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LYNNS INC PARTIAL SELF-FUNDED HEALTH PLAN 401k Plan overview

Plan NameLYNNS INC PARTIAL SELF-FUNDED HEALTH PLAN
Plan identification number 501

LYNNS INC PARTIAL SELF-FUNDED HEALTH PLAN Benefits

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

401k Sponsoring company profile

LYNN'S INC C/O ROD MESSMER has sponsored the creation of one or more 401k plans.

Company Name:LYNN'S INC C/O ROD MESSMER
Employer identification number (EIN):460311458
NAIC Classification:445110
NAIC Description:Supermarkets and Other Grocery (except Convenience) Stores

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LYNNS INC PARTIAL SELF-FUNDED HEALTH PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012021-06-01
5012020-06-01
5012019-06-01
5012018-06-01
5012017-06-01RODNEY MESSMER RODNEY MESSMER2018-11-13
5012016-06-01RODNEY MESSMER RODNEY MESSMER2017-12-13
5012015-06-01RODNEY MESSMER RODNEY MESSMER2016-11-28
5012014-06-01RODNEY MESSMER RODNEY MESSMER2015-08-27
5012013-06-01RODNEY MESSMER RODNEY MESSMER2014-12-17
5012012-06-01RODNEY MESSMER RODNEY MESSMER2013-11-05
5012011-06-01RODNEY MESSMER RODNEY MESSMER2012-10-26
5012010-06-01RODNEY MESSMER RODNEY MESSMER2011-11-10
5012009-06-01RODNEY MESSMER RODNEY MESSMER2010-12-08

Plan Statistics for LYNNS INC PARTIAL SELF-FUNDED HEALTH PLAN

401k plan membership statisitcs for LYNNS INC PARTIAL SELF-FUNDED HEALTH PLAN

Measure Date Value
2021: LYNNS INC PARTIAL SELF-FUNDED HEALTH PLAN 2021 401k membership
Total participants, beginning-of-year2021-06-01216
Total number of active participants reported on line 7a of the Form 55002021-06-01211
Number of retired or separated participants receiving benefits2021-06-012
Number of other retired or separated participants entitled to future benefits2021-06-010
Total of all active and inactive participants2021-06-01213
2020: LYNNS INC PARTIAL SELF-FUNDED HEALTH PLAN 2020 401k membership
Total participants, beginning-of-year2020-06-01217
Total number of active participants reported on line 7a of the Form 55002020-06-01216
Number of retired or separated participants receiving benefits2020-06-010
Number of other retired or separated participants entitled to future benefits2020-06-010
Total of all active and inactive participants2020-06-01216
2019: LYNNS INC PARTIAL SELF-FUNDED HEALTH PLAN 2019 401k membership
Total participants, beginning-of-year2019-06-01187
Total number of active participants reported on line 7a of the Form 55002019-06-01217
Number of retired or separated participants receiving benefits2019-06-010
Number of other retired or separated participants entitled to future benefits2019-06-010
Total of all active and inactive participants2019-06-01217
2018: LYNNS INC PARTIAL SELF-FUNDED HEALTH PLAN 2018 401k membership
Total participants, beginning-of-year2018-06-01155
Total number of active participants reported on line 7a of the Form 55002018-06-01187
Number of retired or separated participants receiving benefits2018-06-010
Number of other retired or separated participants entitled to future benefits2018-06-010
