overview

Plan NameSFM MUTUAL INSURANCE COMPANY FLEXIBLE BENEFITS PLAN
Plan identification number 502

SFM MUTUAL INSURANCE COMPANY FLEXIBLE BENEFITS PLAN Benefits

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

401k Sponsoring company profile

SFM MUTUAL INSURANCE COMPANY has sponsored the creation of one or more 401k plans.

Company Name:SFM MUTUAL INSURANCE COMPANY
Employer identification number (EIN):411459789
NAIC Classification:524150

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SFM MUTUAL INSURANCE COMPANY FLEXIBLE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022022-01-01
5022021-01-01
5022020-01-01
5022019-01-01
5022018-01-01
5022017-12-01PHILLIP ALTMANN PHILLIP ALTMANN2018-09-13
5022016-12-01PHILLIP ALTMANN PHILLIP ALTMANN2018-09-13
5022015-12-01PHILLIP ALTMANN PHILLIP ALTMANN2017-09-12
5022014-12-01PHILLIP ALTMANN PHILLIP ALTMANN2016-09-09
5022013-12-01PHILLIP ALTMANN PHILLIP ALTMANN2015-09-03
5022012-12-01PHILLIP ALTMANN PHILLIP ALTMANN2014-09-08
5022011-12-01PHILLIP ALTMANN PHILLIP ALTMANN2013-09-09
5022010-12-01PHILLIP ALTMANN
5022009-12-01PHILLIP ALTMANN
5022008-12-01PHILLIP ALTMANN

Plan Statistics for SFM MUTUAL INSURANCE COMPANY FLEXIBLE BENEFITS PLAN

401k plan membership statisitcs for SFM MUTUAL INSURANCE COMPANY FLEXIBLE BENEFITS PLAN

Measure Date Value
2022: SFM MUTUAL INSURANCE COMPANY FLEXIBLE BENEFITS PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01308
Total number of active participants reported on line 7a of the Form 55002022-01-01308
Number of retired or separated participants receiving benefits2022-01-0124
Total of all active and inactive participants2022-01-01332
Total participants2022-01-01332
2021: SFM MUTUAL INSURANCE COMPANY FLEXIBLE BENEFITS PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01305
Total number of active participants reported on line 7a of the Form 55002021-01-01281
Number of retired or separated participants receiving benefits2021-01-0128
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-01309
Total participants2021-01-01309
2020: SFM MUTUAL INSURANCE COMPANY FLEXIBLE BENEFITS PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01310
Total number of active participants reported on line 7a of the Form 55002020-01-01276
Number of retired or separated participants receiving benefits2020-01-0125
Number of other retired or separated participants entitled to future benefits2020-01-012
Total of all active and inactive participants2020-01-01303
Total participants2020-01-01303
2019: SFM MUTUAL INSURANCE COMPANY FLEXIBLE BENEFITS PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01307
Total number of active participants reported on line 7a of the Form 55002019-01-01284
Number of retired or separated participants receiving benefits2019-01-0125
Number of other retired or separated participants entitled to future benefits2019-01-011
Total of all active and inactive participants2019-01-01310
Total participants2019-01-01310
2018: SFM MUTUAL INSURANCE COMPANY FLEXIBLE BENEFITS PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01285
Total number of active participants reported on line 7a of the Form 55002018-01-01280
Number of retired or separated participants receiving benefits2018-01-0123
Number of other retired or separated participants entitled to future benefits2018-01-014
Total of all active and inactive participants2018-01-01307
Total participants2018-01-01307
2017: SFM MUTUAL INSURANCE COMPANY FLEXIBLE BENEFITS PLAN 2017 401k membership
Total participants, beginning-of-year2017-12-01285
Total number of active participants reported on line 7a of the Form 55002017-12-01264
Number of retired or separated participants receiving benefits2017-12-0121
Number of other retired or separated participants entitled to future benefits2017-12-013
Total of all active and inactive participants2017-12-01288
Total participants2017-12-01288
2016: SFM MUTUAL INSURANCE COMPANY FLEXIBLE BENEFITS PLAN 2016 401k membership
Total participants, beginning-of-year2016-12-01277
Total number of active participants reported on line 7a of the Form 55002016-12-01261
Number of retired or separated participants receiving benefits2016-12-0121
Number of other retired or separated participants entitled to future benefits2016-12-013
Total of all active and inactive participants2016-12-01285
Total participants2016-12-01285
2015: SFM MUTUAL INSURANCE COMPANY FLEXIBLE BENEFITS PLAN 2015 401k membership
Total participants, beginning-of-year2015-12-01260
Total number of active participants reported on line 7a of the Form 55002015-12-01254
Number of retired or separated participants receiving benefits2015-12-0121
Number of other retired or separated participants entitled to future benefits2015-12-012
Total of all active and inactive participants2015-12-01277
Total participants2015-12-01277
2014: SFM MUTUAL INSURANCE COMPANY FLEXIBLE BENEFITS PLAN 2014 401k membership
Total participants, beginning-of-year2014-12-01240
Total number of active participants reported on line 7a of the Form 55002014-12-01237
Number of retired or separated participants receiving benefits2014-12-0121
Number of other retired or separated participants entitled to future benefits2014-12-012
Total of all active and inactive participants2014-12-01260
Total participants2014-12-01260
2013: SFM MUTUAL INSURANCE COMPANY FLEXIBLE BENEFITS PLAN 2013 401k membership
Total participants, beginning-of-year2013-12-01239
Total number of active participants reported on line 7a of the Form 55002013-12-01215
Number of retired or separated participants receiving benefits2013-12-0123
Number of other retired or separated participants entitled to future benefits2013-12-012
Total of all active and inactive participants2013-12-01240
Total participants2013-12-01240
2012: SFM MUTUAL INSURANCE COMPANY FLEXIBLE BENEFITS PLAN 2012 401k membership
Total participants, beginning-of-year2012-12-01219
Total number of active participants reported on line 7a of the Form 55002012-12-01218
Number of retired or separated participants receiving benefits2012-12-0119
Number of other retired or separated participants entitled to future benefits2012-12-012
Total of all active and inactive participants2012-12-01239
Total participants2012-12-01239
2011: SFM MUTUAL INSURANCE COMPANY FLEXIBLE BENEFITS PLAN 2011 401k membership
Total participants, beginning-of-year2011-12-01221
Total number of active participants reported on line 7a of the Form 55002011-12-01197
Number of retired or separated participants receiving benefits2011-12-0119
Number of other retired or separated participants entitled to future benefits2011-12-013
Total of all active and inactive participants2011-12-01219
Total participants2011-12-01219
2010: SFM MUTUAL INSURANCE COMPANY FLEXIBLE BENEFITS PLAN 2010 401k membership
Total participants, beginning-of-year2010-12-01204
Total number of active participants reported on line 7a of the Form 55002010-12-01197
Number of retired or separated participants receiving benefits2010-12-0119
Number of other retired or separated participants entitled to future benefits2010-12-015
Total of all active and inactive participants2010-12-01221
Total participants2010-12-01221
2009: SFM MUTUAL INSURANCE COMPANY FLEXIBLE BENEFITS PLAN 2009 401k membership
Total participants, beginning-of-year2009-12-01207
