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SYDENSTRICKER IMPLEMENT COMPANY MEDICAL REIMBURSEMENT PLAN 401k Plan overview

Plan NameSYDENSTRICKER IMPLEMENT COMPANY MEDICAL REIMBURSEMENT PLAN
Plan identification number 575

SYDENSTRICKER IMPLEMENT COMPANY MEDICAL REIMBURSEMENT 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
  • Death benefits (include travel accident but not life insurance)
  • Other welfare benefit cover

401k Sponsoring company profile

SYDENSTRICKER NOBBE PARTNERS, INC. has sponsored the creation of one or more 401k plans.

Company Name:SYDENSTRICKER NOBBE PARTNERS, INC.
Employer identification number (EIN):430947529
NAIC Classification:423800

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SYDENSTRICKER IMPLEMENT COMPANY MEDICAL REIMBURSEMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5752021-07-01JASON T. ORR2023-04-17
5752020-07-01JASON T. ORR2022-04-15
5752019-07-01JASON T. ORR2021-04-14
5752018-07-01JASON T. ORR2020-04-06
5752017-07-01
5752016-07-01
5752015-07-01
5752014-07-01
5752013-07-01
5752012-07-01JARED SCOTT
5752012-01-01JARED SCOTT
5752011-01-01JACKIE KNIPFEL
5752010-01-01JACKIE KNIPFEL

Plan Statistics for SYDENSTRICKER IMPLEMENT COMPANY MEDICAL REIMBURSEMENT PLAN

401k plan membership statisitcs for SYDENSTRICKER IMPLEMENT COMPANY MEDICAL REIMBURSEMENT PLAN

Measure Date Value
2021: SYDENSTRICKER IMPLEMENT COMPANY MEDICAL REIMBURSEMENT PLAN 2021 401k membership
Total participants, beginning-of-year2021-07-01475
Total number of active participants reported on line 7a of the Form 55002021-07-01508
Number of retired or separated participants receiving benefits2021-07-017
Number of other retired or separated participants entitled to future benefits2021-07-010
Total of all active and inactive participants2021-07-01515
2020: SYDENSTRICKER IMPLEMENT COMPANY MEDICAL REIMBURSEMENT PLAN 2020 401k membership
Total participants, beginning-of-year2020-07-01294
Total number of active participants reported on line 7a of the Form 55002020-07-01501
Number of retired or separated participants receiving benefits2020-07-010
Number of other retired or separated participants entitled to future benefits2020-07-0111
Total of all active and inactive participants2020-07-01512
2019: SYDENSTRICKER IMPLEMENT COMPANY MEDICAL REIMBURSEMENT PLAN 2019 401k membership
Total participants, beginning-of-year2019-07-01290
Total number of active participants reported on line 7a of the Form 55002019-07-01273
Number of retired or separated participants receiving benefits2019-07-0121
Number of other retired or separated participants entitled to future benefits2019-07-010
Total of all active and inactive participants2019-07-01294
2018: SYDENSTRICKER IMPLEMENT COMPANY MEDICAL REIMBURSEMENT PLAN 2018 401k membership
Total participants, beginning-of-year2018-07-01247
Total number of active participants reported on line 7a of the Form 55002018-07-01286
Number of retired or separated participants receiving benefits2018-07-014
Number of other retired or separated participants entitled to future benefits2018-07-010
Total of all active and inactive participants2018-07-01290
2017: SYDENSTRICKER IMPLEMENT COMPANY MEDICAL REIMBURSEMENT PLAN 2017 401k membership
Total participants, beginning-of-year2017-07-01148
Total number of active participants reported on line 7a of the Form 55002017-07-01244