Total of all active and inactive participants2018-06-01187
2017: LYNNS INC PARTIAL SELF-FUNDED HEALTH PLAN 2017 401k membership
Total participants, beginning-of-year2017-06-01561
Total number of active participants reported on line 7a of the Form 55002017-06-01155
Number of retired or separated participants receiving benefits2017-06-010
Number of other retired or separated participants entitled to future benefits2017-06-010
Total of all active and inactive participants2017-06-01155
2016: LYNNS INC PARTIAL SELF-FUNDED HEALTH PLAN 2016 401k membership
Total participants, beginning-of-year2016-06-01155
Total number of active participants reported on line 7a of the Form 55002016-06-01164
Number of retired or separated participants receiving benefits2016-06-011
Number of other retired or separated participants entitled to future benefits2016-06-010
Total of all active and inactive participants2016-06-01165
2015: LYNNS INC PARTIAL SELF-FUNDED HEALTH PLAN 2015 401k membership
Total participants, beginning-of-year2015-06-01146
Total number of active participants reported on line 7a of the Form 55002015-06-01155
Number of retired or separated participants receiving benefits2015-06-010
Number of other retired or separated participants entitled to future benefits2015-06-010
Total of all active and inactive participants2015-06-01155
2014: LYNNS INC PARTIAL SELF-FUNDED HEALTH PLAN 2014 401k membership
Total participants, beginning-of-year2014-06-01129
Total number of active participants reported on line 7a of the Form 55002014-06-01146
Number of retired or separated participants receiving benefits2014-06-010
Number of other retired or separated participants entitled to future benefits2014-06-010
Total of all active and inactive participants2014-06-01146
2013: LYNNS INC PARTIAL SELF-FUNDED HEALTH PLAN 2013 401k membership
Total participants, beginning-of-year2013-06-01128
Total number of active participants reported on line 7a of the Form 55002013-06-01129
Total of all active and inactive participants2013-06-01129
2012: LYNNS INC PARTIAL SELF-FUNDED HEALTH PLAN 2012 401k membership
Total participants, beginning-of-year2012-06-01129
Total number of active participants reported on line 7a of the Form 55002012-06-01128
Total of all active and inactive participants2012-06-01128
2011: LYNNS INC PARTIAL SELF-FUNDED HEALTH PLAN 2011 401k membership
Total participants, beginning-of-year2011-06-01134
Total number of active participants reported on line 7a of the Form 55002011-06-01129
Total of all active and inactive participants2011-06-01129
2010: LYNNS INC PARTIAL SELF-FUNDED HEALTH PLAN 2010 401k membership
Total participants, beginning-of-year2010-06-01129
Total number of active participants reported on line 7a of the Form 55002010-06-01134
Total of all active and inactive participants2010-06-01134
2009: LYNNS INC PARTIAL SELF-FUNDED HEALTH PLAN 2009 401k membership
Total participants, beginning-of-year2009-06-01132
Total number of active participants reported on line 7a of the Form 55002009-06-01129
Total of all active and inactive participants2009-06-01129

