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CUAD HEALTH BENEFITS PLAN 401k Plan overview

Plan NameCUAD HEALTH BENEFITS PLAN
Plan identification number 501

CUAD HEALTH BENEFITS PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Dental
  • Vision

401k Sponsoring company profile

CUAD HEALTH BENEFITS TRUST has sponsored the creation of one or more 401k plans.

Company Name:CUAD HEALTH BENEFITS TRUST
Employer identification number (EIN):823520467
NAIC Classification:524290

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CUAD HEALTH BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01JEFFREY OLSON2023-10-10 JEFFREY OLSON2023-10-10
5012021-01-01JEFF OLSON2022-09-23 JEFF OLSON2022-09-23
5012020-01-01JEFF OLSON2021-10-12 JEFF OLSON2021-10-12
5012019-01-01JEFF OLSON2020-08-06 JEFF OLSON2020-08-06
5012018-01-01JEFF OLSON2019-09-10 JEFF OLSON2019-09-10

Plan Statistics for CUAD HEALTH BENEFITS PLAN

401k plan membership statisitcs for CUAD HEALTH BENEFITS PLAN

Measure Date Value
2022: CUAD HEALTH BENEFITS PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01626
Total number of active participants reported on line 7a of the Form 55002022-01-01654
Number of retired or separated participants receiving benefits2022-01-0110
Total of all active and inactive participants2022-01-01664
2021: CUAD HEALTH BENEFITS PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01905
Total number of active participants reported on line 7a of the Form 55002021-01-01919
Number of retired or separated participants receiving benefits2021-01-0111
Total of all active and inactive participants2021-01-01930
2020: CUAD HEALTH BENEFITS PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01521
Total number of active participants reported on line 7a of the Form 55002020-01-01514
Number of retired or separated participants receiving benefits2020-01-014
Total of all active and inactive participants2020-01-01518
2019: CUAD HEALTH BENEFITS PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01537
Total number of active participants reported on line 7a of the Form 55002019-01-01517
Number of retired or separated participants receiving benefits2019-01-014
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-01521
2018: CUAD HEALTH BENEFITS PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01504
Total number of active participants reported on line 7a of the Form 55002018-01-01516
Number of retired or separated participants receiving benefits2018-01-016
Total of all active and inactive participants2018-01-01522

