HILLS BANK AND TRUST COMPANY has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan HILLS BANK & TRUST COMPANY GROUP HEALTH INSURANCE & FLEX PLAN
401k plan membership statisitcs for HILLS BANK & TRUST COMPANY GROUP HEALTH INSURANCE & FLEX PLAN
| Measure | Date | Value |
|---|
| 2018: HILLS BANK & TRUST COMPANY GROUP HEALTH INSURANCE & FLEX PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 390 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 0 |
| Number of retired or separated participants receiving benefits | 2018-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-01-01 | 0 |
| Total of all active and inactive participants | 2018-01-01 | 0 |
| 2017: HILLS BANK & TRUST COMPANY GROUP HEALTH INSURANCE & FLEX PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 376 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 376 |
| Number of retired or separated participants receiving benefits | 2017-01-01 | 14 |
| Number of other retired or separated participants entitled to future benefits | 2017-01-01 | 0 |
| Total of all active and inactive participants | 2017-01-01 | 390 |
| 2016: HILLS BANK & TRUST COMPANY GROUP HEALTH INSURANCE & FLEX PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 332 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 376 |
| Number of retired or separated participants receiving benefits | 2016-01-01 | 10 |
| Number of other retired or separated participants entitled to future benefits | 2016-01-01 | 0 |
| Total of all active and inactive participants | 2016-01-01 | 386 |
| 2015: HILLS BANK & TRUST COMPANY GROUP HEALTH INSURANCE & FLEX PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 328 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 332 |
| Number of retired or separated participants receiving benefits | 2015-01-01 | 17 |
| Number of other retired or separated participants entitled to future benefits | 2015-01-01 | 0 |
| Total of all active and inactive participants | 2015-01-01 | 349 |
| 2014: HILLS BANK & TRUST COMPANY GROUP HEALTH INSURANCE & FLEX PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 344 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 328 |
| Number of retired or separated participants receiving benefits | 2014-01-01 | 12 |
| Number of other retired or separated participants entitled to future benefits | 2014-01-01 | 0 |
| Total of all active and inactive participants | 2014-01-01 | 340 |
| 2013: HILLS BANK & TRUST COMPANY GROUP HEALTH INSURANCE & FLEX PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 329 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 344 |
| Number of retired or separated participants receiving benefits | 2013-01-01 | 13 |
| Total of all active and inactive participants | 2013-01-01 | 357 |
| 2012: HILLS BANK & TRUST COMPANY GROUP HEALTH INSURANCE & FLEX PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 339 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 329 |
| Number of retired or separated participants receiving benefits | 2012-01-01 | 13 |
| Total of all active and inactive participants | 2012-01-01 | 342 |
| 2011: HILLS BANK & TRUST COMPANY GROUP HEALTH INSURANCE & FLEX PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-01-01 | 338 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 328 |
| Number of retired or separated participants receiving benefits | 2011-01-01 | 11 |
| Total of all active and inactive participants | 2011-01-01 | 339 |
| 2010: HILLS BANK & TRUST COMPANY GROUP HEALTH INSURANCE & FLEX PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-01-01 | 325 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-01-01 | 338 |
| Number of retired or separated participants receiving benefits | 2010-01-01 | 3 |
| Total of all active and inactive participants | 2010-01-01 | 341 |
| 2009: HILLS BANK & TRUST COMPANY GROUP HEALTH INSURANCE & FLEX PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-01-01 | 312 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 325 |
| Number of retired or separated participants receiving benefits | 2009-01-01 | 10 |
| Total of all active and inactive participants | 2009-01-01 | 335 |
| 2018: HILLS BANK & TRUST COMPANY GROUP HEALTH INSURANCE & FLEX PLAN 2018 form 5500 responses |
|---|
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | This submission is the final filing | Yes |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: HILLS BANK & TRUST COMPANY GROUP HEALTH INSURANCE & FLEX PLAN 2017 form 5500 responses |
|---|
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: HILLS BANK & TRUST COMPANY GROUP HEALTH INSURANCE & FLEX PLAN 2016 form 5500 responses |
|---|
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: HILLS BANK & TRUST COMPANY GROUP HEALTH INSURANCE & FLEX PLAN 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: HILLS BANK & TRUST COMPANY GROUP HEALTH INSURANCE & FLEX PLAN 2014 form 5500 responses |
|---|
| 2014-01-01 | Type of plan entity | Single employer plan |
| 2014-01-01 | Plan funding arrangement – Insurance | Yes |
| 2014-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: HILLS BANK & TRUST COMPANY GROUP HEALTH INSURANCE & FLEX PLAN 2013 form 5500 responses |
|---|
| 2013-01-01 | Type of plan entity | Single employer plan |
| 2013-01-01 | Plan funding arrangement – Insurance | Yes |
| 2013-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2012: HILLS BANK & TRUST COMPANY GROUP HEALTH INSURANCE & FLEX PLAN 2012 form 5500 responses |
|---|
| 2012-01-01 | Type of plan entity | Single employer plan |
| 2012-01-01 | Plan funding arrangement – Insurance | Yes |
| 2012-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2011: HILLS BANK & TRUST COMPANY GROUP HEALTH INSURANCE & FLEX PLAN 2011 form 5500 responses |
|---|
| 2011-01-01 | Type of plan entity | Single employer plan |
| 2011-01-01 | Plan funding arrangement – Insurance | Yes |
| 2011-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2011-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2010: HILLS BANK & TRUST COMPANY GROUP HEALTH INSURANCE & FLEX PLAN 2010 form 5500 responses |
|---|
| 2010-01-01 | Type of plan entity | Single employer plan |
| 2010-01-01 | Plan funding arrangement – Insurance | Yes |
