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ANDERSON ERICKSON DAIRY EMPLOYEE HEALTH PLAN 401k Plan overview

Plan NameANDERSON ERICKSON DAIRY EMPLOYEE HEALTH PLAN
Plan identification number 501

ANDERSON ERICKSON DAIRY EMPLOYEE HEALTH PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Long-term disability cover
  • Other welfare benefit cover

401k Sponsoring company profile

ANDERSON ERICKSON DAIRY COMPANY AND SUBSIDIARY has sponsored the creation of one or more 401k plans.

Company Name:ANDERSON ERICKSON DAIRY COMPANY AND SUBSIDIARY
Employer identification number (EIN):420115611
NAIC Classification:311500
NAIC Description: Dairy Product Manufacturing

Additional information about ANDERSON ERICKSON DAIRY COMPANY AND SUBSIDIARY

Jurisdiction of Incorporation: Iowa Secretary of State Business Entities
Incorporation Date: 1938-08-01
Company Identification Number: 002321
Legal Registered Office Address: 2420 E UNIVERSITY

DES MOINES
United States of America (USA)
50317

More information about ANDERSON ERICKSON DAIRY COMPANY AND SUBSIDIARY

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ANDERSON ERICKSON DAIRY EMPLOYEE HEALTH PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012021-10-01
5012020-10-01
5012019-10-01
5012018-10-01
5012017-10-01
5012016-10-01BOB SEIDL
5012015-10-01BOB SEIDL
5012014-10-01BOB SEIDL
5012013-10-01BOB SEIDL
5012012-10-01BOB SEIDL
5012011-10-01BOB SEIDL
5012009-10-01BOB SEIDL