Total number of active participants reported on line 7a of the Form 55002009-12-01185
Number of retired or separated participants receiving benefits2009-12-0116
Number of other retired or separated participants entitled to future benefits2009-12-013
Total of all active and inactive participants2009-12-01204
Total participants2009-12-01204
2008: SFM MUTUAL INSURANCE COMPANY FLEXIBLE BENEFITS PLAN 2008 401k membership
Total participants, beginning-of-year2008-12-01210
Total number of active participants reported on line 7a of the Form 55002008-12-01183
Number of retired or separated participants receiving benefits2008-12-0115
Number of other retired or separated participants entitled to future benefits2008-12-019
Total of all active and inactive participants2008-12-01207
Total participants2008-12-01207

Financial Data on SFM MUTUAL INSURANCE COMPANY FLEXIBLE BENEFITS PLAN

Measure Date Value
2021 : SFM MUTUAL INSURANCE COMPANY FLEXIBLE BENEFITS PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets2021-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$333,729
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$204,561
Total income from all sources (including contributions)2021-12-31$4,744,007
Total loss/gain on sale of assets2021-12-31$0
Total of all expenses incurred2021-12-31$4,860,817
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$4,860,817
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$4,744,007
Value of total assets at end of year2021-12-31$53,430
Value of total assets at beginning of year2021-12-31$41,072
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$0
Total interest from all sources2021-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2021-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-12-31No
Was this plan covered by a fidelity bond2021-12-31Yes
Value of fidelity bond cover2021-12-31$5,000,000
If this is an individual account plan, was there a blackout period2021-12-31No
Were there any nonexempt tranactions with any party-in-interest2021-12-31No
Contributions received from participants2021-12-31$1,427,448
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2021-12-31$-9,787
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2021-12-31$29,719
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2021-12-31$23,424
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Value of net income/loss2021-12-31$-116,810
Value of net assets at end of year (total assets less liabilities)2021-12-31$-280,299
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$-163,489
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-12-31No
Were any leases to which the plan was party in default or uncollectible2021-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2021-12-31$554,153
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-12-31No
Was there a failure to transmit to the plan any participant contributions2021-12-31No
Has the plan failed to provide any benefit when due under the plan2021-12-31No
Contributions received in cash from employer2021-12-31$3,316,559
Employer contributions (assets) at end of year2021-12-31$53,430
Employer contributions (assets) at beginning of year2021-12-31$41,072
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$4,316,451
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32021-12-31No
Liabilities. Value of benefit claims payable at end of year2021-12-31$304,010
Liabilities. Value of benefit claims payable at beginning of year2021-12-31$181,137
Did the plan have assets held for investment2021-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-12-31No
Opinion of an independent qualified public accountant for this plan2021-12-31Unqualified
Accountancy firm name2021-12-31STROHM BALLWEG
Accountancy firm EIN2021-12-31391969986
2020 : SFM MUTUAL INSURANCE COMPANY FLEXIBLE BENEFITS PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets2020-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$204,561
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$284,413
Total income from all sources (including contributions)2020-12-31$4,741,145
Total loss/gain on sale of assets2020-12-31$0
Total of all expenses incurred2020-12-31$4,665,244
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$4,665,244
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$4,741,145
Value of total assets at end of year2020-12-31$41,072
Value of total assets at beginning of year2020-12-31$45,023
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$0
Total interest from all sources2020-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2020-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-12-31No
Was this plan covered by a fidelity bond2020-12-31Yes
Value of fidelity bond cover2020-12-31$5,000,000
If this is an individual account plan, was there a blackout period2020-12-31No
Were there any nonexempt tranactions with any party-in-interest2020-12-31No
Contributions received from participants2020-12-31$1,344,391
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2020-12-31$8,347
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2020-12-31$23,424
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2020-12-31$34,840
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Value of net income/loss2020-12-31$75,901
Value of net assets at end of year (total assets less liabilities)2020-12-31$-163,489
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$-239,390
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-12-31No
Were any leases to which the plan was party in default or uncollectible2020-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2020-12-31$504,114
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-12-31No
Was there a failure to transmit to the plan any participant contributions2020-12-31No
Has the plan failed to provide any benefit when due under the plan2020-12-31No
Contributions received in cash from employer2020-12-31$3,396,754
Employer contributions (assets) at end of year2020-12-31$41,072
Employer contributions (assets) at beginning of year2020-12-31$45,023
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-12-31$4,152,783
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32020-12-31No
Liabilities. Value of benefit claims payable at end of year2020-12-31$181,137
Liabilities. Value of benefit claims payable at beginning of year2020-12-31$249,573
Did the plan have assets held for investment2020-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-12-31No
Opinion of an independent qualified public accountant for this plan2020-12-31Unqualified
Accountancy firm name2020-12-31STROHM BALLWEG, LLP
Accountancy firm EIN2020-12-31391969986
2019 : SFM MUTUAL INSURANCE COMPANY FLEXIBLE BENEFITS PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets2019-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$284,413
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$127,997
Total income from all sources (including contributions)2019-12-31$4,778,496
Total loss/gain on sale of assets2019-12-31$0
Total of all expenses incurred2019-12-31$4,944,787
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$4,944,787
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$4,778,496
Value of total assets at end of year2019-12-31$45,023
Value of total assets at beginning of year2019-12-31$54,898
