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NORTH DAKOTA TELEPHONE COMPANY & TPC, INC. GROUP BENEFIT PLAN 401k Plan overview

Plan NameNORTH DAKOTA TELEPHONE COMPANY & TPC, INC. GROUP BENEFIT PLAN
Plan identification number 501

NORTH DAKOTA TELEPHONE COMPANY & TPC, INC. GROUP BENEFIT PLAN Benefits

401k Plan TypeOther Pension Benefit
Plan Features/Benefits
  • Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).
  • Health (other than dental or vision)
  • Dental
  • Vision

401k Sponsoring company profile

NORTH DAKOTA TELEPHONE COMPANY & TPC, INC. has sponsored the creation of one or more 401k plans.

Company Name:NORTH DAKOTA TELEPHONE COMPANY & TPC, INC.
Employer identification number (EIN):410902524
NAIC Classification:517000

Form 5500 Filing Information

Submission information for form 5500 for 401k plan NORTH DAKOTA TELEPHONE COMPANY & TPC, INC. GROUP BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01RODNEY HOFFMEYER2023-07-31 RODNEY HOFFMEYER2023-07-31
5012021-01-01RODNEY HOFFMEYER2022-07-25 RODNEY HOFFMEYER2022-07-25
5012020-01-01RODNEY HOFFMEYER2021-07-19 RODNEY HOFFMEYER2021-07-19
5012019-01-01RODNEY HOFFMEYER2020-07-06 RODNEY HOFFMEYER2020-07-06
5012018-01-01
5012017-01-01
5012016-01-01
5012015-01-01
5012014-01-01
5012013-01-01
5012012-01-01DAVE DIRCKS
5012011-01-01DAVE DIRCKS
5012010-01-01DAVE DIRCKS
5012009-01-01DAVE DIRCKS
5012009-01-01DAVE DIRCKS

Plan Statistics for NORTH DAKOTA TELEPHONE COMPANY & TPC, INC. GROUP BENEFIT PLAN

401k plan membership statisitcs for NORTH DAKOTA TELEPHONE COMPANY & TPC, INC. GROUP BENEFIT PLAN

Measure Date Value
2022: NORTH DAKOTA TELEPHONE COMPANY & TPC, INC. GROUP BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-0181
Total number of active participants reported on line 7a of the Form 55002022-01-0157
Number of retired or separated participants receiving benefits2022-01-0123
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-0180
2021: NORTH DAKOTA TELEPHONE COMPANY & TPC, INC. GROUP BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-0181
Total number of active participants reported on line 7a of the Form 55002021-01-0159
Number of retired or separated participants receiving benefits2021-01-0123
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-0182
2020: NORTH DAKOTA TELEPHONE COMPANY & TPC, INC. GROUP BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-0178
Total number of active participants reported on line 7a of the Form 55002020-01-0160
Number of retired or separated participants receiving benefits2020-01-0122
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-0182
2019: NORTH DAKOTA TELEPHONE COMPANY & TPC, INC. GROUP BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-0181
Total number of active participants reported on line 7a of the Form 55002019-01-0164
Number of retired or separated participants receiving benefits2019-01-0120
Total of all active and inactive participants2019-01-0184
2018: NORTH DAKOTA TELEPHONE COMPANY & TPC, INC. GROUP BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-0183
Total number of active participants reported on line 7a of the Form 55002018-01-0161
Number of retired or separated participants receiving benefits2018-01-0120
Total of all active and inactive participants2018-01-0181
2017: NORTH DAKOTA TELEPHONE COMPANY & TPC, INC. GROUP BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-0180
Total number of active participants reported on line 7a of the Form 55002017-01-0167
Number of retired or separated participants receiving benefits2017-01-0119
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-0186
2016: NORTH DAKOTA TELEPHONE COMPANY & TPC, INC. GROUP BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-0182
Total number of active participants reported on line 7a of the Form 55002016-01-0167
Number of retired or separated participants receiving benefits2016-01-0113
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-0180
2015: NORTH DAKOTA TELEPHONE COMPANY & TPC, INC. GROUP BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-0181
Total number of active participants reported on line 7a of the Form 55002015-01-0170
Number of retired or separated participants receiving benefits2015-01-0112
Total of all active and inactive participants2015-01-0182
2014: NORTH DAKOTA TELEPHONE COMPANY & TPC, INC. GROUP BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-0182
Total number of active participants reported on line 7a of the Form 55002014-01-0172
Number of retired or separated participants receiving benefits2014-01-019
Total of all active and inactive participants2014-01-0181
2013: NORTH DAKOTA TELEPHONE COMPANY & TPC, INC. GROUP BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-0184
Total number of active participants reported on line 7a of the Form 55002013-01-0173
Number of retired or separated participants receiving benefits2013-01-019
Number of other retired or separated participants entitled to future benefits2013-01-010
Total of all active and inactive participants2013-01-0182
2012: NORTH DAKOTA TELEPHONE COMPANY & TPC, INC. GROUP BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-0186
Total number of active participants reported on line 7a of the Form 55002012-01-0175
Number of retired or separated participants receiving benefits2012-01-019
Number of other retired or separated participants entitled to future benefits2012-01-018
Total of all active and inactive participants2012-01-0192
2011: NORTH DAKOTA TELEPHONE COMPANY & TPC, INC. GROUP BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-0185
Total number of active participants reported on line 7a of the Form 55002011-01-0175
Number of retired or separated participants receiving benefits2011-01-0111
Number of other retired or separated participants entitled to future benefits2011-01-018
Total of all active and inactive participants2011-01-0194
2010: NORTH DAKOTA TELEPHONE COMPANY & TPC, INC. GROUP BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-0187
Total number of active participants reported on line 7a of the Form 55002010-01-0177
Number of retired or separated participants receiving benefits2010-01-018
Number of other retired or separated participants entitled to future benefits2010-01-015
Total of all active and inactive participants2010-01-0190
2009: NORTH DAKOTA TELEPHONE COMPANY & TPC, INC. GROUP BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-0188
Total number of active participants reported on line 7a of the Form 55002009-01-0184
Number of retired or separated participants receiving benefits2009-01-016
Number of other retired or separated participants entitled to future benefits2009-01-013
Total of all active and inactive participants2009-01-0193
Total participants2009-01-0193