Plan Statistics for ANDERSON ERICKSON DAIRY EMPLOYEE HEALTH PLAN

401k plan membership statisitcs for ANDERSON ERICKSON DAIRY EMPLOYEE HEALTH PLAN

Measure Date Value
2021: ANDERSON ERICKSON DAIRY EMPLOYEE HEALTH PLAN 2021 401k membership
Total participants, beginning-of-year2021-10-01403
Total number of active participants reported on line 7a of the Form 55002021-10-01376
Number of retired or separated participants receiving benefits2021-10-010
Number of other retired or separated participants entitled to future benefits2021-10-010
Total of all active and inactive participants2021-10-01376
2020: ANDERSON ERICKSON DAIRY EMPLOYEE HEALTH PLAN 2020 401k membership
Total participants, beginning-of-year2020-10-01423
Total number of active participants reported on line 7a of the Form 55002020-10-01403
Number of retired or separated participants receiving benefits2020-10-010
Number of other retired or separated participants entitled to future benefits2020-10-010
Total of all active and inactive participants2020-10-01403
2019: ANDERSON ERICKSON DAIRY EMPLOYEE HEALTH PLAN 2019 401k membership
Total participants, beginning-of-year2019-10-01432
Total number of active participants reported on line 7a of the Form 55002019-10-01423
Number of retired or separated participants receiving benefits2019-10-011
Number of other retired or separated participants entitled to future benefits2019-10-010
Total of all active and inactive participants2019-10-01424
2018: ANDERSON ERICKSON DAIRY EMPLOYEE HEALTH PLAN 2018 401k membership
Total participants, beginning-of-year2018-10-01471
Total number of active participants reported on line 7a of the Form 55002018-10-01429
Number of retired or separated participants receiving benefits2018-10-013
Number of other retired or separated participants entitled to future benefits2018-10-010
Total of all active and inactive participants2018-10-01432
2017: ANDERSON ERICKSON DAIRY EMPLOYEE HEALTH PLAN 2017 401k membership
Total participants, beginning-of-year2017-10-01494
Total number of active participants reported on line 7a of the Form 55002017-10-01466
Number of retired or separated participants receiving benefits2017-10-015
Number of other retired or separated participants entitled to future benefits2017-10-010
Total of all active and inactive participants2017-10-01471
2016: ANDERSON ERICKSON DAIRY EMPLOYEE HEALTH PLAN 2016 401k membership
Total participants, beginning-of-year2016-10-01486
Total number of active participants reported on line 7a of the Form 55002016-10-01492
Number of retired or separated participants receiving benefits2016-10-012
Number of other retired or separated participants entitled to future benefits2016-10-010
Total of all active and inactive participants2016-10-01494
2015: ANDERSON ERICKSON DAIRY EMPLOYEE HEALTH PLAN 2015 401k membership
Total participants, beginning-of-year2015-10-01489
Total number of active participants reported on line 7a of the Form 55002015-10-01482
Number of retired or separated participants receiving benefits2015-10-014
Number of other retired or separated participants entitled to future benefits2015-10-010
Total of all active and inactive participants2015-10-01486
2014: ANDERSON ERICKSON DAIRY EMPLOYEE HEALTH PLAN 2014 401k membership
Total participants, beginning-of-year2014-10-01513
Total number of active participants reported on line 7a of the Form 55002014-10-01485
Number of retired or separated participants receiving benefits2014-10-014
Number of other retired or separated participants entitled to future benefits2014-10-010
Total of all active and inactive participants2014-10-01489
2013: ANDERSON ERICKSON DAIRY EMPLOYEE HEALTH PLAN 2013 401k membership
Total participants, beginning-of-year2013-10-01499
Total number of active participants reported on line 7a of the Form 55002013-10-01495
Number of retired or separated participants receiving benefits2013-10-0118
Total of all active and inactive participants2013-10-01513
2012: ANDERSON ERICKSON DAIRY EMPLOYEE HEALTH PLAN 2012 401k membership
Total participants, beginning-of-year2012-10-01500
Total number of active participants reported on line 7a of the Form 55002012-10-01499
Total of all active and inactive participants2012-10-01499
2011: ANDERSON ERICKSON DAIRY EMPLOYEE HEALTH PLAN 2011 401k membership
Total participants, beginning-of-year2011-10-01515
Total number of active participants reported on line 7a of the Form 55002011-10-01500
Total of all active and inactive participants2011-10-01500
2009: ANDERSON ERICKSON DAIRY EMPLOYEE HEALTH PLAN 2009 401k membership
Total participants, beginning-of-year2009-10-01504
Total number of active participants reported on line 7a of the Form 55002009-10-01529
Number of retired or separated participants receiving benefits2009-10-0127
Total of all active and inactive participants2009-10-01556