Form 5500 Responses for LYNNS INC PARTIAL SELF-FUNDED HEALTH PLAN

2021: LYNNS INC PARTIAL SELF-FUNDED HEALTH PLAN 2021 form 5500 responses
2021-06-01Type of plan entityMulitple employer plan
2021-06-01Plan funding arrangement – InsuranceYes
2021-06-01Plan funding arrangement – General assets of the sponsorYes
2021-06-01Plan benefit arrangement – InsuranceYes
2021-06-01Plan benefit arrangement – General assets of the sponsorYes
2020: LYNNS INC PARTIAL SELF-FUNDED HEALTH PLAN 2020 form 5500 responses
2020-06-01Type of plan entityMulitple employer plan
2020-06-01Plan funding arrangement – InsuranceYes
2020-06-01Plan funding arrangement – General assets of the sponsorYes
2020-06-01Plan benefit arrangement – InsuranceYes
2020-06-01Plan benefit arrangement – General assets of the sponsorYes
2019: LYNNS INC PARTIAL SELF-FUNDED HEALTH PLAN 2019 form 5500 responses
2019-06-01Type of plan entityMulitple employer plan
2019-06-01Plan funding arrangement – InsuranceYes
2019-06-01Plan funding arrangement – General assets of the sponsorYes
2019-06-01Plan benefit arrangement – InsuranceYes
2019-06-01Plan benefit arrangement – General assets of the sponsorYes
2018: LYNNS INC PARTIAL SELF-FUNDED HEALTH PLAN 2018 form 5500 responses
2018-06-01Type of plan entityMulitple employer plan
2018-06-01Plan funding arrangement – InsuranceYes
2018-06-01Plan funding arrangement – General assets of the sponsorYes
2018-06-01Plan benefit arrangement – InsuranceYes
2018-06-01Plan benefit arrangement – General assets of the sponsorYes
2017: LYNNS INC PARTIAL SELF-FUNDED HEALTH PLAN 2017 form 5500 responses
2017-06-01Type of plan entityMulitple employer plan
2017-06-01Plan funding arrangement – InsuranceYes
2017-06-01Plan funding arrangement – General assets of the sponsorYes
2017-06-01Plan benefit arrangement – InsuranceYes
2017-06-01Plan benefit arrangement – General assets of the sponsorYes
2016: LYNNS INC PARTIAL SELF-FUNDED HEALTH PLAN 2016 form 5500 responses
2016-06-01Type of plan entityMulitple employer plan
2016-06-01Plan funding arrangement – InsuranceYes
2016-06-01Plan funding arrangement – General assets of the sponsorYes
2016-06-01Plan benefit arrangement – InsuranceYes
2016-06-01Plan benefit arrangement – General assets of the sponsorYes
2015: LYNNS INC PARTIAL SELF-FUNDED HEALTH PLAN 2015 form 5500 responses
2015-06-01Type of plan entityMulitple employer plan
2015-06-01Plan funding arrangement – InsuranceYes
2015-06-01Plan funding arrangement – General assets of the sponsorYes
2015-06-01Plan benefit arrangement – InsuranceYes
2015-06-01Plan benefit arrangement – General assets of the sponsorYes
2014: LYNNS INC PARTIAL SELF-FUNDED HEALTH PLAN 2014 form 5500 responses
2014-06-01Type of plan entityMulitple employer plan
2014-06-01Plan funding arrangement – InsuranceYes
2014-06-01Plan funding arrangement – General assets of the sponsorYes
2014-06-01Plan benefit arrangement – InsuranceYes
2014-06-01Plan benefit arrangement – General assets of the sponsorYes
2013: LYNNS INC PARTIAL SELF-FUNDED HEALTH PLAN 2013 form 5500 responses
2013-06-01Type of plan entityMulitple employer plan
2013-06-01Plan funding arrangement – InsuranceYes
2013-06-01Plan funding arrangement – General assets of the sponsorYes
2013-06-01Plan benefit arrangement – InsuranceYes
2013-06-01Plan benefit arrangement – General assets of the sponsorYes
2012: LYNNS INC PARTIAL SELF-FUNDED HEALTH PLAN 2012 form 5500 responses
2012-06-01Type of plan entityMulitple employer plan
2012-06-01Plan funding arrangement – InsuranceYes
2012-06-01Plan funding arrangement – General assets of the sponsorYes
2012-06-01Plan benefit arrangement – InsuranceYes
2012-06-01Plan benefit arrangement – General assets of the sponsorYes
2011: LYNNS INC PARTIAL SELF-FUNDED HEALTH PLAN 2011 form 5500 responses
2011-06-01Type of plan entityMulitple employer plan
2011-06-01Plan funding arrangement – InsuranceYes
2011-06-01Plan funding arrangement – General assets of the sponsorYes
2011-06-01Plan benefit arrangement – InsuranceYes
2011-06-01Plan benefit arrangement – General assets of the sponsorYes
2010: LYNNS INC PARTIAL SELF-FUNDED HEALTH PLAN 2010 form 5500 responses
2010-06-01Type of plan entityMulitple employer plan
2010-06-01Plan funding arrangement – InsuranceYes
2010-06-01Plan funding arrangement – General assets of the sponsorYes
2010-06-01Plan benefit arrangement – InsuranceYes
2010-06-01Plan benefit arrangement – General assets of the sponsorYes
2009: LYNNS INC PARTIAL SELF-FUNDED HEALTH PLAN 2009 form 5500 responses
2009-06-01Type of plan entityMulitple employer plan
2009-06-01Plan funding arrangement – InsuranceYes
2009-06-01Plan funding arrangement – General assets of the sponsorYes
2009-06-01Plan benefit arrangement – InsuranceYes
2009-06-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