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$0
Total interest from all sources2019-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2019-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-12-31No
Was this plan covered by a fidelity bond2019-12-31Yes
Value of fidelity bond cover2019-12-31$5,000,000
If this is an individual account plan, was there a blackout period2019-12-31No
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Contributions received from participants2019-12-31$1,324,365
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2019-12-31$3,790
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2019-12-31$34,840
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2019-12-31$44,749
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Value of net income/loss2019-12-31$-166,291
Value of net assets at end of year (total assets less liabilities)2019-12-31$-239,390
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$-73,099
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2019-12-31$485,552
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-12-31No
Was there a failure to transmit to the plan any participant contributions2019-12-31No
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Contributions received in cash from employer2019-12-31$3,454,131
Employer contributions (assets) at end of year2019-12-31$45,023
Employer contributions (assets) at beginning of year2019-12-31$54,898
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$4,455,445
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32019-12-31No
Liabilities. Value of benefit claims payable at end of year2019-12-31$249,573
Liabilities. Value of benefit claims payable at beginning of year2019-12-31$83,248
Did the plan have assets held for investment2019-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31No
Opinion of an independent qualified public accountant for this plan2019-12-31Unqualified
Accountancy firm name2019-12-31STROHM BALLWEG, LLP
Accountancy firm EIN2019-12-31391969986
2018 : SFM MUTUAL INSURANCE COMPANY FLEXIBLE BENEFITS PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets2018-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$127,997
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$39,562
Total income from all sources (including contributions)2018-12-31$4,505,569
Total loss/gain on sale of assets2018-12-31$0
Total of all expenses incurred2018-12-31$4,539,106
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-12-31$4,539,106
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-12-31$4,505,569
Value of total assets at end of year2018-12-31$54,898
Value of total assets at beginning of year2018-12-31$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-12-31$0
Total interest from all sources2018-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2018-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-12-31No
Was this plan covered by a fidelity bond2018-12-31Yes
Value of fidelity bond cover2018-12-31$5,000,000
If this is an individual account plan, was there a blackout period2018-12-31No
Were there any nonexempt tranactions with any party-in-interest2018-12-31No
Contributions received from participants2018-12-31$1,204,685
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2018-12-31$-389
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2018-12-31$44,749
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Value of net income/loss2018-12-31$-33,537
Value of net assets at end of year (total assets less liabilities)2018-12-31$-73,099
Value of net assets at beginning of year (total assets less liabilities)2018-12-31$-39,562
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2018-12-31No
Were any leases to which the plan was party in default or uncollectible2018-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2018-12-31$431,081
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-12-31No
Was there a failure to transmit to the plan any participant contributions2018-12-31No
Has the plan failed to provide any benefit when due under the plan2018-12-31No
Contributions received in cash from employer2018-12-31$3,300,884
Employer contributions (assets) at end of year2018-12-31$54,898
Employer contributions (assets) at beginning of year2018-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-12-31$4,108,414
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32018-12-31No
Liabilities. Value of benefit claims payable at end of year2018-12-31$83,248
Liabilities. Value of benefit claims payable at beginning of year2018-12-31$39,562
Did the plan have assets held for investment2018-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-12-31No
Opinion of an independent qualified public accountant for this plan2018-12-31Unqualified
Accountancy firm name2018-12-31STROHM BALLWEG, LLP
Accountancy firm EIN2018-12-31391969986
2017 : SFM MUTUAL INSURANCE COMPANY FLEXIBLE BENEFITS PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets2017-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$39,562
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$108,272
Total income from all sources (including contributions)2017-12-31$301,232
Total loss/gain on sale of assets2017-12-31$0
Total of all expenses incurred2017-12-31$282,059
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-12-31$282,059
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-12-31$301,232
Value of total assets at end of year2017-12-31$0
Value of total assets at beginning of year2017-12-31$49,537
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-12-31$0
Total interest from all sources2017-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2017-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-12-31No
Was this plan covered by a fidelity bond2017-12-31Yes
Value of fidelity bond cover2017-12-31$5,000,000
If this is an individual account plan, was there a blackout period2017-12-31No
Were there any nonexempt tranactions with any party-in-interest2017-12-31No
Contributions received from participants2017-12-31$81,701
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2017-12-31$49,537
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Value of net income/loss2017-12-31$19,173
Value of net assets at end of year (total assets less liabilities)2017-12-31$-39,562
Value of net assets at beginning of year (total assets less liabilities)2017-12-31$-58,735
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2017-12-31No
Were any leases to which the plan was party in default or uncollectible2017-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2017-12-31$35,663
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-12-31No
Was there a failure to transmit to the plan any participant contributions2017-12-31No
Has the plan failed to provide any benefit when due under the plan2017-12-31No
Contributions received in cash from employer2017-12-31$219,531
Employer contributions (assets) at end of year2017-12-31$0
Employer contributions (assets) at beginning of year2017-12-31$49,537
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-12-31$246,396
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32017-12-31No
Liabilities. Value of benefit claims payable at end of year2017-12-31$39,562
Liabilities. Value of benefit claims payable at beginning of year2017-12-31$58,735