Financial Data on CUAD HEALTH BENEFITS PLAN

Measure Date Value
2022 : CUAD HEALTH BENEFITS PLAN 2022 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$1,954,498
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$1,772,018
Total income from all sources (including contributions)2022-12-31$14,609,979
Total of all expenses incurred2022-12-31$14,096,226
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$12,644,306
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$14,538,315
Value of total assets at end of year2022-12-31$4,405,126
Value of total assets at beginning of year2022-12-31$3,708,893
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$1,451,920
Total interest from all sources2022-12-31$14,697
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-12-31No
Administrative expenses professional fees incurred2022-12-31$128,986
Was this plan covered by a fidelity bond2022-12-31Yes
Value of fidelity bond cover2022-12-31$500,000
If this is an individual account plan, was there a blackout period2022-12-31No
Were there any nonexempt tranactions with any party-in-interest2022-12-31No
Contributions received from participants2022-12-31$14,538,315
Participant contributions at end of year2022-12-31$683,270
Participant contributions at beginning of year2022-12-31$534,998
Value of other receiveables (less allowance for doubtful accounts) at end of year2022-12-31$780,252
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2022-12-31$229,766
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2022-12-31$712,690
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2022-12-31$823,579
Other income not declared elsewhere2022-12-31$56,967
Administrative expenses (other) incurred2022-12-31$203,365
Total non interest bearing cash at end of year2022-12-31$2,941,604
Total non interest bearing cash at beginning of year2022-12-31$2,944,129
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Value of net income/loss2022-12-31$513,753
Value of net assets at end of year (total assets less liabilities)2022-12-31$2,450,628
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$1,936,875
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2022-12-31No
Were any leases to which the plan was party in default or uncollectible2022-12-31No
Investment advisory and management fees2022-12-31$178,071
Interest earned on other investments2022-12-31$14,697
Expenses. Payments to insurance carriers foe the provision of benefits2022-12-31$2,862,432
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-12-31No
Was there a failure to transmit to the plan any participant contributions2022-12-31No
Has the plan failed to provide any benefit when due under the plan2022-12-31No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$9,781,874
Contract administrator fees2022-12-31$941,498
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32022-12-31No
Liabilities. Value of benefit claims payable at end of year2022-12-31$1,241,808
Liabilities. Value of benefit claims payable at beginning of year2022-12-31$948,439
Did the plan have assets held for investment2022-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-12-31No
Opinion of an independent qualified public accountant for this plan2022-12-31Unqualified
Accountancy firm name2022-12-31EIDE BAILLY LLP
Accountancy firm EIN2022-12-31450250958
2021 : CUAD HEALTH BENEFITS PLAN 2021 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$1,772,018
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$1,933,043
Total income from all sources (including contributions)2021-12-31$12,162,305
Total of all expenses incurred2021-12-31$10,998,182
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$9,835,050
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$12,156,818
Value of total assets at end of year2021-12-31$3,708,893
Value of total assets at beginning of year2021-12-31$2,705,795
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$1,163,132
Total interest from all sources2021-12-31$5,487
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-12-31No
Administrative expenses professional fees incurred2021-12-31$95,871
Was this plan covered by a fidelity bond2021-12-31Yes
Value of fidelity bond cover2021-12-31$500,000
If this is an individual account plan, was there a blackout period2021-12-31No
Were there any nonexempt tranactions with any party-in-interest2021-12-31No
Contributions received from participants2021-12-31$12,156,818
Participant contributions at end of year2021-12-31$534,998
Participant contributions at beginning of year2021-12-31$22,142
Value of other receiveables (less allowance for doubtful accounts) at end of year2021-12-31$229,766
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2021-12-31$129,118
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2021-12-31$823,579
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2021-12-31$1,436,816
Administrative expenses (other) incurred2021-12-31$114,273
Liabilities. Value of operating payables at beginning of year2021-12-31$4,970
Total non interest bearing cash at end of year2021-12-31$2,944,129
Total non interest bearing cash at beginning of year2021-12-31$2,554,535
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Value of net income/loss2021-12-31$1,164,123
Value of net assets at end of year (total assets less liabilities)2021-12-31$1,936,875
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$772,752
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-12-31No
Were any leases to which the plan was party in default or uncollectible2021-12-31No
Investment advisory and management fees2021-12-31$135,298
Interest earned on other investments2021-12-31$5,487
Expenses. Payments to insurance carriers foe the provision of benefits2021-12-31$2,151,021
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-12-31No
Was there a failure to transmit to the plan any participant contributions2021-12-31No
Has the plan failed to provide any benefit when due under the plan2021-12-31No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$7,684,029
Contract administrator fees2021-12-31$817,690
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32021-12-31No
Liabilities. Value of benefit claims payable at end of year2021-12-31$948,439
Liabilities. Value of benefit claims payable at beginning of year2021-12-31$491,257
Did the plan have assets held for investment2021-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-12-31No
Opinion of an independent qualified public accountant for this plan2021-12-31Unqualified
Accountancy firm name2021-12-31EIDE BAILLY LLP
Accountancy firm EIN2021-12-31450250958
2020 : CUAD HEALTH BENEFITS PLAN 2020 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$1,933,043
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$1,152,400
Total income from all sources (including contributions)2020-12-31$6,270,472
Total of all expenses incurred2020-12-31$5,636,887
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$4,705,769
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$6,265,539
Value of total assets at end of year2020-12-31$2,705,795
Value of total assets at beginning of year2020-12-31$1,291,567
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$931,118
Total interest from all sources2020-12-31$4,933
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-12-31No
Administrative expenses professional fees incurred2020-12-31$77,922
Was this plan covered by a fidelity bond2020-12-31Yes
Value of fidelity bond cover2020-12-31$500,000
If this is an individual account plan, was there a blackout period2020-12-31No
Were there any nonexempt tranactions with any party-in-interest2020-12-31No