DELTA DENTAL OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 54097 )
Policy contract number2342
Policy instance 5
Insurance contract or identification number2342
Number of Individuals Covered212
Insurance policy start date2022-06-01
Insurance policy end date2023-05-31
Total amount of commissions paid to insurance brokerUSD $1,749
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $95,775
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,749
Insurance broker organization code?3
WELLMARK BLUE CROSS AND BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 60128 )
Policy contract number00067549
Policy instance 4
Insurance contract or identification number00067549
Number of Individuals Covered56
Insurance policy start date2022-06-01
Insurance policy end date2023-05-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $629,679
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number159979
Policy instance 3
Insurance contract or identification number159979
Number of Individuals Covered168
Insurance policy start date2022-06-01
Insurance policy end date2023-05-31
Total amount of commissions paid to insurance brokerUSD $2,605
Temporary Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,605
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number159979
Policy instance 2
Insurance contract or identification number159979
Number of Individuals Covered168
Insurance policy start date2022-06-01
Insurance policy end date2023-05-31
Total amount of commissions paid to insurance brokerUSD $2,661
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,661
Insurance broker organization code?3
WELLMARK BLUE CROSS AND BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 60128 )
Policy contract number00032844
Policy instance 1
Insurance contract or identification number00032844
Number of Individuals Covered106
Insurance policy start date2022-06-01
Insurance policy end date2023-05-31
Total amount of commissions paid to insurance brokerUSD $15,120
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,103,359
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,120
Insurance broker organization code?3
WELLMARK BLUE CROSS AND BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 60128 )
Policy contract number00032844
Policy instance 1
Insurance contract or identification number00032844
Number of Individuals Covered152
Insurance policy start date2021-06-01
Insurance policy end date2022-05-31
Total amount of commissions paid to insurance brokerUSD $12,837
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,939,721
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,837
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number159979
Policy instance 2
Insurance contract or identification number159979
Number of Individuals Covered214
Insurance policy start date2021-06-01
Insurance policy end date2022-05-31
Total amount of commissions paid to insurance brokerUSD $2,751
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,751
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number159979
Policy instance 3
Insurance contract or identification number159979
Number of Individuals Covered214
Insurance policy start date2021-06-01
Insurance policy end date2022-05-31
Total amount of commissions paid to insurance brokerUSD $2,697
Temporary Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,697
Insurance broker organization code?3
WELLMARK BLUE CROSS AND BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 60128 )
Policy contract number00067549
Policy instance 4
Insurance contract or identification number00067549
Number of Individuals Covered59
Insurance policy start date2021-06-01
Insurance policy end date2022-05-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $513,248
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 54097 )
Policy contract number2342
Policy instance 5
Insurance contract or identification number2342
Number of Individuals Covered299
Insurance policy start date2021-06-01
Insurance policy end date2022-05-31
Total amount of commissions paid to insurance brokerUSD $1,848
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $99,174
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,848
Insurance broker organization code?3
DELTA DENTAL OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 54097 )
Policy contract number2342
Policy instance 5
Insurance contract or identification number2342
Number of Individuals Covered313
Insurance policy start date2020-06-01
Insurance policy end date2021-05-31
Total amount of commissions paid to insurance brokerUSD $1,803
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $100,909
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,803
Insurance broker organization code?3
WELLMARK BLUE CROSS AND BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 60128 )
Policy contract number00067549
Policy instance 4
Insurance contract or identification number00067549
Number of Individuals Covered57
Insurance policy start date2020-06-01
Insurance policy end date2021-05-31
Total amount of commissions paid to insurance brokerUSD $4,134
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,134
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number159979
Policy instance 3
Insurance contract or identification number159979
Number of Individuals Covered216
Insurance policy start date2020-06-01
Insurance policy end date2021-05-31
Total amount of commissions paid to insurance brokerUSD $2,732
Temporary Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,732
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number159979
Policy instance 2
Insurance contract or identification number159979
Number of Individuals Covered216
Insurance policy start date2020-06-01
Insurance policy end date2021-05-31
Total amount of commissions paid to insurance brokerUSD $2,694
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,694
Insurance broker organization code?3
WELLMARK BLUE CROSS AND BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 60128 )
Policy contract number00032844