Form 5500 Responses for ANDERSON ERICKSON DAIRY EMPLOYEE HEALTH PLAN

2021: ANDERSON ERICKSON DAIRY EMPLOYEE HEALTH PLAN 2021 form 5500 responses
2021-10-01Type of plan entitySingle employer plan
2021-10-01Plan funding arrangement – InsuranceYes
2021-10-01Plan funding arrangement – General assets of the sponsorYes
2021-10-01Plan benefit arrangement – InsuranceYes
2021-10-01Plan benefit arrangement – General assets of the sponsorYes
2020: ANDERSON ERICKSON DAIRY EMPLOYEE HEALTH PLAN 2020 form 5500 responses
2020-10-01Type of plan entitySingle employer plan
2020-10-01Plan funding arrangement – InsuranceYes
2020-10-01Plan funding arrangement – General assets of the sponsorYes
2020-10-01Plan benefit arrangement – InsuranceYes
2020-10-01Plan benefit arrangement – General assets of the sponsorYes
2019: ANDERSON ERICKSON DAIRY EMPLOYEE HEALTH PLAN 2019 form 5500 responses
2019-10-01Type of plan entitySingle employer plan
2019-10-01Plan funding arrangement – InsuranceYes
2019-10-01Plan funding arrangement – General assets of the sponsorYes
2019-10-01Plan benefit arrangement – InsuranceYes
2019-10-01Plan benefit arrangement – General assets of the sponsorYes
2018: ANDERSON ERICKSON DAIRY EMPLOYEE HEALTH PLAN 2018 form 5500 responses
2018-10-01Type of plan entitySingle employer plan
2018-10-01Plan funding arrangement – InsuranceYes
2018-10-01Plan funding arrangement – General assets of the sponsorYes
2018-10-01Plan benefit arrangement – InsuranceYes
2018-10-01Plan benefit arrangement – General assets of the sponsorYes
2017: ANDERSON ERICKSON DAIRY EMPLOYEE HEALTH PLAN 2017 form 5500 responses
2017-10-01Type of plan entitySingle employer plan
2017-10-01Plan funding arrangement – InsuranceYes
2017-10-01Plan funding arrangement – General assets of the sponsorYes
2017-10-01Plan benefit arrangement – InsuranceYes
2017-10-01Plan benefit arrangement – General assets of the sponsorYes
2016: ANDERSON ERICKSON DAIRY EMPLOYEE HEALTH PLAN 2016 form 5500 responses
2016-10-01Type of plan entitySingle employer plan
2016-10-01Plan funding arrangement – InsuranceYes
2016-10-01Plan funding arrangement – General assets of the sponsorYes
2016-10-01Plan benefit arrangement – InsuranceYes
2016-10-01Plan benefit arrangement – General assets of the sponsorYes
2015: ANDERSON ERICKSON DAIRY EMPLOYEE HEALTH PLAN 2015 form 5500 responses
2015-10-01Type of plan entitySingle employer plan
2015-10-01Plan funding arrangement – InsuranceYes
2015-10-01Plan funding arrangement – General assets of the sponsorYes
2015-10-01Plan benefit arrangement – InsuranceYes
2015-10-01Plan benefit arrangement – General assets of the sponsorYes
2014: ANDERSON ERICKSON DAIRY EMPLOYEE HEALTH PLAN 2014 form 5500 responses
2014-10-01Type of plan entitySingle employer plan
2014-10-01Plan funding arrangement – InsuranceYes
2014-10-01Plan funding arrangement – General assets of the sponsorYes
2014-10-01Plan benefit arrangement – InsuranceYes
2014-10-01Plan benefit arrangement – General assets of the sponsorYes
2013: ANDERSON ERICKSON DAIRY EMPLOYEE HEALTH PLAN 2013 form 5500 responses
2013-10-01Type of plan entitySingle employer plan
2013-10-01Plan funding arrangement – InsuranceYes
2013-10-01Plan funding arrangement – General assets of the sponsorYes
2013-10-01Plan benefit arrangement – InsuranceYes
2013-10-01Plan benefit arrangement – General assets of the sponsorYes
2012: ANDERSON ERICKSON DAIRY EMPLOYEE HEALTH PLAN 2012 form 5500 responses
2012-10-01Type of plan entitySingle employer plan
2012-10-01Plan funding arrangement – InsuranceYes
2012-10-01Plan funding arrangement – General assets of the sponsorYes
2012-10-01Plan benefit arrangement – InsuranceYes
2012-10-01Plan benefit arrangement – General assets of the sponsorYes
2011: ANDERSON ERICKSON DAIRY EMPLOYEE HEALTH PLAN 2011 form 5500 responses
2011-10-01Type of plan entitySingle employer plan
2011-10-01Plan funding arrangement – InsuranceYes
2011-10-01Plan funding arrangement – General assets of the sponsorYes
2011-10-01Plan benefit arrangement – InsuranceYes
2011-10-01Plan benefit arrangement – General assets of the sponsorYes
2009: ANDERSON ERICKSON DAIRY EMPLOYEE HEALTH PLAN 2009 form 5500 responses
2009-10-01Type of plan entitySingle employer plan
2009-10-01Plan funding arrangement – InsuranceYes
2009-10-01Plan funding arrangement – General assets of the sponsorYes
2009-10-01Plan benefit arrangement – InsuranceYes
2009-10-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK 966295
Policy instance 5
Insurance contract or identification numberOK 966295
Number of Individuals Covered354
Insurance policy start date2021-04-01
Insurance policy end date2022-03-31
Total amount of fees paid to insurance companyUSD $46
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $3,000
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees46
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberLK 963308
Policy instance 4
Insurance contract or identification numberLK 963308
Number of Individuals Covered354
Insurance policy start date2021-04-01
Insurance policy end date2022-03-31
Total amount of fees paid to insurance companyUSD $959
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $61,643
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees959
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX964723
Policy instance 3
Insurance contract or identification numberFLX964723
Number of Individuals Covered144
Insurance policy start date2021-04-01
Insurance policy end date2022-03-31
Total amount of commissions paid to insurance brokerUSD $5,088
Total amount of fees paid to insurance companyUSD $725
Other welfare benefits providedSUPPLEMENTAL & DEPENDENT LIFE