Contributions received from participants2020-12-31$6,265,539
Participant contributions at end of year2020-12-31$22,142
Participant contributions at beginning of year2020-12-31$256,858
Value of other receiveables (less allowance for doubtful accounts) at end of year2020-12-31$129,118
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2020-12-31$138,610
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2020-12-31$1,436,816
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2020-12-31$672,400
Liabilities. Value of operating payables at end of year2020-12-31$4,970
Total non interest bearing cash at end of year2020-12-31$2,554,535
Total non interest bearing cash at beginning of year2020-12-31$896,099
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Value of net income/loss2020-12-31$633,585
Value of net assets at end of year (total assets less liabilities)2020-12-31$772,752
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$139,167
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-12-31No
Were any leases to which the plan was party in default or uncollectible2020-12-31No
Investment advisory and management fees2020-12-31$94,221
Interest earned on other investments2020-12-31$4,933
Expenses. Payments to insurance carriers foe the provision of benefits2020-12-31$1,264,297
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-12-31No
Was there a failure to transmit to the plan any participant contributions2020-12-31No
Has the plan failed to provide any benefit when due under the plan2020-12-31No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-12-31$3,441,472
Contract administrator fees2020-12-31$758,975
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32020-12-31No
Liabilities. Value of benefit claims payable at end of year2020-12-31$491,257
Liabilities. Value of benefit claims payable at beginning of year2020-12-31$480,000
Did the plan have assets held for investment2020-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-12-31No
Opinion of an independent qualified public accountant for this plan2020-12-31Unqualified
Accountancy firm name2020-12-31EIDE BAILLY LLP
Accountancy firm EIN2020-12-31450250958
2019 : CUAD HEALTH BENEFITS PLAN 2019 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$1,152,400
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$761,741
Total income from all sources (including contributions)2019-12-31$6,316,701
Total of all expenses incurred2019-12-31$6,010,896
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$5,373,883
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$6,313,591
Value of total assets at end of year2019-12-31$1,291,567
Value of total assets at beginning of year2019-12-31$595,103
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$637,013
Total interest from all sources2019-12-31$3,110
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-12-31No
Administrative expenses professional fees incurred2019-12-31$104,439
Was this plan covered by a fidelity bond2019-12-31No
If this is an individual account plan, was there a blackout period2019-12-31No
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Contributions received from participants2019-12-31$6,313,591
Participant contributions at end of year2019-12-31$256,858
Value of other receiveables (less allowance for doubtful accounts) at end of year2019-12-31$138,610
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2019-12-31$108,910
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2019-12-31$672,400
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2019-12-31$300,000
Liabilities. Value of operating payables at beginning of year2019-12-31$1,741
Total non interest bearing cash at end of year2019-12-31$896,099
Total non interest bearing cash at beginning of year2019-12-31$486,193
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Value of net income/loss2019-12-31$305,805
Value of net assets at end of year (total assets less liabilities)2019-12-31$139,167
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$-166,638
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Investment advisory and management fees2019-12-31$95,554
Interest earned on other investments2019-12-31$3,110
Expenses. Payments to insurance carriers foe the provision of benefits2019-12-31$1,186,093
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-12-31No
Was there a failure to transmit to the plan any participant contributions2019-12-31No
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$4,187,790
Contract administrator fees2019-12-31$437,020
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32019-12-31No
Liabilities. Value of benefit claims payable at end of year2019-12-31$480,000
Liabilities. Value of benefit claims payable at beginning of year2019-12-31$460,000
Did the plan have assets held for investment2019-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31No
Opinion of an independent qualified public accountant for this plan2019-12-31Unqualified
Accountancy firm name2019-12-31EIDE BAILLY LLP
Accountancy firm EIN2019-12-31450250958
2018 : CUAD HEALTH BENEFITS PLAN 2018 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$761,741
Total income from all sources (including contributions)2018-12-31$5,499,600
Total of all expenses incurred2018-12-31$5,666,238
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-12-31$5,207,916
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-12-31$5,499,121
Value of total assets at end of year2018-12-31$595,103
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-12-31$458,322
Total interest from all sources2018-12-31$479
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-12-31No
Administrative expenses professional fees incurred2018-12-31$37,301
Was this plan covered by a fidelity bond2018-12-31No
If this is an individual account plan, was there a blackout period2018-12-31No
Were there any nonexempt tranactions with any party-in-interest2018-12-31No
Value of other receiveables (less allowance for doubtful accounts) at end of year2018-12-31$108,910
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2018-12-31$300,000
Liabilities. Value of operating payables at end of year2018-12-31$1,741
Total non interest bearing cash at end of year2018-12-31$486,193
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Value of net income/loss2018-12-31$-166,638
Value of net assets at end of year (total assets less liabilities)2018-12-31$-166,638
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2018-12-31No
Were any leases to which the plan was party in default or uncollectible2018-12-31No
Investment advisory and management fees2018-12-31$95,236
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2018-12-31$479
Expenses. Payments to insurance carriers foe the provision of benefits2018-12-31$1,026,156
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-12-31No
Was there a failure to transmit to the plan any participant contributions2018-12-31No
Has the plan failed to provide any benefit when due under the plan2018-12-31No
Contributions received in cash from employer2018-12-31$5,499,121
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-12-31$4,181,760
Contract administrator fees2018-12-31$325,785
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32018-12-31No
Liabilities. Value of benefit claims payable at end of year2018-12-31$460,000
Did the plan have assets held for investment2018-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-12-31No
Opinion of an independent qualified public accountant for this plan2018-12-31Unqualified
Accountancy firm name2018-12-31EIDE BAILLY LLP
Accountancy firm EIN2018-12-31450250958