Did the plan have assets held for investment2017-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-12-31No
Opinion of an independent qualified public accountant for this plan2017-12-31Unqualified
Accountancy firm name2017-12-31STROHM BALLWEG, LLP
Accountancy firm EIN2017-12-31391969986
Total unrealized appreciation/depreciation of assets2017-11-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-11-30$108,272
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-11-30$63,619
Total income from all sources (including contributions)2017-11-30$4,169,170
Total loss/gain on sale of assets2017-11-30$0
Total of all expenses incurred2017-11-30$4,211,278
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-11-30$4,211,278
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-11-30$4,169,170
Value of total assets at end of year2017-11-30$49,537
Value of total assets at beginning of year2017-11-30$46,992
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-11-30$0
Total interest from all sources2017-11-30$0
Total dividends received (eg from common stock, registered investment company shares)2017-11-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-11-30No
Was this plan covered by a fidelity bond2017-11-30Yes
Value of fidelity bond cover2017-11-30$5,000,000
If this is an individual account plan, was there a blackout period2017-11-30No
Were there any nonexempt tranactions with any party-in-interest2017-11-30No
Contributions received from participants2017-11-30$1,176,417
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2017-11-30$975
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2017-11-30$49,537
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2017-11-30$46,992
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-11-30No
Value of net income/loss2017-11-30$-42,108
Value of net assets at end of year (total assets less liabilities)2017-11-30$-58,735
Value of net assets at beginning of year (total assets less liabilities)2017-11-30$-16,627
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-11-30No
Were any loans by the plan or fixed income obligations due to the plan in default2017-11-30No
Were any leases to which the plan was party in default or uncollectible2017-11-30No
Expenses. Payments to insurance carriers foe the provision of benefits2017-11-30$462,799
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-11-30No
Was there a failure to transmit to the plan any participant contributions2017-11-30No
Has the plan failed to provide any benefit when due under the plan2017-11-30No
Contributions received in cash from employer2017-11-30$2,992,753
Employer contributions (assets) at end of year2017-11-30$49,537
Employer contributions (assets) at beginning of year2017-11-30$46,992
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-11-30$3,747,504
Liabilities. Value of benefit claims payable at end of year2017-11-30$58,735
Liabilities. Value of benefit claims payable at beginning of year2017-11-30$16,627
Did the plan have assets held for investment2017-11-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-11-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-11-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-11-30No
Opinion of an independent qualified public accountant for this plan2017-11-30Unqualified
Accountancy firm name2017-11-30STROHM BALLWEG, LLP
Accountancy firm EIN2017-11-30391969986
2016 : SFM MUTUAL INSURANCE COMPANY FLEXIBLE BENEFITS PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets2016-11-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-11-30$63,619
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-11-30$52,104
Total income from all sources (including contributions)2016-11-30$3,365,958
Total loss/gain on sale of assets2016-11-30$0
Total of all expenses incurred2016-11-30$3,379,443
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-11-30$3,379,443
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-11-30$3,365,958
Value of total assets at end of year2016-11-30$46,992
Value of total assets at beginning of year2016-11-30$48,962
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-11-30$0
Total interest from all sources2016-11-30$0
Total dividends received (eg from common stock, registered investment company shares)2016-11-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-11-30No
Was this plan covered by a fidelity bond2016-11-30Yes
Value of fidelity bond cover2016-11-30$5,000,000
If this is an individual account plan, was there a blackout period2016-11-30No
Were there any nonexempt tranactions with any party-in-interest2016-11-30No
Contributions received from participants2016-11-30$1,048,297
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2016-11-30$6,944
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2016-11-30$46,992
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2016-11-30$48,962
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-11-30No
Value of net income/loss2016-11-30$-13,485
Value of net assets at end of year (total assets less liabilities)2016-11-30$-16,627
Value of net assets at beginning of year (total assets less liabilities)2016-11-30$-3,142
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-11-30No
Were any loans by the plan or fixed income obligations due to the plan in default2016-11-30No
Were any leases to which the plan was party in default or uncollectible2016-11-30No
Expenses. Payments to insurance carriers foe the provision of benefits2016-11-30$715,986
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-11-30No
Was there a failure to transmit to the plan any participant contributions2016-11-30No
Has the plan failed to provide any benefit when due under the plan2016-11-30No
Contributions received in cash from employer2016-11-30$2,317,661
Employer contributions (assets) at end of year2016-11-30$46,992
Employer contributions (assets) at beginning of year2016-11-30$48,962
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-11-30$2,656,513
Liabilities. Value of benefit claims payable at end of year2016-11-30$16,627
Liabilities. Value of benefit claims payable at beginning of year2016-11-30$3,142
Did the plan have assets held for investment2016-11-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-11-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-11-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-11-30No
Opinion of an independent qualified public accountant for this plan2016-11-30Unqualified
Accountancy firm name2016-11-30STROHM BALLWEG, LLP
Accountancy firm EIN2016-11-30391969986
2015 : SFM MUTUAL INSURANCE COMPANY FLEXIBLE BENEFITS PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets2015-11-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-11-30$52,104
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-11-30$94,108
Total income from all sources (including contributions)2015-11-30$3,132,411
Total loss/gain on sale of assets2015-11-30$0
Total of all expenses incurred2015-11-30$3,089,294
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-11-30$3,089,294
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-11-30$3,132,411
Value of total assets at end of year2015-11-30$48,962
Value of total assets at beginning of year2015-11-30$47,849
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-11-30$0
Total interest from all sources2015-11-30$0
