LUVERNE SUPERMARKET, INC. has sponsored the creation of one or more 401k plans.
| Measure | Date | Value |
|---|
| 2022: LUVERNE SUPERMARKET INC 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 194 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 176 |
| Number of retired or separated participants receiving benefits | 2022-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2022-01-01 | 0 |
| Total of all active and inactive participants | 2022-01-01 | 176 |
| 2021: LUVERNE SUPERMARKET INC 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 195 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 194 |
| Number of retired or separated participants receiving benefits | 2021-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-01-01 | 0 |
| Total of all active and inactive participants | 2021-01-01 | 194 |
| 2020: LUVERNE SUPERMARKET INC 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 194 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 195 |
| Number of retired or separated participants receiving benefits | 2020-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2020-01-01 | 0 |
| Total of all active and inactive participants | 2020-01-01 | 195 |
| 2019: LUVERNE SUPERMARKET INC 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 195 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 194 |
| Number of retired or separated participants receiving benefits | 2019-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-01-01 | 0 |
| Total of all active and inactive participants | 2019-01-01 | 194 |
| 2018: LUVERNE SUPERMARKET INC 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 195 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 195 |
| Number of retired or separated participants receiving benefits | 2018-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-01-01 | 0 |
| Total of all active and inactive participants | 2018-01-01 | 195 |
| 2017: LUVERNE SUPERMARKET INC 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 199 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 0 |
| Number of retired or separated participants receiving benefits | 2017-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-01-01 | 0 |
| Total of all active and inactive participants | 2017-01-01 | 0 |
| 2016: LUVERNE SUPERMARKET INC 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 214 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 0 |
| Number of retired or separated participants receiving benefits | 2016-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2016-01-01 | 0 |
| Total of all active and inactive participants | 2016-01-01 | 0 |
| 2015: LUVERNE SUPERMARKET INC 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 168 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 214 |
| Number of retired or separated participants receiving benefits | 2015-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2015-01-01 | 0 |
| Total of all active and inactive participants | 2015-01-01 | 214 |
| 2014: LUVERNE SUPERMARKET INC 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 135 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 168 |
| Number of retired or separated participants receiving benefits | 2014-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2014-01-01 | 0 |
| Total of all active and inactive participants | 2014-01-01 | 168 |
| 2013: LUVERNE SUPERMARKET INC 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 128 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 135 |
| Total of all active and inactive participants | 2013-01-01 | 135 |
| 2012: LUVERNE SUPERMARKET INC 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 85 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 128 |
| Total of all active and inactive participants | 2012-01-01 | 128 |
| Measure | Date | Value |
|---|
| 2022 : LUVERNE SUPERMARKET INC 2022 401k financial data |
|---|
| Total income from all sources | 2022-12-31 | $0 |
| Total plan assets at end of year | 2022-12-31 | $0 |
| Total plan assets at beginning of year | 2022-12-31 | $0 |
| Net plan assets at end of year (total assets less liabilities) | 2022-12-31 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2022-12-31 | $0 |
| 2021 : LUVERNE SUPERMARKET INC 2021 401k financial data |
|---|
| Total income from all sources | 2021-12-31 | $0 |
| Total plan assets at end of year | 2021-12-31 | $0 |
| Total plan assets at beginning of year | 2021-12-31 | $0 |
| Net plan assets at end of year (total assets less liabilities) | 2021-12-31 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2021-12-31 | $0 |
| 2020 : LUVERNE SUPERMARKET INC 2020 401k financial data |
|---|
| Total income from all sources | 2020-12-31 | $0 |
| Total plan assets at end of year | 2020-12-31 | $0 |
| Total plan assets at beginning of year | 2020-12-31 | $0 |
| Net plan assets at end of year (total assets less liabilities) | 2020-12-31 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2020-12-31 | $0 |
| 2019 : LUVERNE SUPERMARKET INC 2019 401k financial data |
|---|
| Total income from all sources | 2019-12-31 | $0 |
| Total plan assets at end of year | 2019-12-31 | $0 |
| Total plan assets at beginning of year | 2019-12-31 | $0 |
| Net plan assets at end of year (total assets less liabilities) | 2019-12-31 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2019-12-31 | $0 |