Form 5500 Responses for CUAD HEALTH BENEFITS PLAN

2022: CUAD HEALTH BENEFITS PLAN 2022 form 5500 responses
2022-01-01Type of plan entityMulitple employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – TrustYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement - TrustYes
2021: CUAD HEALTH BENEFITS PLAN 2021 form 5500 responses
2021-01-01Type of plan entityMulitple employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – TrustYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement - TrustYes
2020: CUAD HEALTH BENEFITS PLAN 2020 form 5500 responses
2020-01-01Type of plan entityMulitple employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – TrustYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement - TrustYes
2019: CUAD HEALTH BENEFITS PLAN 2019 form 5500 responses
2019-01-01Type of plan entityMulitple employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement - TrustYes
2018: CUAD HEALTH BENEFITS PLAN 2018 form 5500 responses
2018-01-01Type of plan entityMulitple employer plan
2018-01-01First time form 5500 has been submittedYes
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 )
Policy contract number0597
Policy instance 1
Insurance contract or identification number0597
Number of Individuals Covered1118
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $72,336
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,126,935
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $72,336
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 numberB70
Policy instance 2
Insurance contract or identification numberB70
Number of Individuals Covered614
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedHOSP/MED-SURGICAL
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 )
Policy contract number0597
Policy instance 1
Insurance contract or identification number0597
Number of Individuals Covered1066
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $73,692
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,061,410
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $73,692
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 numberB70
Policy instance 2
Insurance contract or identification numberB70
Number of Individuals Covered406
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedHOSP/MED-SURGICAL
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 )
Policy contract number0597
Policy instance 1
Insurance contract or identification number0597
Number of Individuals Covered1077
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $94,097
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,264,277
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $62,494
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 )
Policy contract number0597
Policy instance 1
Insurance contract or identification number0597
Number of Individuals Covered1112
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $95,347
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,185,910
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $95,347
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 )
Policy contract number90203+,90214+
Policy instance 1
Insurance contract or identification number90203+,90214+
Number of Individuals Covered1107
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $81,345
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,025,471
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $81,345
Insurance broker organization code?3

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