Total dividends received (eg from common stock, registered investment company shares)2015-11-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-11-30No
Was this plan covered by a fidelity bond2015-11-30Yes
Value of fidelity bond cover2015-11-30$5,000,000
If this is an individual account plan, was there a blackout period2015-11-30No
Were there any nonexempt tranactions with any party-in-interest2015-11-30No
Contributions received from participants2015-11-30$1,008,384
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2015-11-30$24
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2015-11-30$48,962
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2015-11-30$47,849
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-11-30No
Value of net income/loss2015-11-30$43,117
Value of net assets at end of year (total assets less liabilities)2015-11-30$-3,142
Value of net assets at beginning of year (total assets less liabilities)2015-11-30$-46,259
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-11-30No
Were any loans by the plan or fixed income obligations due to the plan in default2015-11-30No
Were any leases to which the plan was party in default or uncollectible2015-11-30No
Expenses. Payments to insurance carriers foe the provision of benefits2015-11-30$713,629
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-11-30No
Was there a failure to transmit to the plan any participant contributions2015-11-30No
Has the plan failed to provide any benefit when due under the plan2015-11-30No
Contributions received in cash from employer2015-11-30$2,124,027
Employer contributions (assets) at end of year2015-11-30$48,962
Employer contributions (assets) at beginning of year2015-11-30$47,849
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-11-30$2,375,641
Liabilities. Value of benefit claims payable at end of year2015-11-30$3,142
Liabilities. Value of benefit claims payable at beginning of year2015-11-30$46,259
Did the plan have assets held for investment2015-11-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-11-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-11-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-11-30No
Opinion of an independent qualified public accountant for this plan2015-11-30Unqualified
Accountancy firm name2015-11-30STROHM BALLWEG, LLP
Accountancy firm EIN2015-11-30391969986
2014 : SFM MUTUAL INSURANCE COMPANY FLEXIBLE BENEFITS PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets2014-11-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-11-30$94,108
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-11-30$64,405
Total income from all sources (including contributions)2014-11-30$2,777,584
Total loss/gain on sale of assets2014-11-30$0
Total of all expenses incurred2014-11-30$2,791,583
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-11-30$2,791,583
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-11-30$2,777,584
Value of total assets at end of year2014-11-30$47,849
Value of total assets at beginning of year2014-11-30$32,145
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-11-30$0
Total interest from all sources2014-11-30$0
Total dividends received (eg from common stock, registered investment company shares)2014-11-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-11-30No
Was this plan covered by a fidelity bond2014-11-30Yes
Value of fidelity bond cover2014-11-30$5,000,000
If this is an individual account plan, was there a blackout period2014-11-30No
Were there any nonexempt tranactions with any party-in-interest2014-11-30No
Contributions received from participants2014-11-30$968,374
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2014-11-30$-1,551
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2014-11-30$47,849
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2014-11-30$32,145
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-11-30No
Value of net income/loss2014-11-30$-13,999
Value of net assets at end of year (total assets less liabilities)2014-11-30$-46,259
Value of net assets at beginning of year (total assets less liabilities)2014-11-30$-32,260
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-11-30No
Were any loans by the plan or fixed income obligations due to the plan in default2014-11-30No
Were any leases to which the plan was party in default or uncollectible2014-11-30No
Expenses. Payments to insurance carriers foe the provision of benefits2014-11-30$685,813
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-11-30No
Was there a failure to transmit to the plan any participant contributions2014-11-30No
Has the plan failed to provide any benefit when due under the plan2014-11-30No
Contributions received in cash from employer2014-11-30$1,809,210
Employer contributions (assets) at end of year2014-11-30$47,849
Employer contributions (assets) at beginning of year2014-11-30$32,145
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-11-30$2,107,321
Liabilities. Value of benefit claims payable at end of year2014-11-30$46,259
Liabilities. Value of benefit claims payable at beginning of year2014-11-30$32,260
Did the plan have assets held for investment2014-11-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-11-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-11-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-11-30No
Opinion of an independent qualified public accountant for this plan2014-11-30Unqualified
Accountancy firm name2014-11-30STROHM BALLWEG, LLP
Accountancy firm EIN2014-11-30391969986
2013 : SFM MUTUAL INSURANCE COMPANY FLEXIBLE BENEFITS PLAN 2013 401k financial data
Total unrealized appreciation/depreciation of assets2013-11-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-11-30$64,405
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-11-30$62,870
Total income from all sources (including contributions)2013-11-30$2,575,537
Total loss/gain on sale of assets2013-11-30$0
Total of all expenses incurred2013-11-30$2,582,790
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-11-30$2,582,790
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-11-30$2,575,537
Value of total assets at end of year2013-11-30$32,145
Value of total assets at beginning of year2013-11-30$37,863
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-11-30$0
Total interest from all sources2013-11-30$0
Total dividends received (eg from common stock, registered investment company shares)2013-11-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-11-30No
Was this plan covered by a fidelity bond2013-11-30Yes
Value of fidelity bond cover2013-11-30$5,000,000
If this is an individual account plan, was there a blackout period2013-11-30No
Were there any nonexempt tranactions with any party-in-interest2013-11-30No
Contributions received from participants2013-11-30$894,440
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2013-11-30$2,475
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2013-11-30$32,145
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2013-11-30$37,863
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-11-30No
Value of net income/loss2013-11-30$-7,253
Value of net assets at end of year (total assets less liabilities)2013-11-30$-32,260
Value of net assets at beginning of year (total assets less liabilities)2013-11-30$-25,007
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-11-30No