| 2018 : LUVERNE SUPERMARKET INC 2018 401k financial data |
|---|
| Total income from all sources | 2018-12-31 | $0 |
| Total plan assets at end of year | 2018-12-31 | $0 |
| Total plan assets at beginning of year | 2018-12-31 | $0 |
| Net plan assets at end of year (total assets less liabilities) | 2018-12-31 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2018-12-31 | $0 |
| 2017 : LUVERNE SUPERMARKET INC 2017 401k financial data |
|---|
| Total income from all sources | 2017-12-31 | $0 |
| Total plan assets at end of year | 2017-12-31 | $0 |
| Total plan assets at beginning of year | 2017-12-31 | $0 |
| Net plan assets at end of year (total assets less liabilities) | 2017-12-31 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2017-12-31 | $0 |
| 2016 : LUVERNE SUPERMARKET INC 2016 401k financial data |
|---|
| Total income from all sources | 2016-12-31 | $0 |
| Total plan assets at end of year | 2016-12-31 | $0 |
| Total plan assets at beginning of year | 2016-12-31 | $0 |
| Net plan assets at end of year (total assets less liabilities) | 2016-12-31 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2016-12-31 | $0 |
| 2015 : LUVERNE SUPERMARKET INC 2015 401k financial data |
|---|
| Total income from all sources | 2015-12-31 | $0 |
| Total plan assets at end of year | 2015-12-31 | $0 |
| Total plan assets at beginning of year | 2015-12-31 | $0 |
| Net plan assets at end of year (total assets less liabilities) | 2015-12-31 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2015-12-31 | $0 |
| 2014 : LUVERNE SUPERMARKET INC 2014 401k financial data |
|---|
| Total income from all sources | 2014-12-31 | $0 |
| Total plan assets at end of year | 2014-12-31 | $0 |
| Total plan assets at beginning of year | 2014-12-31 | $0 |
| Net plan assets at end of year (total assets less liabilities) | 2014-12-31 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2014-12-31 | $0 |
| 2013 : LUVERNE SUPERMARKET INC 2013 401k financial data |
|---|
| Total income from all sources | 2013-12-31 | $0 |
| Total plan assets at end of year | 2013-12-31 | $0 |
| Total plan assets at beginning of year | 2013-12-31 | $0 |
| Net plan assets at end of year (total assets less liabilities) | 2013-12-31 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2013-12-31 | $0 |
| 2012 : LUVERNE SUPERMARKET INC 2012 401k financial data |
|---|
| Total income from all sources | 2012-12-31 | $0 |
| Total plan assets at end of year | 2012-12-31 | $0 |
| Total plan assets at beginning of year | 2012-12-31 | $0 |
| Net plan assets at end of year (total assets less liabilities) | 2012-12-31 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2012-12-31 | $0 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VPS 328049 |
| Policy instance | 6 |
| Insurance contract or identification number | VPS 328049 | | Number of Individuals Covered | 18 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $3,123 | | Temporary Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,123 | | Additional information about fees paid to insurance broker | SALES COMMISSION | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VPL 303013 |
| Policy instance | 5 |
| Insurance contract or identification number | VPL 303013 | | Number of Individuals Covered | 8 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $601 | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $601 | | Additional information about fees paid to insurance broker | SALES COMMISSION | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VG 187521 |
| Policy instance | 4 |
| Insurance contract or identification number | VG 187521 | | Number of Individuals Covered | 13 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $2,288 | | Life Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,288 | | Additional information about fees paid to insurance broker | SALES COMMISSION | | Insurance broker organization code? | 3 |
|
| HEALTHPARTNERS INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 44547 ) |
| Policy contract number | 36750 |
| Policy instance | 3 |
| Insurance contract or identification number | 36750 | | Number of Individuals Covered | 156 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $15,440 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $15,440 | | Additional information about fees paid to insurance broker | SALES COMMISSION | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL 160009 |
| Policy instance | 2 |
| Insurance contract or identification number | GL 160009 | | Number of Individuals Covered | 119 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $1,138 | | Life Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,138 | | Additional information about fees paid to insurance broker | SALES COMMISSION | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 54097 ) |
| Policy contract number | 2584 |
| Policy instance | 1 |
| Insurance contract or identification number | 2584 | | Number of Individuals Covered | 12 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $176 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $176 | | Additional information about fees paid to insurance broker | SALES COMMISSION | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 54097 ) |
| Policy contract number | 2584 |
| Policy instance | 1 |