Welfare Benefit Premiums Paid to CarrierUSD $50,878
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,088
Amount paid for insurance broker fees725
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK 966312
Policy instance 2
Insurance contract or identification numberOK 966312
Number of Individuals Covered128
Insurance policy start date2021-04-01
Insurance policy end date2022-03-31
Total amount of commissions paid to insurance brokerUSD $336
Total amount of fees paid to insurance companyUSD $57
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $3,362
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $336
Amount paid for insurance broker fees57
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX964706
Policy instance 1
Insurance contract or identification numberFLX964706
Number of Individuals Covered697
Insurance policy start date2021-04-01
Insurance policy end date2022-03-31
Total amount of fees paid to insurance companyUSD $309
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $21,540
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees309
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX964706
Policy instance 1
Insurance contract or identification numberFLX964706
Number of Individuals Covered698
Insurance policy start date2020-04-01
Insurance policy end date2021-03-31
Total amount of fees paid to insurance companyUSD $103
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $22,208
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees103
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK 966312
Policy instance 2
Insurance contract or identification numberOK 966312
Number of Individuals Covered151
Insurance policy start date2020-04-01
Insurance policy end date2021-03-31
Total amount of commissions paid to insurance brokerUSD $377
Total amount of fees paid to insurance companyUSD $18
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $3,768
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $377
Amount paid for insurance broker fees18
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX964723
Policy instance 3
Insurance contract or identification numberFLX964723
Number of Individuals Covered160
Insurance policy start date2020-04-01
Insurance policy end date2021-03-31
Total amount of commissions paid to insurance brokerUSD $4,903
Total amount of fees paid to insurance companyUSD $210
Other welfare benefits providedSUPPLEMENTAL & DEPENDENT LIFE
Welfare Benefit Premiums Paid to CarrierUSD $49,031
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,903
Amount paid for insurance broker fees210
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberLK 963308
Policy instance 4
Insurance contract or identification numberLK 963308
Number of Individuals Covered348
Insurance policy start date2020-04-01
Insurance policy end date2021-03-31
Total amount of fees paid to insurance companyUSD $318
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $62,317
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees318
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK 966295
Policy instance 5
Insurance contract or identification numberOK 966295
Number of Individuals Covered348
Insurance policy start date2020-04-01
Insurance policy end date2021-03-31
Total amount of fees paid to insurance companyUSD $16
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $3,091
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees16
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX964706
Policy instance 1
Insurance contract or identification numberFLX964706
Number of Individuals Covered724
Insurance policy start date2019-04-01
Insurance policy end date2020-03-31
Total amount of fees paid to insurance companyUSD $359
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $22,488
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees359
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK 966312
Policy instance 2
Insurance contract or identification numberOK 966312
Number of Individuals Covered126
Insurance policy start date2019-04-01
Insurance policy end date2020-03-31
Total amount of commissions paid to insurance brokerUSD $358
Total amount of fees paid to insurance companyUSD $60
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $3,577
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $358
Amount paid for insurance broker fees60
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX964723
Policy instance 3
Insurance contract or identification numberFLX964723
Number of Individuals Covered163
Insurance policy start date2019-04-01
Insurance policy end date2020-03-31
Total amount of commissions paid to insurance brokerUSD $4,604
Total amount of fees paid to insurance companyUSD $647
Other welfare benefits providedSUPPLEMENTAL & DEPENDENT LIFE
Welfare Benefit Premiums Paid to CarrierUSD $46,035
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,604
Amount paid for insurance broker fees647
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberLK 963308
Policy instance 4
Insurance contract or identification numberLK 963308
Number of Individuals Covered364
Insurance policy start date2019-04-01
Insurance policy end date2020-03-31
Total amount of fees paid to insurance companyUSD $975
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $63,540
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees975
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK 966295
Policy instance 5
Insurance contract or identification numberOK 966295
Number of Individuals Covered364
Insurance policy start date2019-04-01
Insurance policy end date2020-03-31
Total amount of fees paid to insurance companyUSD $50
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $3,144