Were any loans by the plan or fixed income obligations due to the plan in default2013-11-30No
Were any leases to which the plan was party in default or uncollectible2013-11-30No
Expenses. Payments to insurance carriers foe the provision of benefits2013-11-30$632,967
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-11-30No
Was there a failure to transmit to the plan any participant contributions2013-11-30No
Has the plan failed to provide any benefit when due under the plan2013-11-30No
Contributions received in cash from employer2013-11-30$1,681,097
Employer contributions (assets) at end of year2013-11-30$32,145
Employer contributions (assets) at beginning of year2013-11-30$37,863
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-11-30$1,947,348
Liabilities. Value of benefit claims payable at end of year2013-11-30$32,260
Liabilities. Value of benefit claims payable at beginning of year2013-11-30$25,007
Did the plan have assets held for investment2013-11-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-11-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-11-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-11-30No
Opinion of an independent qualified public accountant for this plan2013-11-30Unqualified
Accountancy firm name2013-11-30STROHM BALLWEG, LLP
Accountancy firm EIN2013-11-30391969986
2012 : SFM MUTUAL INSURANCE COMPANY FLEXIBLE BENEFITS PLAN 2012 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-11-30$62,870
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-11-30$75,305
Total income from all sources (including contributions)2012-11-30$2,348,327
Total of all expenses incurred2012-11-30$2,330,882
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-11-30$2,330,882
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-11-30$2,348,327
Value of total assets at end of year2012-11-30$37,863
Value of total assets at beginning of year2012-11-30$32,853
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-11-30No
Was this plan covered by a fidelity bond2012-11-30Yes
Value of fidelity bond cover2012-11-30$5,000,000
If this is an individual account plan, was there a blackout period2012-11-30No
Were there any nonexempt tranactions with any party-in-interest2012-11-30No
Contributions received from participants2012-11-30$809,978
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2012-11-30$1,937
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2012-11-30$37,863
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2012-11-30$32,853
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-11-30No
Value of net income/loss2012-11-30$17,445
Value of net assets at end of year (total assets less liabilities)2012-11-30$-25,007
Value of net assets at beginning of year (total assets less liabilities)2012-11-30$-42,452
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-11-30No
Were any loans by the plan or fixed income obligations due to the plan in default2012-11-30No
Were any leases to which the plan was party in default or uncollectible2012-11-30No
Expenses. Payments to insurance carriers foe the provision of benefits2012-11-30$585,601
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-11-30No
Was there a failure to transmit to the plan any participant contributions2012-11-30No
Has the plan failed to provide any benefit when due under the plan2012-11-30No
Contributions received in cash from employer2012-11-30$1,538,349
Employer contributions (assets) at end of year2012-11-30$37,863
Employer contributions (assets) at beginning of year2012-11-30$32,853
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-11-30$1,743,344
Liabilities. Value of benefit claims payable at end of year2012-11-30$25,007
Liabilities. Value of benefit claims payable at beginning of year2012-11-30$42,452
Did the plan have assets held for investment2012-11-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-11-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-11-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-11-30No
Opinion of an independent qualified public accountant for this plan2012-11-30Unqualified
Accountancy firm name2012-11-30STROHM BALLWEG, LLP
Accountancy firm EIN2012-11-30391969986
2011 : SFM MUTUAL INSURANCE COMPANY FLEXIBLE BENEFITS PLAN 2011 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-11-30$75,305
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-11-30$100,894
Total income from all sources (including contributions)2011-11-30$2,301,728
Total of all expenses incurred2011-11-30$2,278,889
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-11-30$2,278,889
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-11-30$2,301,728
Value of total assets at end of year2011-11-30$32,853
Value of total assets at beginning of year2011-11-30$35,603
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-11-30No
Was this plan covered by a fidelity bond2011-11-30Yes
Value of fidelity bond cover2011-11-30$5,000,000
If this is an individual account plan, was there a blackout period2011-11-30No
Were there any nonexempt tranactions with any party-in-interest2011-11-30No
Contributions received from participants2011-11-30$835,527
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2011-11-30$1,167
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2011-11-30$32,853
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2011-11-30$35,603
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-11-30No
Value of net income/loss2011-11-30$22,839
Value of net assets at end of year (total assets less liabilities)2011-11-30$-42,452
Value of net assets at beginning of year (total assets less liabilities)2011-11-30$-65,291
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-11-30No
Were any loans by the plan or fixed income obligations due to the plan in default2011-11-30No
Were any leases to which the plan was party in default or uncollectible2011-11-30No
Expenses. Payments to insurance carriers foe the provision of benefits2011-11-30$545,626
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-11-30No
Was there a failure to transmit to the plan any participant contributions2011-11-30No
Has the plan failed to provide any benefit when due under the plan2011-11-30No
Contributions received in cash from employer2011-11-30$1,466,201
Employer contributions (assets) at end of year2011-11-30$32,853
Employer contributions (assets) at beginning of year2011-11-30$35,603
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-11-30$1,732,096
Liabilities. Value of benefit claims payable at end of year2011-11-30$42,452
Liabilities. Value of benefit claims payable at beginning of year2011-11-30$65,291
Did the plan have assets held for investment2011-11-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-11-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-11-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-11-30No
Opinion of an independent qualified public accountant for this plan2011-11-30Unqualified
Accountancy firm name2011-11-30STROHM BALLWEG, LLP
Accountancy firm EIN2011-11-30391969986

Form 5500 Responses for SFM MUTUAL INSURANCE COMPANY FLEXIBLE BENEFITS PLAN

2022: SFM MUTUAL INSURANCE COMPANY FLEXIBLE BENEFITS PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: SFM MUTUAL INSURANCE COMPANY FLEXIBLE BENEFITS PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01First time form 5500 has been submittedYes