Number of retired or separated participants receiving benefits2017-07-012
Number of other retired or separated participants entitled to future benefits2017-07-012
Total of all active and inactive participants2017-07-01248
2016: SYDENSTRICKER IMPLEMENT COMPANY MEDICAL REIMBURSEMENT PLAN 2016 401k membership
Total participants, beginning-of-year2016-07-01152
Total number of active participants reported on line 7a of the Form 55002016-07-01147
Number of retired or separated participants receiving benefits2016-07-014
Number of other retired or separated participants entitled to future benefits2016-07-013
Total of all active and inactive participants2016-07-01154
2015: SYDENSTRICKER IMPLEMENT COMPANY MEDICAL REIMBURSEMENT PLAN 2015 401k membership
Total participants, beginning-of-year2015-07-01130
Total number of active participants reported on line 7a of the Form 55002015-07-01132
Number of retired or separated participants receiving benefits2015-07-011
Number of other retired or separated participants entitled to future benefits2015-07-010
Total of all active and inactive participants2015-07-01133
2014: SYDENSTRICKER IMPLEMENT COMPANY MEDICAL REIMBURSEMENT PLAN 2014 401k membership
Total participants, beginning-of-year2014-07-01123
Total number of active participants reported on line 7a of the Form 55002014-07-01124
Number of retired or separated participants receiving benefits2014-07-013
Number of other retired or separated participants entitled to future benefits2014-07-010
Total of all active and inactive participants2014-07-01127
2013: SYDENSTRICKER IMPLEMENT COMPANY MEDICAL REIMBURSEMENT PLAN 2013 401k membership
Total participants, beginning-of-year2013-07-01126
Total number of active participants reported on line 7a of the Form 55002013-07-01120
Number of retired or separated participants receiving benefits2013-07-011
Total of all active and inactive participants2013-07-01121
2012: SYDENSTRICKER IMPLEMENT COMPANY MEDICAL REIMBURSEMENT PLAN 2012 401k membership
Total participants, beginning-of-year2012-07-01130
Total number of active participants reported on line 7a of the Form 55002012-07-01126
Number of retired or separated participants receiving benefits2012-07-011
Total of all active and inactive participants2012-07-01127
Total participants, beginning-of-year2012-01-01126
Total number of active participants reported on line 7a of the Form 55002012-01-01127
Total of all active and inactive participants2012-01-01127
Total participants2012-01-01127
2011: SYDENSTRICKER IMPLEMENT COMPANY MEDICAL REIMBURSEMENT PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01115
Total number of active participants reported on line 7a of the Form 55002011-01-01130
Number of retired or separated participants receiving benefits2011-01-012
Number of other retired or separated participants entitled to future benefits2011-01-010
Total of all active and inactive participants2011-01-01132
2010: SYDENSTRICKER IMPLEMENT COMPANY MEDICAL REIMBURSEMENT PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-01116
Total number of active participants reported on line 7a of the Form 55002010-01-01116
Number of retired or separated participants receiving benefits2010-01-010
Number of other retired or separated participants entitled to future benefits2010-01-010
Total of all active and inactive participants2010-01-01116