Financial Data on NORTH DAKOTA TELEPHONE COMPANY & TPC, INC. GROUP BENEFIT PLAN

Measure Date Value
2022 : NORTH DAKOTA TELEPHONE COMPANY & TPC, INC. GROUP BENEFIT PLAN 2022 401k financial data
Total income from all sources2022-12-31$1,269,560
Expenses. Total of all expenses incurred2022-12-31$1,300,103
Benefits paid (including direct rollovers)2022-12-31$1,299,099
Total plan assets at end of year2022-12-31$658,198
Total plan assets at beginning of year2022-12-31$688,741
Total contributions received or receivable from participants2022-12-31$300,447
Contributions received from other sources (not participants or employers)2022-12-31$2,288
Other income received2022-12-31$29,510
Net income (gross income less expenses)2022-12-31$-30,543
Net plan assets at end of year (total assets less liabilities)2022-12-31$658,198
Net plan assets at beginning of year (total assets less liabilities)2022-12-31$688,741
Total contributions received or receivable from employer(s)2022-12-31$937,315
Expenses. Administrative service providers (salaries,fees and commissions)2022-12-31$1,004
2021 : NORTH DAKOTA TELEPHONE COMPANY & TPC, INC. GROUP BENEFIT PLAN 2021 401k financial data
Total income from all sources2021-12-31$1,239,786
Expenses. Total of all expenses incurred2021-12-31$1,039,492
Benefits paid (including direct rollovers)2021-12-31$1,027,347
Total plan assets at end of year2021-12-31$688,741
Total plan assets at beginning of year2021-12-31$488,447
Total contributions received or receivable from participants2021-12-31$289,100
Contributions received from other sources (not participants or employers)2021-12-31$3,397
Other income received2021-12-31$15,708
Net income (gross income less expenses)2021-12-31$200,294
Net plan assets at end of year (total assets less liabilities)2021-12-31$688,741
Net plan assets at beginning of year (total assets less liabilities)2021-12-31$488,447
Total contributions received or receivable from employer(s)2021-12-31$931,581
Expenses. Administrative service providers (salaries,fees and commissions)2021-12-31$12,145
2020 : NORTH DAKOTA TELEPHONE COMPANY & TPC, INC. GROUP BENEFIT PLAN 2020 401k financial data
Total income from all sources2020-12-31$1,228,964
Expenses. Total of all expenses incurred2020-12-31$1,080,573
Benefits paid (including direct rollovers)2020-12-31$1,062,399
Total plan assets at end of year2020-12-31$488,447
Total plan assets at beginning of year2020-12-31$340,056
Total contributions received or receivable from participants2020-12-31$289,646
Contributions received from other sources (not participants or employers)2020-12-31$1,975
Other income received2020-12-31$16,359
Net income (gross income less expenses)2020-12-31$148,391
Net plan assets at end of year (total assets less liabilities)2020-12-31$488,447
Net plan assets at beginning of year (total assets less liabilities)2020-12-31$340,056
Total contributions received or receivable from employer(s)2020-12-31$920,984
Expenses. Administrative service providers (salaries,fees and commissions)2020-12-31$18,174
2019 : NORTH DAKOTA TELEPHONE COMPANY & TPC, INC. GROUP BENEFIT PLAN 2019 401k financial data
Total income from all sources2019-12-31$1,325,410
Expenses. Total of all expenses incurred2019-12-31$1,230,278
Benefits paid (including direct rollovers)2019-12-31$1,229,848
Total plan assets at end of year2019-12-31$340,056
Total plan assets at beginning of year2019-12-31$244,924
Total contributions received or receivable from participants2019-12-31$310,776
Contributions received from other sources (not participants or employers)2019-12-31$516
Other income received2019-12-31$9,260
Net income (gross income less expenses)2019-12-31$95,132
Net plan assets at end of year (total assets less liabilities)2019-12-31$340,056
Net plan assets at beginning of year (total assets less liabilities)2019-12-31$244,924
Total contributions received or receivable from employer(s)2019-12-31$1,004,858