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees50
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX964706
Policy instance 1
Insurance contract or identification numberFLX964706
Number of Individuals Covered743
Insurance policy start date2018-04-01
Insurance policy end date2019-03-31
Total amount of fees paid to insurance companyUSD $455
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $23,716
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees455
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK 966312
Policy instance 2
Insurance contract or identification numberOK 966312
Number of Individuals Covered120
Insurance policy start date2018-04-01
Insurance policy end date2019-03-31
Total amount of commissions paid to insurance brokerUSD $388
Total amount of fees paid to insurance companyUSD $77
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $3,880
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $388
Amount paid for insurance broker fees77
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX964723
Policy instance 3
Insurance contract or identification numberFLX964723
Number of Individuals Covered159
Insurance policy start date2018-04-01
Insurance policy end date2019-03-31
Total amount of commissions paid to insurance brokerUSD $4,317
Total amount of fees paid to insurance companyUSD $711
Other welfare benefits providedSUPPLEMENTAL & DEPENDENT LIFE
Welfare Benefit Premiums Paid to CarrierUSD $43,169
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,317
Amount paid for insurance broker fees711
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberLK 963308
Policy instance 4
Insurance contract or identification numberLK 963308
Number of Individuals Covered370
Insurance policy start date2018-04-01
Insurance policy end date2019-03-31
Total amount of fees paid to insurance companyUSD $1,230
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $65,193
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees1230
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK 966295
Policy instance 5
Insurance contract or identification numberOK 966295
Number of Individuals Covered355
Insurance policy start date2018-04-01
Insurance policy end date2019-03-31
Total amount of fees paid to insurance companyUSD $63
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $3,304
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees63
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK 966295
Policy instance 5
Insurance contract or identification numberOK 966295
Number of Individuals Covered404
Insurance policy start date2017-04-01
Insurance policy end date2018-03-31
Total amount of fees paid to insurance companyUSD $63
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $3,589
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberLK 963308
Policy instance 4
Insurance contract or identification numberLK 963308
Number of Individuals Covered404
Insurance policy start date2017-04-01
Insurance policy end date2018-03-31
Total amount of fees paid to insurance companyUSD $1,127
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $68,859
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK 966312
Policy instance 2
Insurance contract or identification numberOK 966312
Number of Individuals Covered142
Insurance policy start date2017-04-01
Insurance policy end date2018-03-31
Total amount of commissions paid to insurance brokerUSD $444
Total amount of fees paid to insurance companyUSD $76
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $4,443
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX964723
Policy instance 3
Insurance contract or identification numberFLX964723
Number of Individuals Covered185
Insurance policy start date2017-04-01
Insurance policy end date2018-03-31
Total amount of commissions paid to insurance brokerUSD $4,197
Total amount of fees paid to insurance companyUSD $708
Other welfare benefits providedSUPPLEMENTAL & DEPENDENT LIFE
Welfare Benefit Premiums Paid to CarrierUSD $41,974
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX964706
Policy instance 1
Insurance contract or identification numberFLX964706
Number of Individuals Covered801
Insurance policy start date2017-04-01
Insurance policy end date2018-03-31
Total amount of fees paid to insurance companyUSD $452
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $25,791
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberLK 963308
Policy instance 4
Insurance contract or identification numberLK 963308
Number of Individuals Covered420
Insurance policy start date2015-04-01
Insurance policy end date2016-03-31
Total amount of fees paid to insurance companyUSD $1,105
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $67,063
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees1105
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3
Insurance broker nameLOCKTON COMPANIES, LLC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK 966295
Policy instance 5
Insurance contract or identification numberOK 966295
Number of Individuals Covered421
Insurance policy start date2015-04-01
Insurance policy end date2016-03-31
Total amount of fees paid to insurance companyUSD $71
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $3,839
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees71
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3
Insurance broker nameLOCKTON COMPANIES, LLC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX964723
Policy instance 3
Insurance contract or identification numberFLX964723
Number of Individuals Covered188
Insurance policy start date2015-04-01
Insurance policy end date2016-03-31
Total amount of commissions paid to insurance brokerUSD $4,100