| Insurance contract or identification number | 2584 | | Number of Individuals Covered | 97 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $1,442 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,442 | | Additional information about fees paid to insurance broker | SALES COMMISSION | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL 160009 |
| Policy instance | 2 |
| Insurance contract or identification number | GL 160009 | | Number of Individuals Covered | 179 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $1,192 | | Life Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,192 | | Additional information about fees paid to insurance broker | SALES COMMISSION | | Insurance broker organization code? | 3 |
|
| AVERA HEALTH PLANS, INC. (National Association of Insurance Commissioners NAIC id number: 95839 ) |
| Policy contract number | SD751 |
| Policy instance | 3 |
| Insurance contract or identification number | SD751 | | Number of Individuals Covered | 165 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $13,880 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,880 | | Additional information about fees paid to insurance broker | SALES COMMISSION | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VG 187521 |
| Policy instance | 4 |
| Insurance contract or identification number | VG 187521 | | Number of Individuals Covered | 32 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $2,547 | | Life Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,547 | | Additional information about fees paid to insurance broker | SALES COMMISSION | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VPL 303013 |
| Policy instance | 5 |
| Insurance contract or identification number | VPL 303013 | | Number of Individuals Covered | 15 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $815 | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $815 | | Additional information about fees paid to insurance broker | SALES COMMISSION | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VPS 328049 |
| Policy instance | 6 |
| Insurance contract or identification number | VPS 328049 | | Number of Individuals Covered | 28 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $3,455 | | Temporary Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,455 | | Additional information about fees paid to insurance broker | SALES COMMISSION | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VPS 328049 |
| Policy instance | 6 |
| Insurance contract or identification number | VPS 328049 | | Number of Individuals Covered | 25 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $3,639 | | Temporary Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,639 | | Additional information about fees paid to insurance broker | SALES COMMISSION | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VPL 303013 |
| Policy instance | 5 |
| Insurance contract or identification number | VPL 303013 | | Number of Individuals Covered | 14 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $893 | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $893 | | Additional information about fees paid to insurance broker | SALES COMMISSION | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VG 187521 |
| Policy instance | 4 |
| Insurance contract or identification number | VG 187521 | | Number of Individuals Covered | 34 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $2,346 | | Life Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,346 | | Additional information about fees paid to insurance broker | SALES COMMISSION | | Insurance broker organization code? | 3 |
|
| AVERA HEALTH PLANS, INC. (National Association of Insurance Commissioners NAIC id number: 95839 ) |
| Policy contract number | SD751 |
| Policy instance | 3 |
| Insurance contract or identification number | SD751 | | Number of Individuals Covered | 174 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $26,600 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $26,600 | | Additional information about fees paid to insurance broker | SALES COMMISSION | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL 160009 |
| Policy instance | 2 |
| Insurance contract or identification number | GL 160009 | | Number of Individuals Covered | 157 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $1,182 | | Life Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,182 | | Additional information about fees paid to insurance broker | SALES COMMISSION | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 54097 ) |
| Policy contract number | 2584 |
| Policy instance | 1 |
| Insurance contract or identification number | 2584 | | Number of Individuals Covered | 89 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $1,441 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,441 | | Additional information about fees paid to insurance broker | SALES COMMISSION | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 54097 ) |
| Policy contract number | 2584 |
| Policy instance | 1 |
| Insurance contract or identification number | 2584 | | Number of Individuals Covered | 100 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $1,433 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $739 | | Additional information about fees paid to insurance broker | SALES COMMISSION | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL 160009 |
| Policy instance | 2 |