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – TrustYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement - TrustYes
2020: SFM MUTUAL INSURANCE COMPANY FLEXIBLE BENEFITS PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – TrustYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement - TrustYes
2019: SFM MUTUAL INSURANCE COMPANY FLEXIBLE BENEFITS PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – General assets of the sponsorYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – General assets of the sponsorYes
2018: SFM MUTUAL INSURANCE COMPANY FLEXIBLE BENEFITS PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: SFM MUTUAL INSURANCE COMPANY FLEXIBLE BENEFITS PLAN 2017 form 5500 responses
2017-12-01Type of plan entitySingle employer plan
2017-12-01Submission has been amendedNo
2017-12-01This submission is the final filingNo
2017-12-01This return/report is a short plan year return/report (less than 12 months)Yes
2017-12-01Plan is a collectively bargained planNo
2017-12-01Plan funding arrangement – InsuranceYes
2017-12-01Plan funding arrangement – General assets of the sponsorYes
2017-12-01Plan benefit arrangement – InsuranceYes
2017-12-01Plan benefit arrangement – General assets of the sponsorYes
2016: SFM MUTUAL INSURANCE COMPANY FLEXIBLE BENEFITS PLAN 2016 form 5500 responses
2016-12-01Type of plan entitySingle employer plan
2016-12-01Submission has been amendedNo
2016-12-01This submission is the final filingNo
2016-12-01This return/report is a short plan year return/report (less than 12 months)No
2016-12-01Plan is a collectively bargained planNo
2016-12-01Plan funding arrangement – InsuranceYes
2016-12-01Plan funding arrangement – General assets of the sponsorYes
2016-12-01Plan benefit arrangement – InsuranceYes
2016-12-01Plan benefit arrangement – General assets of the sponsorYes
2015: SFM MUTUAL INSURANCE COMPANY FLEXIBLE BENEFITS PLAN 2015 form 5500 responses
2015-12-01Type of plan entitySingle employer plan
2015-12-01Submission has been amendedNo
2015-12-01This submission is the final filingNo
2015-12-01This return/report is a short plan year return/report (less than 12 months)No
2015-12-01Plan is a collectively bargained planNo
2015-12-01Plan funding arrangement – InsuranceYes
2015-12-01Plan funding arrangement – General assets of the sponsorYes
2015-12-01Plan benefit arrangement – InsuranceYes
2015-12-01Plan benefit arrangement – General assets of the sponsorYes
2014: SFM MUTUAL INSURANCE COMPANY FLEXIBLE BENEFITS PLAN 2014 form 5500 responses
2014-12-01Type of plan entitySingle employer plan
2014-12-01Submission has been amendedNo
2014-12-01This submission is the final filingNo
2014-12-01This return/report is a short plan year return/report (less than 12 months)No
2014-12-01Plan is a collectively bargained planNo
2014-12-01Plan funding arrangement – InsuranceYes
2014-12-01Plan funding arrangement – General assets of the sponsorYes
2014-12-01Plan benefit arrangement – InsuranceYes
2014-12-01Plan benefit arrangement – General assets of the sponsorYes
2013: SFM MUTUAL INSURANCE COMPANY FLEXIBLE BENEFITS PLAN 2013 form 5500 responses
2013-12-01Type of plan entitySingle employer plan
2013-12-01Submission has been amendedNo
2013-12-01This submission is the final filingNo
2013-12-01This return/report is a short plan year return/report (less than 12 months)No
2013-12-01Plan is a collectively bargained planNo
2013-12-01Plan funding arrangement – InsuranceYes
2013-12-01Plan funding arrangement – General assets of the sponsorYes
2013-12-01Plan benefit arrangement – InsuranceYes
2013-12-01Plan benefit arrangement – General assets of the sponsorYes
2012: SFM MUTUAL INSURANCE COMPANY FLEXIBLE BENEFITS PLAN 2012 form 5500 responses
2012-12-01Type of plan entitySingle employer plan
2012-12-01Submission has been amendedNo
2012-12-01This submission is the final filingNo
2012-12-01This return/report is a short plan year return/report (less than 12 months)No
2012-12-01Plan is a collectively bargained planNo
2012-12-01Plan funding arrangement – InsuranceYes
2012-12-01Plan funding arrangement – General assets of the sponsorYes
2012-12-01Plan benefit arrangement – InsuranceYes
2012-12-01Plan benefit arrangement – General assets of the sponsorYes
2011: SFM MUTUAL INSURANCE COMPANY FLEXIBLE BENEFITS PLAN 2011 form 5500 responses
2011-12-01Type of plan entitySingle employer plan
2011-12-01Submission has been amendedNo
2011-12-01This submission is the final filingNo
2011-12-01This return/report is a short plan year return/report (less than 12 months)No
2011-12-01Plan is a collectively bargained planNo
2011-12-01Plan funding arrangement – InsuranceYes
2011-12-01Plan funding arrangement – General assets of the sponsorYes
2011-12-01Plan benefit arrangement – InsuranceYes
2011-12-01Plan benefit arrangement – General assets of the sponsorYes
2010: SFM MUTUAL INSURANCE COMPANY FLEXIBLE BENEFITS PLAN 2010 form 5500 responses
2010-12-01Type of plan entitySingle employer plan
2010-12-01Submission has been amendedNo
2010-12-01This submission is the final filingNo
2010-12-01This return/report is a short plan year return/report (less than 12 months)No
2010-12-01Plan is a collectively bargained planNo
2010-12-01Plan funding arrangement – InsuranceYes
2010-12-01Plan funding arrangement – General assets of the sponsorYes
2010-12-01Plan benefit arrangement – InsuranceYes
2010-12-01Plan benefit arrangement – General assets of the sponsorYes
2009: SFM MUTUAL INSURANCE COMPANY FLEXIBLE BENEFITS PLAN 2009 form 5500 responses
2009-12-01Type of plan entitySingle employer plan
2009-12-01Submission has been amendedNo
2009-12-01This submission is the final filingNo
2009-12-01This return/report is a short plan year return/report (less than 12 months)No
2009-12-01Plan is a collectively bargained planNo
2009-12-01Plan funding arrangement – InsuranceYes
2009-12-01Plan funding arrangement – General assets of the sponsorYes
2009-12-01Plan benefit arrangement – InsuranceYes
2009-12-01Plan benefit arrangement – General assets of the sponsorYes
2008: SFM MUTUAL INSURANCE COMPANY FLEXIBLE BENEFITS PLAN 2008 form 5500 responses
2008-12-01Type of plan entitySingle employer plan
2008-12-01Submission has been amendedNo
2008-12-01This submission is the final filingNo
2008-12-01This return/report is a short plan year return/report (less than 12 months)No
2008-12-01Plan is a collectively bargained planNo
2008-12-01Plan funding arrangement – InsuranceYes
2008-12-01Plan funding arrangement – General assets of the sponsorYes
2008-12-01Plan benefit arrangement – InsuranceYes
2008-12-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0224607
Policy instance 3
Insurance contract or identification number0224607
Number of Individuals Covered155
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $2,104
Total amount of fees paid to insurance companyUSD $304
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $21,411
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees3
Additional information about fees paid to insurance brokerMARKETING FEES
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0224608
Policy instance 2
Insurance contract or identification number0224608
Number of Individuals Covered151
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $1,618