Total amount of fees paid to insurance companyUSD $783
Other welfare benefits providedSUPPLEMENTAL & DEPENDENT LIFE
Welfare Benefit Premiums Paid to CarrierUSD $40,996
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,100
Amount paid for insurance broker fees783
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3
Insurance broker nameLOCKTON COMPANIES, LLC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK 966312
Policy instance 2
Insurance contract or identification numberOK 966312
Number of Individuals Covered142
Insurance policy start date2015-04-01
Insurance policy end date2016-03-31
Total amount of commissions paid to insurance brokerUSD $460
Total amount of fees paid to insurance companyUSD $84
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $4,599
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $460
Amount paid for insurance broker fees84
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3
Insurance broker nameLOCKTON COMPANIES, LLC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX964706
Policy instance 1
Insurance contract or identification numberFLX964706
Number of Individuals Covered843
Insurance policy start date2015-04-01
Insurance policy end date2016-03-31
Total amount of fees paid to insurance companyUSD $514
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $27,672
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees514
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3
Insurance broker nameLOCKTON COMPANIES, LLC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK 966312
Policy instance 2
Insurance contract or identification numberOK 966312
Number of Individuals Covered146
Insurance policy start date2014-04-01
Insurance policy end date2015-03-31
Total amount of commissions paid to insurance brokerUSD $425
Total amount of fees paid to insurance companyUSD $65
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $4,248
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $425
Amount paid for insurance broker fees65
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3
Insurance broker nameLOCKTON COMPANIES, LLC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX964706
Policy instance 1
Insurance contract or identification numberFLX964706
Number of Individuals Covered845
Insurance policy start date2014-04-01
Insurance policy end date2015-03-31
Total amount of fees paid to insurance companyUSD $455
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $25,725
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees455
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3
Insurance broker nameLOCKTON COMPANIES, LLC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX964723
Policy instance 3
Insurance contract or identification numberFLX964723
Number of Individuals Covered200
Insurance policy start date2014-04-01
Insurance policy end date2015-03-31
Total amount of commissions paid to insurance brokerUSD $3,896
Total amount of fees paid to insurance companyUSD $713
Other welfare benefits providedSUPPLEMENTAL & DEPENDENT LIFE
Welfare Benefit Premiums Paid to CarrierUSD $38,963
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,896
Amount paid for insurance broker fees713
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3
Insurance broker nameLOCKTON COMPANIES, LLC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberLK 963308
Policy instance 4
Insurance contract or identification numberLK 963308
Number of Individuals Covered413
Insurance policy start date2014-04-01
Insurance policy end date2015-03-31
Total amount of fees paid to insurance companyUSD $932
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $55,267
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees932
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3
Insurance broker nameLOCKTON COMPANIES, LLC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK 966295
Policy instance 5
Insurance contract or identification numberOK 966295
Number of Individuals Covered413
Insurance policy start date2014-04-01
Insurance policy end date2015-03-31
Total amount of fees paid to insurance companyUSD $63
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $3,560
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees63
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3
Insurance broker nameLOCKTON COMPANIES, LLC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX964706
Policy instance 1
Insurance contract or identification numberFLX964706
Number of Individuals Covered861
Insurance policy start date2013-04-01
Insurance policy end date2014-03-31
Total amount of fees paid to insurance companyUSD $1,058
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $23,740
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees1058
Insurance broker organization code?3
Insurance broker nameLOCKTON COMPANIES, LLC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK 966312
Policy instance 2
Insurance contract or identification numberOK 966312
Number of Individuals Covered135
Insurance policy start date2013-04-01
Insurance policy end date2014-03-31
Total amount of commissions paid to insurance brokerUSD $343
Total amount of fees paid to insurance companyUSD $210
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $3,426
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $343
Amount paid for insurance broker fees210
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3
Insurance broker nameLOCKTON COMPANIES, LLC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX964723
Policy instance 3
Insurance contract or identification numberFLX964723
Number of Individuals Covered194
Insurance policy start date2013-04-01
Insurance policy end date2014-03-31