Form 5500 Responses for SYDENSTRICKER IMPLEMENT COMPANY MEDICAL REIMBURSEMENT PLAN

2021: SYDENSTRICKER IMPLEMENT COMPANY MEDICAL REIMBURSEMENT PLAN 2021 form 5500 responses
2021-07-01Type of plan entitySingle employer plan
2021-07-01Submission has been amendedNo
2021-07-01This submission is the final filingNo
2021-07-01This return/report is a short plan year return/report (less than 12 months)No
2021-07-01Plan is a collectively bargained planNo
2021-07-01Plan funding arrangement – InsuranceYes
2021-07-01Plan funding arrangement – General assets of the sponsorYes
2021-07-01Plan benefit arrangement – InsuranceYes
2021-07-01Plan benefit arrangement – General assets of the sponsorYes
2020: SYDENSTRICKER IMPLEMENT COMPANY MEDICAL REIMBURSEMENT PLAN 2020 form 5500 responses
2020-07-01Type of plan entitySingle employer plan
2020-07-01Submission has been amendedNo
2020-07-01This submission is the final filingNo
2020-07-01This return/report is a short plan year return/report (less than 12 months)No
2020-07-01Plan is a collectively bargained planNo
2020-07-01Plan funding arrangement – InsuranceYes
2020-07-01Plan funding arrangement – General assets of the sponsorYes
2020-07-01Plan benefit arrangement – InsuranceYes
2020-07-01Plan benefit arrangement – General assets of the sponsorYes
2019: SYDENSTRICKER IMPLEMENT COMPANY MEDICAL REIMBURSEMENT PLAN 2019 form 5500 responses
2019-07-01Type of plan entitySingle employer plan
2019-07-01Submission has been amendedNo
2019-07-01This submission is the final filingNo
2019-07-01This return/report is a short plan year return/report (less than 12 months)No
2019-07-01Plan is a collectively bargained planNo
2019-07-01Plan funding arrangement – InsuranceYes
2019-07-01Plan funding arrangement – General assets of the sponsorYes
2019-07-01Plan benefit arrangement – InsuranceYes
2019-07-01Plan benefit arrangement – General assets of the sponsorYes
2018: SYDENSTRICKER IMPLEMENT COMPANY MEDICAL REIMBURSEMENT PLAN 2018 form 5500 responses
2018-07-01Type of plan entitySingle employer plan
2018-07-01Submission has been amendedNo
2018-07-01This submission is the final filingNo
2018-07-01This return/report is a short plan year return/report (less than 12 months)No
2018-07-01Plan is a collectively bargained planNo
2018-07-01Plan funding arrangement – InsuranceYes
2018-07-01Plan funding arrangement – General assets of the sponsorYes
2018-07-01Plan benefit arrangement – InsuranceYes
2018-07-01Plan benefit arrangement – General assets of the sponsorYes
2017: SYDENSTRICKER IMPLEMENT COMPANY MEDICAL REIMBURSEMENT PLAN 2017 form 5500 responses
2017-07-01Type of plan entitySingle employer plan
2017-07-01Submission has been amendedNo
2017-07-01This submission is the final filingNo
2017-07-01This return/report is a short plan year return/report (less than 12 months)No
2017-07-01Plan is a collectively bargained planNo
2017-07-01Plan funding arrangement – InsuranceYes
2017-07-01Plan funding arrangement – General assets of the sponsorYes
2017-07-01Plan benefit arrangement – InsuranceYes
2017-07-01Plan benefit arrangement – General assets of the sponsorYes
2016: SYDENSTRICKER IMPLEMENT COMPANY MEDICAL REIMBURSEMENT PLAN 2016 form 5500 responses
2016-07-01Type of plan entitySingle employer plan
2016-07-01Submission has been amendedNo
2016-07-01This submission is the final filingNo
2016-07-01This return/report is a short plan year return/report (less than 12 months)No
2016-07-01Plan is a collectively bargained planNo
2016-07-01Plan funding arrangement – InsuranceYes
2016-07-01Plan funding arrangement – General assets of the sponsorYes
2016-07-01Plan benefit arrangement – InsuranceYes
2016-07-01Plan benefit arrangement – General assets of the sponsorYes
2015: SYDENSTRICKER IMPLEMENT COMPANY MEDICAL REIMBURSEMENT PLAN 2015 form 5500 responses
2015-07-01Type of plan entitySingle employer plan
2015-07-01Submission has been amendedNo
2015-07-01This submission is the final filingNo
2015-07-01This return/report is a short plan year return/report (less than 12 months)No
2015-07-01Plan is a collectively bargained planNo
2015-07-01Plan funding arrangement – InsuranceYes
2015-07-01Plan benefit arrangement – InsuranceYes
2014: SYDENSTRICKER IMPLEMENT COMPANY MEDICAL REIMBURSEMENT PLAN 2014 form 5500 responses
2014-07-01Type of plan entitySingle employer plan
2014-07-01Submission has been amendedNo
2014-07-01This submission is the final filingNo
2014-07-01This return/report is a short plan year return/report (less than 12 months)No
2014-07-01Plan is a collectively bargained planNo
2014-07-01Plan funding arrangement – InsuranceYes
2014-07-01Plan benefit arrangement – InsuranceYes
2013: SYDENSTRICKER IMPLEMENT COMPANY MEDICAL REIMBURSEMENT PLAN 2013 form 5500 responses
2013-07-01Type of plan entitySingle employer plan
2013-07-01Submission has been amendedNo
2013-07-01This submission is the final filingNo
2013-07-01This return/report is a short plan year return/report (less than 12 months)No
2013-07-01Plan is a collectively bargained planNo
2013-07-01Plan funding arrangement – InsuranceYes
2013-07-01Plan benefit arrangement – InsuranceYes
2012: SYDENSTRICKER IMPLEMENT COMPANY MEDICAL REIMBURSEMENT PLAN 2012 form 5500 responses
2012-07-01Type of plan entitySingle employer plan
2012-07-01Submission has been amendedNo
2012-07-01This submission is the final filingNo
2012-07-01This return/report is a short plan year return/report (less than 12 months)No
2012-07-01Plan is a collectively bargained planNo
2012-07-01Plan funding arrangement – InsuranceYes
2012-07-01Plan benefit arrangement – InsuranceYes
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedYes
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)Yes
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – General assets of the sponsorYes
2012-01-01Plan benefit arrangement – General assets of the sponsorYes
2011: SYDENSTRICKER IMPLEMENT COMPANY MEDICAL REIMBURSEMENT PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – General assets of the sponsorYes
2011-01-01Plan benefit arrangement – General assets of the sponsorYes
2010: SYDENSTRICKER IMPLEMENT COMPANY MEDICAL REIMBURSEMENT PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01First time form 5500 has been submittedYes