Policy instance 1
Insurance contract or identification number00032844
Number of Individuals Covered159
Insurance policy start date2020-06-01
Insurance policy end date2021-05-31
Total amount of commissions paid to insurance brokerUSD $9,045
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,045
Insurance broker organization code?3
DELTA DENTAL OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 54097 )
Policy contract number2342
Policy instance 5
Insurance contract or identification number2342
Number of Individuals Covered325
Insurance policy start date2019-06-01
Insurance policy end date2020-05-31
Total amount of commissions paid to insurance brokerUSD $1,800
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $96,273
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,800
Insurance broker organization code?3
WELLMARK BLUE CROSS AND BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 60128 )
Policy contract number00067549
Policy instance 4
Insurance contract or identification number00067549
Number of Individuals Covered55
Insurance policy start date2019-06-01
Insurance policy end date2020-05-31
Total amount of commissions paid to insurance brokerUSD $5,256
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,256
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number159979
Policy instance 3
Insurance contract or identification number159979
Number of Individuals Covered219
Insurance policy start date2019-06-01
Insurance policy end date2020-05-31
Total amount of commissions paid to insurance brokerUSD $2,786
Temporary Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,786
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number159979
Policy instance 2
Insurance contract or identification number159979
Number of Individuals Covered219
Insurance policy start date2019-06-01
Insurance policy end date2020-05-31
Total amount of commissions paid to insurance brokerUSD $2,696
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,696
Insurance broker organization code?3
WELLMARK BLUE CROSS AND BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 60128 )
Policy contract number00032844
Policy instance 1
Insurance contract or identification number00032844
Number of Individuals Covered162
Insurance policy start date2019-06-01
Insurance policy end date2020-05-31
Total amount of commissions paid to insurance brokerUSD $11,344
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,344
Insurance broker organization code?3
WELLMARK BLUE CROSS AND BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 60128 )
Policy contract number00032844
Policy instance 1
Insurance contract or identification number00032844
Number of Individuals Covered160
Insurance policy start date2018-06-01
Insurance policy end date2019-05-31
Total amount of commissions paid to insurance brokerUSD $11,237
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,237
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number159979
Policy instance 2
Insurance contract or identification number159979
Number of Individuals Covered186
Insurance policy start date2018-06-01
Insurance policy end date2019-05-31
Total amount of commissions paid to insurance brokerUSD $2,117
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,117
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number159979
Policy instance 3
Insurance contract or identification number159979
Number of Individuals Covered186
Insurance policy start date2018-06-01
Insurance policy end date2019-05-31
Total amount of commissions paid to insurance brokerUSD $2,155
Temporary Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,155
Insurance broker organization code?3
WELLMARK BLUE CROSS AND BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 60128 )
Policy contract number00067549
Policy instance 4
Insurance contract or identification number00067549
Number of Individuals Covered26
Insurance policy start date2018-06-01
Insurance policy end date2019-05-31
Total amount of commissions paid to insurance brokerUSD $1,980
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,980
Insurance broker organization code?3
DELTA DENTAL OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 54097 )
Policy contract number2342
Policy instance 5
Insurance contract or identification number2342
Number of Individuals Covered295
Insurance policy start date2018-06-01
Insurance policy end date2019-05-31
Total amount of commissions paid to insurance brokerUSD $1,394
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $87,709
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,394
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number159979
Policy instance 3
Insurance contract or identification number159979
Number of Individuals Covered179
Insurance policy start date2017-06-01
Insurance policy end date2018-05-31
Total amount of commissions paid to insurance brokerUSD $2,142
Temporary Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,142
Insurance broker organization code?3
Insurance broker nameJAMES R MCDONALD
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number159979
Policy instance 2
Insurance contract or identification number159979
Number of Individuals Covered179
Insurance policy start date2017-06-01
Insurance policy end date2018-05-31
Total amount of commissions paid to insurance brokerUSD $1,701
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,701
Insurance broker organization code?3
Insurance broker nameJAMES R MCDONALD
WELLMARK BLUE CROSS AND BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 60128 )
Policy contract number00032844
Policy instance 1
Insurance contract or identification number00032844
Number of Individuals Covered177
Insurance policy start date2017-06-01
Insurance policy end date2018-05-31
Total amount of commissions paid to insurance brokerUSD $20,659
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $20,659
Insurance broker organization code?3
Insurance broker nameJAMES MCDONALD

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