Total amount of commissions paid to insurance brokerUSD $3,713
Total amount of fees paid to insurance companyUSD $1,321
Other welfare benefits providedSUPPLEMENTAL & DEPENDENT LIFE
Welfare Benefit Premiums Paid to CarrierUSD $37,126
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,713
Amount paid for insurance broker fees1321
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3
Insurance broker nameLOCKTON COMPANIES, LLC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberLK 963308
Policy instance 4
Insurance contract or identification numberLK 963308
Number of Individuals Covered418
Insurance policy start date2013-04-01
Insurance policy end date2014-03-31
Total amount of fees paid to insurance companyUSD $1,788
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $49,776
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees1788
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3
Insurance broker nameLOCKTON COMPANIES, LLC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK 966295
Policy instance 5
Insurance contract or identification numberOK 966295
Number of Individuals Covered419
Insurance policy start date2013-04-01
Insurance policy end date2014-03-31
Total amount of fees paid to insurance companyUSD $148
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $3,283
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees148
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3
Insurance broker nameLOCKTON COMPANIES, LLC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX964706
Policy instance 1
Insurance contract or identification numberFLX964706
Number of Individuals Covered874
Insurance policy start date2012-04-01
Insurance policy end date2013-03-31
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $24,271
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK 966295
Policy instance 6
Insurance contract or identification numberOK 966295
Number of Individuals Covered427
Insurance policy start date2012-04-01
Insurance policy end date2013-03-31
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $3,359
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK 966312
Policy instance 3
Insurance contract or identification numberOK 966312
Number of Individuals Covered121
Insurance policy start date2012-04-01
Insurance policy end date2013-03-31
Total amount of commissions paid to insurance brokerUSD $341
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $3,408
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $341
Insurance broker organization code?3
Insurance broker nameLOCKTON COMPANIES, LLC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX964723
Policy instance 4
Insurance contract or identification numberFLX964723
Number of Individuals Covered184
Insurance policy start date2012-04-01
Insurance policy end date2013-03-31
Total amount of commissions paid to insurance brokerUSD $3,646
Other welfare benefits providedSUPPLEMENTAL & DEPENDENT LIFE
Welfare Benefit Premiums Paid to CarrierUSD $36,456
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,646
Insurance broker organization code?3
Insurance broker nameLOCKTON COMPANIES, LLC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberLK 963308
Policy instance 5
Insurance contract or identification numberLK 963308
Number of Individuals Covered426
Insurance policy start date2012-04-01
Insurance policy end date2013-03-31
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $48,844
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
WELLMARK BLUE CROSS BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 88848 )
Policy contract number730
Policy instance 2
Insurance contract or identification number730
Number of Individuals Covered449
Insurance policy start date2012-10-01
Insurance policy end date2013-09-30
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )
Policy contract numberVARIOUS
Policy instance 3
Insurance contract or identification numberVARIOUS
Number of Individuals Covered500
Insurance policy start date2012-04-01
Insurance policy end date2012-09-30
Total amount of commissions paid to insurance brokerUSD $1,782
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $52,292
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number347151G
Policy instance 1
Insurance contract or identification number347151G
Insurance policy start date2011-10-01
Insurance policy end date2012-03-31
Total amount of commissions paid to insurance brokerUSD $3,912
Total amount of fees paid to insurance companyUSD $4,122
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $77,352
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
WELLMARK BLUE CROSS BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 88848 )
Policy contract number730
Policy instance 2
Insurance contract or identification number730
Number of Individuals Covered465
Insurance policy start date2011-10-01
Insurance policy end date2012-09-30
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number347151G
Policy instance 1
Insurance contract or identification number347151G
Number of Individuals Covered515
Insurance policy start date2010-10-01
Insurance policy end date2011-09-30
Total amount of commissions paid to insurance brokerUSD $8,769
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $126,540
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
WELLMARK BLUE CROSS BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 88848 )
Policy contract number730
Policy instance 2
Insurance contract or identification number730
Number of Individuals Covered476
Insurance policy start date2010-10-01
Insurance policy end date2011-09-30
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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