2010-01-01Submission has been amendedNo
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – General assets of the sponsorYes
2010-01-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGVTL0BSMK
Policy instance 4
Insurance contract or identification numberGVTL0BSMK
Number of Individuals Covered320
Insurance policy start date2021-11-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $10,689
Total amount of fees paid to insurance companyUSD $9,838
Life Insurance Welfare BenefitYes
Other welfare benefits providedA D & D
Welfare Benefit Premiums Paid to CarrierUSD $106,885
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,949
Amount paid for insurance broker fees9838
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0BSMK
Policy instance 3
Insurance contract or identification numberGLUG0BSMK
Number of Individuals Covered701
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $2,946
Total amount of fees paid to insurance companyUSD $2,639
Life Insurance Welfare BenefitYes
Other welfare benefits providedA D & D
Welfare Benefit Premiums Paid to CarrierUSD $29,462
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,122
Amount paid for insurance broker fees2639
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUPR0BSMK
Policy instance 2
Insurance contract or identification numberGUPR0BSMK
Number of Individuals Covered268
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $6,444
Total amount of fees paid to insurance companyUSD $5,726
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $64,431
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,264
Amount paid for insurance broker fees5726
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUC0BSMK
Policy instance 1
Insurance contract or identification numberGUC0BSMK
Number of Individuals Covered303
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $8,122
Total amount of fees paid to insurance companyUSD $6,988
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $81,220
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,904
Amount paid for insurance broker fees6988
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUPR0BSMK
Policy instance 1
Insurance contract or identification numberGUPR0BSMK
Number of Individuals Covered226
Insurance policy start date2020-11-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $4,085
Total amount of fees paid to insurance companyUSD $351
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $40,853
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,085
Amount paid for insurance broker fees351
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGVTL0BSMK
Policy instance 2
Insurance contract or identification numberGVTL0BSMK
Number of Individuals Covered312
Insurance policy start date2020-11-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $7,188
Total amount of fees paid to insurance companyUSD $573
Life Insurance Welfare BenefitYes
Other welfare benefits providedA D & D
Welfare Benefit Premiums Paid to CarrierUSD $71,881
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,188
Amount paid for insurance broker fees573
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number1089027
Policy instance 3
Insurance contract or identification number1089027
Number of Individuals Covered527
Insurance policy start date2020-07-01
Insurance policy end date2020-10-31
Total amount of commissions paid to insurance brokerUSD $7,773
Total amount of fees paid to insurance companyUSD $-75
Dental Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $54,110
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,773
Amount paid for insurance broker fees-75
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0BSMK
Policy instance 4
Insurance contract or identification numberGLUG0BSMK
Number of Individuals Covered643
Insurance policy start date2020-11-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $1,901
Total amount of fees paid to insurance companyUSD $156
Life Insurance Welfare BenefitYes
Other welfare benefits providedA D & D
Welfare Benefit Premiums Paid to CarrierUSD $19,005
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,901
Amount paid for insurance broker fees156
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUC0BSMK
Policy instance 5
Insurance contract or identification numberGUC0BSMK
Number of Individuals Covered273
Insurance policy start date2020-11-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $5,014
Total amount of fees paid to insurance companyUSD $419
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $50,143
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,014
Amount paid for insurance broker fees419
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number1089027
Policy instance 1
Insurance contract or identification number1089027
Number of Individuals Covered444
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $21,160
Total amount of fees paid to insurance companyUSD $75
Dental Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $214,795
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $21,160
Amount paid for insurance broker fees75
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number1089027
Policy instance 1
Insurance contract or identification number1089027
Number of Individuals Covered463
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $19,407
Total amount of fees paid to insurance companyUSD $12,589
Dental Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $193,984
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,407
Amount paid for insurance broker fees12589
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number1089027
Policy instance 4
Insurance contract or identification number1089027
Number of Individuals Covered437
Insurance policy start date2018-02-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $6,766
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $67,857
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number0616471
Policy instance 3
Insurance contract or identification number0616471
Number of Individuals Covered88
Insurance policy start date2017-07-01
Insurance policy end date2018-01-31
Total amount of commissions paid to insurance brokerUSD $2,504