Expenses. Administrative service providers (salaries,fees and commissions)2019-12-31$430
2018 : NORTH DAKOTA TELEPHONE COMPANY & TPC, INC. GROUP BENEFIT PLAN 2018 401k financial data
Total income from all sources2018-12-31$1,270,332
Expenses. Total of all expenses incurred2018-12-31$1,165,379
Benefits paid (including direct rollovers)2018-12-31$1,164,922
Total plan assets at end of year2018-12-31$244,924
Total plan assets at beginning of year2018-12-31$139,971
Total contributions received or receivable from participants2018-12-31$270,897
Contributions received from other sources (not participants or employers)2018-12-31$1,605
Other income received2018-12-31$13,575
Net income (gross income less expenses)2018-12-31$104,953
Net plan assets at end of year (total assets less liabilities)2018-12-31$244,924
Net plan assets at beginning of year (total assets less liabilities)2018-12-31$139,971
Total contributions received or receivable from employer(s)2018-12-31$984,255
Expenses. Administrative service providers (salaries,fees and commissions)2018-12-31$457
2017 : NORTH DAKOTA TELEPHONE COMPANY & TPC, INC. GROUP BENEFIT PLAN 2017 401k financial data
Total income from all sources2017-12-31$1,187,612
Expenses. Total of all expenses incurred2017-12-31$1,187,985
Benefits paid (including direct rollovers)2017-12-31$1,187,556
Total plan assets at end of year2017-12-31$139,971
Total plan assets at beginning of year2017-12-31$140,344
Total contributions received or receivable from participants2017-12-31$231,006
Other income received2017-12-31$11,286
Net income (gross income less expenses)2017-12-31$-373
Net plan assets at end of year (total assets less liabilities)2017-12-31$139,971
Net plan assets at beginning of year (total assets less liabilities)2017-12-31$140,344
Total contributions received or receivable from employer(s)2017-12-31$945,320
Expenses. Administrative service providers (salaries,fees and commissions)2017-12-31$429
2016 : NORTH DAKOTA TELEPHONE COMPANY & TPC, INC. GROUP BENEFIT PLAN 2016 401k financial data
Total income from all sources2016-12-31$991,269
Expenses. Total of all expenses incurred2016-12-31$1,101,148
Benefits paid (including direct rollovers)2016-12-31$1,100,714
Total plan assets at end of year2016-12-31$140,344
Total plan assets at beginning of year2016-12-31$250,223
Total contributions received or receivable from participants2016-12-31$178,973
Other income received2016-12-31$16,654
Net income (gross income less expenses)2016-12-31$-109,879
Net plan assets at end of year (total assets less liabilities)2016-12-31$140,344
Net plan assets at beginning of year (total assets less liabilities)2016-12-31$250,223
Total contributions received or receivable from employer(s)2016-12-31$795,642
Expenses. Administrative service providers (salaries,fees and commissions)2016-12-31$434
2015 : NORTH DAKOTA TELEPHONE COMPANY & TPC, INC. GROUP BENEFIT PLAN 2015 401k financial data
Total income from all sources2015-12-31$975,866
Expenses. Total of all expenses incurred2015-12-31$975,060
Benefits paid (including direct rollovers)2015-12-31$974,619
Total plan assets at end of year2015-12-31$250,223
Total plan assets at beginning of year2015-12-31$249,417
Total contributions received or receivable from participants2015-12-31$160,653
Other income received2015-12-31$22,245
Net income (gross income less expenses)2015-12-31$806
Net plan assets at end of year (total assets less liabilities)2015-12-31$250,223
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$249,417
Total contributions received or receivable from employer(s)2015-12-31$792,968
Expenses. Administrative service providers (salaries,fees and commissions)2015-12-31$441
2014 : NORTH DAKOTA TELEPHONE COMPANY & TPC, INC. GROUP BENEFIT PLAN 2014 401k financial data
Total income from all sources2014-12-31$919,821
Expenses. Total of all expenses incurred2014-12-31$1,015,565
Benefits paid (including direct rollovers)2014-12-31$1,015,137