| Insurance contract or identification number | GL 160009 | | Number of Individuals Covered | 180 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $1,229 | | Life Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $615 | | Additional information about fees paid to insurance broker | SALES COMMISSION | | Insurance broker organization code? | 3 |
|
| AVERA HEALTH PLANS, INC. (National Association of Insurance Commissioners NAIC id number: 95839 ) |
| Policy contract number | SD751 |
| Policy instance | 3 |
| Insurance contract or identification number | SD751 | | Number of Individuals Covered | 177 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $23,000 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,280 | | Additional information about fees paid to insurance broker | SALES COMMISSION | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VG 187521 |
| Policy instance | 4 |
| Insurance contract or identification number | VG 187521 | | Number of Individuals Covered | 33 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $2,127 | | Life Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,086 | | Additional information about fees paid to insurance broker | SALES COMMISSION | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VPL 303013 |
| Policy instance | 5 |
| Insurance contract or identification number | VPL 303013 | | Number of Individuals Covered | 14 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $1,012 | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $535 | | Additional information about fees paid to insurance broker | SALES COMMISSION | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VPS 328049 |
| Policy instance | 6 |
| Insurance contract or identification number | VPS 328049 | | Number of Individuals Covered | 34 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $4,096 | | Temporary Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,075 | | Additional information about fees paid to insurance broker | SALES COMMISSION | | Insurance broker organization code? | 3 |
|
| AVERA HEALTH PLANS, INC. (National Association of Insurance Commissioners NAIC id number: 95839 ) |
| Policy contract number | SD751 |
| Policy instance | 3 |
| Insurance contract or identification number | SD751 | | Number of Individuals Covered | 149 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $21,780 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,000 | | Additional information about fees paid to insurance broker | SALES COMMISSION | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 403651 |
| Policy instance | 2 |
| Insurance contract or identification number | 403651 | | Number of Individuals Covered | 25 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $1,450 | | Total amount of fees paid to insurance company | USD $57 | | Life Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $960 | | Additional information about fees paid to insurance broker | SALES COMMISSION | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 57 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 403650 |
| Policy instance | 1 |
| Insurance contract or identification number | 403650 | | Number of Individuals Covered | 170 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $3,856 | | Total amount of fees paid to insurance company | USD $197 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,577 | | Additional information about fees paid to insurance broker | SALES COMMISSION | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 197 |
|
| AVERA HEALTH PLANS, INC. (National Association of Insurance Commissioners NAIC id number: 95839 ) |
| Policy contract number | SD751 |
| Policy instance | 3 |
| Insurance contract or identification number | SD751 | | Number of Individuals Covered | 150 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $20,586 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $20,586 | | Additional information about fees paid to insurance broker | SALES COMMISSION | | Insurance broker organization code? | 3 | | Insurance broker name | LORI LEWISON, MUTUAL MED INC |
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| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 403651 |
| Policy instance | 2 |
| Insurance contract or identification number | 403651 | | Number of Individuals Covered | 24 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $2,952 | | Total amount of fees paid to insurance company | USD $28 | | Life Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,952 | | Amount paid for insurance broker fees | 28 | | Additional information about fees paid to insurance broker | SALES COMMISSION | | Insurance broker organization code? | 3 | | Insurance broker name | MUTUAL MED INSURANCE SERVICES |
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| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 403650 |
| Policy instance | 1 |
| Insurance contract or identification number | 403650 | | Number of Individuals Covered | 175 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $7,926 | | Total amount of fees paid to insurance company | USD $112 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,926 | | Amount paid for insurance broker fees | 112 | | Additional information about fees paid to insurance broker | SALES COMMISSION | | Insurance broker organization code? | 3 | | Insurance broker name | MUTUAL MED INSURANCE SERVICES |
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