Total amount of fees paid to insurance companyUSD $202
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $13,069
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees2
Additional information about fees paid to insurance brokerMARKETING FEES
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number97044201001
Policy instance 1
Insurance contract or identification number97044201001
Number of Individuals Covered323
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $1,449
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $13,558
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,449
Insurance broker organization code?3
DELTA DENTAL PLAN OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number620466
Policy instance 1
Insurance contract or identification number620466
Number of Individuals Covered552
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $22,253
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $22,253
Insurance broker organization code?3
HEALTHPARTNERS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number34413
Policy instance 2
Insurance contract or identification number34413
Number of Individuals Covered527
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $17,679
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $363,657
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,679
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number97044201001
Policy instance 3
Insurance contract or identification number97044201001
Number of Individuals Covered289
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $1,460
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $13,715
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,460
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0224608
Policy instance 4
Insurance contract or identification number0224608
Number of Individuals Covered136
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $1,373
Total amount of fees paid to insurance companyUSD $171
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $11,218
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,373
Amount paid for insurance broker fees171
Additional information about fees paid to insurance brokerNON-MONETARY COMPENSATION & SUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0224607
Policy instance 5
Insurance contract or identification number0224607
Number of Individuals Covered128
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $1,814
Total amount of fees paid to insurance companyUSD $261
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $18,733
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,814
Amount paid for insurance broker fees261
Additional information about fees paid to insurance brokerNON-MONETARY COMPENSATION AND SUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number97044201001
Policy instance 3
Insurance contract or identification number97044201001
Number of Individuals Covered289
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $1,369
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $13,642
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,369
Insurance broker organization code?3
HEALTHPARTNERS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number34413
Policy instance 2
Insurance contract or identification number34413
Number of Individuals Covered545
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $15,240
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $292,940
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,240
Insurance broker organization code?3
DELTA DENTAL PLAN OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number620466
Policy instance 1
Insurance contract or identification number620466
Number of Individuals Covered540
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $21,025
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $21,025
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number97044201001
Policy instance 3
Insurance contract or identification number97044201001
Number of Individuals Covered294
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $1,354
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $13,854
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,354
Insurance broker organization code?3
HEALTHPARTNERS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number34413
Policy instance 2
Insurance contract or identification number34413
Number of Individuals Covered561
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $24,050
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $305,344
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $24,050
Insurance broker organization code?3
DELTA DENTAL PLAN OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number620466
Policy instance 1
Insurance contract or identification number620466
Number of Individuals Covered531
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $21,319
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $21,319
Insurance broker organization code?3
DELTA DENTAL PLAN OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number0000717027
Policy instance 1
Insurance contract or identification number0000717027
Number of Individuals Covered547
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $37,217
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $37,217
Insurance broker organization code?3
HEALTHPARTNERS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number34413
Policy instance 2
Insurance contract or identification number34413
Number of Individuals Covered564
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $29,568
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $312,983
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $29,568
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number97044201001
Policy instance 3
Insurance contract or identification number97044201001
Number of Individuals Covered277
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $1,164
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $12,416
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,164
Insurance broker organization code?3
HEALTHPARTNERS (National Association of Insurance Commissioners NAIC id number: 95766 )
Policy contract number34413
Policy instance 3
Insurance contract or identification number34413
Number of Individuals Covered534
Insurance policy start date2017-12-01
Insurance policy end date2017-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $21,855
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 number97044201001
Policy instance 2
Insurance contract or identification number97044201001
Number of Individuals Covered233
Insurance policy start date2017-12-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $93
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $1,675
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $93
Insurance broker organization code?3
Insurance broker nameMARSH & MCLENNAN AGENCY, LLC
DELTA DENTAL PLAN OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number0000717027
Policy instance 1
Insurance contract or identification number0000717027
Number of Individuals Covered523
Insurance policy start date2017-12-01
Insurance policy end date2017-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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