Total plan assets at end of year2014-12-31$249,417
Total plan assets at beginning of year2014-12-31$345,161
Total contributions received or receivable from participants2014-12-31$156,268
Other income received2014-12-31$10,646
Net income (gross income less expenses)2014-12-31$-95,744
Net plan assets at end of year (total assets less liabilities)2014-12-31$249,417
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$345,161
Total contributions received or receivable from employer(s)2014-12-31$752,907
Expenses. Administrative service providers (salaries,fees and commissions)2014-12-31$428
2013 : NORTH DAKOTA TELEPHONE COMPANY & TPC, INC. GROUP BENEFIT PLAN 2013 401k financial data
Total income from all sources2013-12-31$794,526
Expenses. Total of all expenses incurred2013-12-31$983,214
Benefits paid (including direct rollovers)2013-12-31$982,993
Total plan assets at end of year2013-12-31$345,161
Total plan assets at beginning of year2013-12-31$533,849
Total contributions received or receivable from participants2013-12-31$134,110
Other income received2013-12-31$11,183
Net income (gross income less expenses)2013-12-31$-188,688
Net plan assets at end of year (total assets less liabilities)2013-12-31$345,161
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$533,849
Total contributions received or receivable from employer(s)2013-12-31$649,233
Expenses. Administrative service providers (salaries,fees and commissions)2013-12-31$221
2012 : NORTH DAKOTA TELEPHONE COMPANY & TPC, INC. GROUP BENEFIT PLAN 2012 401k financial data
Total income from all sources2012-12-31$939,509
Expenses. Total of all expenses incurred2012-12-31$985,597
Benefits paid (including direct rollovers)2012-12-31$985,597
Total plan assets at end of year2012-12-31$533,849
Total plan assets at beginning of year2012-12-31$579,937
Total contributions received or receivable from participants2012-12-31$170,705
Other income received2012-12-31$5,133
Net income (gross income less expenses)2012-12-31$-46,088
Net plan assets at end of year (total assets less liabilities)2012-12-31$533,849
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$579,937
Total contributions received or receivable from employer(s)2012-12-31$763,671
2011 : NORTH DAKOTA TELEPHONE COMPANY & TPC, INC. GROUP BENEFIT PLAN 2011 401k financial data
Total income from all sources2011-12-31$871,432
Expenses. Total of all expenses incurred2011-12-31$810,457
Benefits paid (including direct rollovers)2011-12-31$810,457
Total plan assets at end of year2011-12-31$579,937
Total plan assets at beginning of year2011-12-31$518,962
Total contributions received or receivable from participants2011-12-31$180,242
Contributions received from other sources (not participants or employers)2011-12-31$2,108
Other income received2011-12-31$7,528
Net income (gross income less expenses)2011-12-31$60,975
Net plan assets at end of year (total assets less liabilities)2011-12-31$579,937
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$518,962
Total contributions received or receivable from employer(s)2011-12-31$681,554
2010 : NORTH DAKOTA TELEPHONE COMPANY & TPC, INC. GROUP BENEFIT PLAN 2010 401k financial data
Total income from all sources2010-12-31$809,053
Expenses. Total of all expenses incurred2010-12-31$882,631
Benefits paid (including direct rollovers)2010-12-31$882,631
Total plan assets at end of year2010-12-31$518,962
Total plan assets at beginning of year2010-12-31$592,540
Total contributions received or receivable from participants2010-12-31$143,787
Contributions received from other sources (not participants or employers)2010-12-31$4,041
Other income received2010-12-31$8,433
Net income (gross income less expenses)2010-12-31$-73,578
Net plan assets at end of year (total assets less liabilities)2010-12-31$518,962
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$592,540
Total contributions received or receivable from employer(s)2010-12-31$652,792