| 2010-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2010-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2010-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2009: HILLS BANK & TRUST COMPANY GROUP HEALTH INSURANCE & FLEX PLAN 2009 form 5500 responses |
|---|
| 2009-01-01 | Type of plan entity | Single employer plan |
| 2009-01-01 | Plan funding arrangement – Insurance | Yes |
| 2009-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2009-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30011358 |
| Policy instance | 3 |
| Insurance contract or identification number | 30011358 | | Number of Individuals Covered | 321 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $2,291 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $79,376 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,781 | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL OF IOWA (National Association of Insurance Commissioners NAIC id number: 55786 ) |
| Policy contract number | 33434 |
| Policy instance | 2 |
| Insurance contract or identification number | 33434 | | Number of Individuals Covered | 356 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $2,953 | | Total amount of fees paid to insurance company | USD $569 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,953 | | Amount paid for insurance broker fees | 569 | | Additional information about fees paid to insurance broker | SALES AND PERSISTENCY BONUS | | Insurance broker organization code? | 3 |
|
| WELLMARK BLUE CROSS BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 88848 ) |
| Policy contract number | 00017875 |
| Policy instance | 1 |
| Insurance contract or identification number | 00017875 | | Number of Individuals Covered | 357 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of fees paid to insurance company | USD $23,230 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Amount paid for insurance broker fees | 14731 | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL OF IOWA (National Association of Insurance Commissioners NAIC id number: 55786 ) |
| Policy contract number | 90069 |
| Policy instance | 2 |
| Insurance contract or identification number | 90069 | | Number of Individuals Covered | 338 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $2,614 | | Total amount of fees paid to insurance company | USD $528 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,614 | | Amount paid for insurance broker fees | 528 | | Additional information about fees paid to insurance broker | SALES AND PERSISTENCY BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | BENEFIT SOLUTIONS, INC. |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30011358 |
| Policy instance | 3 |
| Insurance contract or identification number | 30011358 | | Number of Individuals Covered | 318 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $2,271 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $77,978 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,271 | | Insurance broker organization code? | 3 | | Insurance broker name | BENEFIT SOLUTIONS, INC. |
|
| WELLMARK BLUE CROSS BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 88848 ) |
| Policy contract number | 00017875 |
| Policy instance | 1 |
| Insurance contract or identification number | 00017875 | | Number of Individuals Covered | 344 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $25 | | Total amount of fees paid to insurance company | USD $34,819 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $25 | | Amount paid for insurance broker fees | 34819 | | Insurance broker organization code? | 3 | | Insurance broker name | BENEFIT SOLUTIONS, INC |
|
| WELLMARK BLUE CROSS BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 88848 ) |
| Policy contract number | 00017875 |
| Policy instance | 1 |
| Insurance contract or identification number | 00017875 | | Number of Individuals Covered | 300 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $29,580 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $29,580 | | Insurance broker organization code? | 3 | | Insurance broker name | BENEFIT SOLUTIONS, INC |
|
| DELTA DENTAL OF IOWA (National Association of Insurance Commissioners NAIC id number: 55786 ) |
| Policy contract number | 90069 |
| Policy instance | 2 |
| Insurance contract or identification number | 90069 | | Number of Individuals Covered | 301 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $2,500 | | Total amount of fees paid to insurance company | USD $487 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,500 | | Amount paid for insurance broker fees | 487 | | Additional information about fees paid to insurance broker | SALES AND PERSISTENCY BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | BENEFIT SOLUTIONS, INC. |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30011358 |
| Policy instance | 3 |
| Insurance contract or identification number | 30011358 | | Number of Individuals Covered | 280 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $2,072 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $64,188 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,072 | | Insurance broker organization code? | 3 | | Insurance broker name | BENEFIT SOLUTIONS, INC. |
|
| WELLMARK BLUE CROSS BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 88848 ) |
| Policy contract number | 00017875 |
| Policy instance | 1 |
| Insurance contract or identification number | 00017875 | | Number of Individuals Covered | 288 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $29,006 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $29,006 | | Insurance broker organization code? | 3 | | Insurance broker name | BENEFIT SOLUTIONS, INC |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30011358 |
| Policy instance | 3 |
| Insurance contract or identification number | 30011358 | | Number of Individuals Covered | 262 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $2,031 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $61,323 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,031 | | Insurance broker organization code? | 3 | | Insurance broker name | BENEFIT SOLUTIONS, INC. |
|
| DELTA DENTAL OF IOWA (National Association of Insurance Commissioners NAIC id number: 55786 ) |
| Policy contract number | 90069 |
| Policy instance | 2 |