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $25,446
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 numberSGM608323
Policy instance 2
Insurance contract or identification numberSGM608323
Number of Individuals Covered162
Insurance policy start date2017-07-01
Insurance policy end date2018-01-31
Total amount of commissions paid to insurance brokerUSD $1,933
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $19,325
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 numberSOK606083
Policy instance 1
Insurance contract or identification numberSOK606083
Number of Individuals Covered162
Insurance policy start date2017-07-01
Insurance policy end date2018-01-31
Total amount of commissions paid to insurance brokerUSD $159
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedACCIDENTAL DEATH
Welfare Benefit Premiums Paid to CarrierUSD $1,594
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number1036559
Policy instance 2
Insurance contract or identification number1036559
Number of Individuals Covered223
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $4,781
Total amount of fees paid to insurance companyUSD $52
Dental Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $57,818
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,070
Amount paid for insurance broker fees52
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
Insurance broker nameUSI MIDWEST INC
CONVENTRY HEALTH AND LIFE (National Association of Insurance Commissioners NAIC id number: 81973 )
Policy contract number9212100000
Policy instance 1
Insurance contract or identification number9212100000
Number of Individuals Covered175
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $8,175
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $599,196
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,553
Insurance broker organization code?3
Insurance broker nameUSI MIDWEST, INC
CONVENTRY HEALTH AND LIFE (National Association of Insurance Commissioners NAIC id number: 81973 )
Policy contract number9212100000
Policy instance 2
Insurance contract or identification number9212100000
Number of Individuals Covered178
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $8,673
Total amount of fees paid to insurance companyUSD $2,055
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $693,840
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,673
Amount paid for insurance broker fees2055
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
Insurance broker nameLANDWEHR INSURANCE SERVICES
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number1036559
Policy instance 1
Insurance contract or identification number1036559
Number of Individuals Covered207
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $4,394
Total amount of fees paid to insurance companyUSD $284
Dental Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $47,732
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,394
Amount paid for insurance broker fees284
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
Insurance broker nameLANDWEHR INSURANCE SERVICES INC
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number1036559
Policy instance 1
Insurance contract or identification number1036559
Number of Individuals Covered204
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $3,984
Total amount of fees paid to insurance companyUSD $2,876
Dental Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $41,370
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,984
Amount paid for insurance broker fees2876
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
Insurance broker nameLANDWEHR INSURANCE SERVICES INC
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract number00163820
Policy instance 2
Insurance contract or identification number00163820
Number of Individuals Covered0
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedA D & D
Welfare Benefit Premiums Paid to CarrierUSD $-3
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CONVENTRY HEALTH AND LIFE (National Association of Insurance Commissioners NAIC id number: 81973 )
Policy contract number9212100000
Policy instance 3
Insurance contract or identification number9212100000
Number of Individuals Covered168
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $8,528
Total amount of fees paid to insurance companyUSD $1,905
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $682,213
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,528
Amount paid for insurance broker fees1905
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
Insurance broker nameLANDWEHR INSURANCE SERVICES
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract number00163820
Policy instance 3
Insurance contract or identification number00163820
Number of Individuals Covered126
Insurance policy start date2013-03-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $419
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedA D & D
Welfare Benefit Premiums Paid to CarrierUSD $4,199
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $419
Insurance broker organization code?3
Insurance broker nameMBT FINANCIAL SERVICES LLC
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract number00163820
Policy instance 2
Insurance contract or identification number00163820
Number of Individuals Covered126
Insurance policy start date2012-03-01
Insurance policy end date2013-02-28
Total amount of commissions paid to insurance brokerUSD $1,269
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedA D & D
Welfare Benefit Premiums Paid to CarrierUSD $12,698
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,269
Insurance broker organization code?3
Insurance broker nameMBT FINANCIAL SERVICES LLC
CONVENTRY HEALTH AND LIFE (National Association of Insurance Commissioners NAIC id number: 81973 )
Policy contract number9212100000
Policy instance 1
Insurance contract or identification number9212100000
Number of Individuals Covered161
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $11,904
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $628,786
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,499
Insurance broker organization code?3
Insurance broker nameLANDWEHR INSURANCE SERVICES

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