Form 5500 Responses for NORTH DAKOTA TELEPHONE COMPANY & TPC, INC. GROUP BENEFIT PLAN

2022: NORTH DAKOTA TELEPHONE COMPANY & TPC, INC. GROUP BENEFIT PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle 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: NORTH DAKOTA TELEPHONE COMPANY & TPC, INC. GROUP BENEFIT PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle 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: NORTH DAKOTA TELEPHONE COMPANY & TPC, INC. GROUP BENEFIT PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle 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: NORTH DAKOTA TELEPHONE COMPANY & TPC, INC. GROUP BENEFIT PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle 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: NORTH DAKOTA TELEPHONE COMPANY & TPC, INC. GROUP BENEFIT PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement - TrustYes
2017: NORTH DAKOTA TELEPHONE COMPANY & TPC, INC. GROUP BENEFIT PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement - TrustYes
2016: NORTH DAKOTA TELEPHONE COMPANY & TPC, INC. GROUP BENEFIT PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement - TrustYes
2015: NORTH DAKOTA TELEPHONE COMPANY & TPC, INC. GROUP BENEFIT PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement - TrustYes
2014: NORTH DAKOTA TELEPHONE COMPANY & TPC, INC. GROUP BENEFIT PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement - TrustYes
2013: NORTH DAKOTA TELEPHONE COMPANY & TPC, INC. GROUP BENEFIT PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement - TrustYes
2012: NORTH DAKOTA TELEPHONE COMPANY & TPC, INC. GROUP BENEFIT PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement - TrustYes
2011: NORTH DAKOTA TELEPHONE COMPANY & TPC, INC. GROUP BENEFIT PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement - TrustYes
2010: NORTH DAKOTA TELEPHONE COMPANY & TPC, INC. GROUP BENEFIT PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan funding arrangement – TrustYes
2010-01-01Plan benefit arrangement – InsuranceYes
2010-01-01Plan benefit arrangement - TrustYes
2009: NORTH DAKOTA TELEPHONE COMPANY & TPC, INC. GROUP BENEFIT PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01First time form 5500 has been submittedYes
2009-01-01Submission has been amendedYes
2009-01-01This submission is the final filingNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan 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 number19437
Policy instance 3
Insurance contract or identification number19437
Number of Individuals Covered160
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $8,972
Total amount of fees paid to insurance companyUSD $39,550
Welfare Benefit Premiums Paid to CarrierUSD $481,329
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,972
Amount paid for insurance broker fees39550
Additional information about fees paid to insurance brokerADMINISTRATIVE FEES
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 )
Policy contract number19437
Policy instance 2
Insurance contract or identification number19437
Number of Individuals Covered217
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 $11,436
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees11436
Additional information about fees paid to insurance brokerADMINISTRATIVE FEES
Insurance broker organization code?4
BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 )
Policy contract number19437
Policy instance 1
Insurance contract or identification number19437
Number of Individuals Covered207
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 $1,762
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees1762
Additional information about fees paid to insurance brokerADMINISTRATIVE FEES
Insurance broker organization code?1
BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 )
Policy contract number19437
Policy instance 1
Insurance contract or identification number19437
Number of Individuals Covered207
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $1,744
Total amount of fees paid to insurance companyUSD $1,933
Vision 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 $1,744
Amount paid for insurance broker fees1933
Additional information about fees paid to insurance brokerADMINISTRATIVE FEES
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 )
Policy contract number19437
Policy instance 2
Insurance contract or identification number19437
Number of Individuals Covered216
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $4,239
Total amount of fees paid to insurance companyUSD $12,191
Dental 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 $4,239
Amount paid for insurance broker fees12191
Additional information about fees paid to insurance brokerADMINISTRATIVE FEES
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 )
Policy contract number19437
Policy instance 3
Insurance contract or identification number19437
Number of Individuals Covered161
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $9,324
Total amount of fees paid to insurance companyUSD $36,044
Welfare Benefit Premiums Paid to CarrierUSD $455,615
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,324
Amount paid for insurance broker fees36044
Additional information about fees paid to insurance brokerADMINISTRATIVE FEES
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 )
Policy contract number19437
Policy instance 3
Insurance contract or identification number19437
Number of Individuals Covered165
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $9,219
Total amount of fees paid to insurance companyUSD $40,083
Welfare Benefit Premiums Paid to CarrierUSD $432,872
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,847
Amount paid for insurance broker fees40083
Additional information about fees paid to insurance brokerADMINISTRATIVE FEES
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 )
Policy contract number19437
Policy instance 2
Insurance contract or identification number19437
Number of Individuals Covered221
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $4,177
Total amount of fees paid to insurance companyUSD $10,914
Dental 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 $1,728
Amount paid for insurance broker fees10914
Additional information about fees paid to insurance brokerADMINISTRATIVE FEES