| Insurance contract or identification number | 90069 | | Number of Individuals Covered | 297 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $2,487 | | Total amount of fees paid to insurance company | USD $507 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,487 | | Amount paid for insurance broker fees | 507 | | Additional information about fees paid to insurance broker | SALES AND PERSISTENCY BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | BENEFIT SOLUTIONS, INC. |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30011358 |
| Policy instance | 3 |
| Insurance contract or identification number | 30011358 | | Number of Individuals Covered | 263 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $2,014 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $60,129 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,014 | | Insurance broker organization code? | 3 | | Insurance broker name | BENEFIT SOLUTIONS, INC. |
|
| DELTA DENTAL OF IOWA (National Association of Insurance Commissioners NAIC id number: 55786 ) |
| Policy contract number | 90069 |
| Policy instance | 2 |
| Insurance contract or identification number | 90069 | | Number of Individuals Covered | 309 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $2,540 | | Total amount of fees paid to insurance company | USD $433 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,540 | | Amount paid for insurance broker fees | 433 | | Additional information about fees paid to insurance broker | SALES AND PERSISTENCY BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | BENEFIT SOLUTIONS, INC. |
|
| WELLMARK BLUE CROSS BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 88848 ) |
| Policy contract number | 00017875 |
| Policy instance | 1 |
| Insurance contract or identification number | 00017875 | | Number of Individuals Covered | 300 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $25,532 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $25,532 | | Insurance broker organization code? | 3 | | Insurance broker name | BENEFIT SOLUTIONS, INC |
|
| WELLMARK BLUE CROSS BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 88848 ) |
| Policy contract number | 00017875 |
| Policy instance | 1 |
| Insurance contract or identification number | 00017875 | | Number of Individuals Covered | 295 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $24,977 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $24,977 | | Insurance broker organization code? | 3 | | Insurance broker name | BENEFIT SOLUTIONS, INC |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30011358 |
| Policy instance | 3 |
| Insurance contract or identification number | 30011358 | | Number of Individuals Covered | 250 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $1,987 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $58,285 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,987 | | Insurance broker organization code? | 3 | | Insurance broker name | BENEFIT SOLUTIONS, INC. |
|
| DELTA DENTAL OF IOWA (National Association of Insurance Commissioners NAIC id number: 55786 ) |
| Policy contract number | 90069 |
| Policy instance | 2 |
| Insurance contract or identification number | 90069 | | Number of Individuals Covered | 299 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $2,480 | | Total amount of fees paid to insurance company | USD $464 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,480 | | Amount paid for insurance broker fees | 464 | | Additional information about fees paid to insurance broker | SALES AND PERSISTENCY BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | BENEFIT SOLUTIONS, INC. |
|
| WELLMARK BLUE CROSS BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 88848 ) |
| Policy contract number | 00017875 |
| Policy instance | 1 |
| Insurance contract or identification number | 00017875 | | Number of Individuals Covered | 286 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $22,110 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| DELTA DENTAL OF IOWA (National Association of Insurance Commissioners NAIC id number: 55786 ) |
| Policy contract number | 90069 |
| Policy instance | 2 |
| Insurance contract or identification number | 90069 | | Number of Individuals Covered | 297 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $2,516 | | Total amount of fees paid to insurance company | USD $475 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30011358 |
| Policy instance | 3 |
| Insurance contract or identification number | 30011358 | | Number of Individuals Covered | 247 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $1,964 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $56,640 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30011358 |
| Policy instance | 3 |
| Insurance contract or identification number | 30011358 | | Number of Individuals Covered | 246 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $1,896 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $51,978 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,896 | | Insurance broker organization code? | 3 | | Insurance broker name | BENEFIT SOLUTIONS, INC. |
|
| DELTA DENTAL OF IOWA (National Association of Insurance Commissioners NAIC id number: 55786 ) |
| Policy contract number | 90069 |
| Policy instance | 2 |
| Insurance contract or identification number | 90069 | | Number of Individuals Covered | 312 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $2,576 | | Total amount of fees paid to insurance company | USD $373 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,576 | | Amount paid for insurance broker fees | 373 | | Additional information about fees paid to insurance broker | SALES AND PERSISTENCY BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | BENEFIT SOLUTIONS, INC. |
|
| WELLMARK BLUE CROSS BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 88848 ) |
| Policy contract number | 00017875 |
| Policy instance | 1 |
| Insurance contract or identification number | 00017875 | | Number of Individuals Covered | 300 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $25,014 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $25,014 | | Insurance broker organization code? | 3 | | Insurance broker name | BENEFIT SOLUTIONS, INC |
|