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 )
Policy contract number19437
Policy instance 1
Insurance contract or identification number19437
Number of Individuals Covered210
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $1,721
Total amount of fees paid to insurance companyUSD $1,755
Vision 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 $1,011
Insurance broker organization code?3
Amount paid for insurance broker fees1755
Additional information about fees paid to insurance brokerADMINISTRATIVE FEES
BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 )
Policy contract number19437
Policy instance 1
Insurance contract or identification number19437
Number of Individuals Covered215
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $1,748
Total amount of fees paid to insurance companyUSD $1,226
Vision 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 $1,748
Amount paid for insurance broker fees1226
Additional information about fees paid to insurance brokerADMINISTRATIVE FEES
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 )
Policy contract number19437
Policy instance 2
Insurance contract or identification number19437
Number of Individuals Covered225
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $4,181
Total amount of fees paid to insurance companyUSD $9,546
Dental 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 $4,181
Amount paid for insurance broker fees9546
Additional information about fees paid to insurance brokerADMINISTRATIVE FEES
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 )
Policy contract number19437
Policy instance 3
Insurance contract or identification number19437
Number of Individuals Covered171
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $9,571
Total amount of fees paid to insurance companyUSD $52,047
Welfare Benefit Premiums Paid to CarrierUSD $392,717
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,571
Amount paid for insurance broker fees52047
Additional information about fees paid to insurance brokerADMINISTRATIVE FEES
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 )
Policy contract number19437
Policy instance 3
Insurance contract or identification number19437
Number of Individuals Covered169
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $10,362
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $392,818
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,362
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 )
Policy contract number19437
Policy instance 2
Insurance contract or identification number19437
Number of Individuals Covered225
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $4,223
Total amount of fees paid to insurance companyUSD $0
Dental 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 $4,223
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 )
Policy contract number19437
Policy instance 1
Insurance contract or identification number19437
Number of Individuals Covered219
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $1,788
Total amount of fees paid to insurance companyUSD $0
Vision 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 $1,788
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 )
Policy contract number19437
Policy instance 3
Insurance contract or identification number19437
Number of Individuals Covered187
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $11,324
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $388,635
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,324
Insurance broker organization code?3
Insurance broker nameMIDDAUGH BENEFITS CONSULTING INC
BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 )
Policy contract number19437
Policy instance 2
Insurance contract or identification number19437
Number of Individuals Covered228
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $4,299
Total amount of fees paid to insurance companyUSD $0
Dental 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 $4,299
Insurance broker organization code?3
Insurance broker nameMIDDAUGH BENEFITS CONSULTING INC
BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 )
Policy contract number19437
Policy instance 1
Insurance contract or identification number19437
Number of Individuals Covered222
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $1,792
Total amount of fees paid to insurance companyUSD $0
Vision 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 $1,792
Insurance broker organization code?3
Insurance broker nameMIDDAUGH BENEFITS CONSULTING INC
BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 )
Policy contract number19437
Policy instance 1
Insurance contract or identification number19437
Number of Individuals Covered225
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $445
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,325
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $445
Insurance broker organization code?3
Insurance broker nameD A MIDDAUGH & ASSOCIATES INC
BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 )
Policy contract number19437
Policy instance 2
Insurance contract or identification number19437
Number of Individuals Covered231
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $349
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,787
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $349
Insurance broker organization code?3
Insurance broker nameD A MIDDAUGH & ASSOCIATES INC
BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 )
Policy contract number19437
Policy instance 3
Insurance contract or identification number19437
Number of Individuals Covered199
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $2,717
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $331,707
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,717
Insurance broker organization code?3
Insurance broker nameD A MIDDAUGH & ASSOCIATES INC
BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 )
Policy contract number19437
Policy instance 3
Insurance contract or identification number19437
Number of Individuals Covered210
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $10,491
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $228,500
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,491
Insurance broker organization code?3
Insurance broker nameD A MIDDAUGH & ASSOCIATES INC
BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 )
Policy contract number19437
Policy instance 1
Insurance contract or identification number19437
Number of Individuals Covered229
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $1,794
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision 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 $1,794
Insurance broker organization code?3
Insurance broker nameD A MIDDAUGH & ASSOCIATES INC
BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 )
Policy contract number19437
Policy instance 2
Insurance contract or identification number19437
Number of Individuals Covered230
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $4,166
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental 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 $4,166
Insurance broker organization code?3
Insurance broker nameD A MIDDAUGH & ASSOCIATES INC
THE DENTAL SERVICE CORPORATION OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 47054 )
Policy contract number19437
Policy instance 2
Insurance contract or identification number19437
Number of Individuals Covered237
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $4,189
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental 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 $4,189
Insurance broker organization code?3
Insurance broker nameD A MIDDAUGH & ASSOCIATES INC
THE VISION SERVICE CORPORATION OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 47053 )
Policy contract number19437
Policy instance 1
Insurance contract or identification number19437
Number of Individuals Covered234
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $1,808
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision 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 $1,808
Insurance broker organization code?3
Insurance broker nameD A MIDDAUGH & ASSOCIATES INC
BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 )
Policy contract number19437
Policy instance 3
Insurance contract or identification number19437
Number of Individuals Covered214
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $9,975
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $208,778
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,975
Insurance broker organization code?3
Insurance broker nameD A MIDDAUGH & ASSOCIATES INC
BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 )
Policy contract number19437
Policy instance 3
Insurance contract or identification number19437
Number of Individuals Covered219
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $10,363
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $203,544
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,363
Insurance broker organization code?3
Insurance broker nameD A MIDDAUGH & ASSOCIATES INC
THE DENTAL SERVICE CORPORATION OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 47054 )
Policy contract number19437
Policy instance 2
Insurance contract or identification number19437
Number of Individuals Covered240
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $4,275
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental 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 $4,275
Insurance broker organization code?3
Insurance broker nameD A MIDDAUGH & ASSOCIATES INC
THE VISION SERVICE CORPORATION OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 47053 )
Policy contract number19437
Policy instance 1
Insurance contract or identification number19437
Number of Individuals Covered238
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $1,757
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision 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 $1,757
Insurance broker organization code?3
Insurance broker nameD A MIDDAUGH & ASSOCIATES INC
THE VISION SERVICE CORPORATION OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 47053 )
Policy contract number19437
Policy instance 1
Insurance contract or identification number19437
Number of Individuals Covered238
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $1,730
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE DENTAL SERVICE CORPORATION OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 47054 )
Policy contract number19437
Policy instance 2
Insurance contract or identification number19437
Number of Individuals Covered239
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $4,258
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
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 number19437
Policy instance 3
Insurance contract or identification number19437
Number of Individuals Covered223
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $10,294
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $251,581
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE VISION SERVICE CORPORATION OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 47053 )
Policy contract number19437
Policy instance 1
Insurance contract or identification number19437
Number of Individuals Covered238
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $1,707
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision 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 $1,707
Insurance broker organization code?3
Insurance broker nameD A MIDDAUGH & ASSOCIATES INC
THE DENTAL SERVICE CORPORATION OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 47054 )
Policy contract number19437
Policy instance 2
Insurance contract or identification number19437
Number of Individuals Covered240
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $4,147
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental 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 $4,147
Insurance broker organization code?3
Insurance broker nameD A MIDDAUGH & ASSOCIATES INC
BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 )
Policy contract number19437
Policy instance 3
Insurance contract or identification number19437
Number of Individuals Covered226
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $9,988
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $243,152
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,988
Insurance broker organization code?3
Insurance broker nameD A MIDDAUGH & ASSOCIATES INC

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