TRUSTEES OF TWIN CITIES PRINTING HEALTH AND WELFARE FUND has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan TWIN CITIES PRINTING PRESSMEN HEALTH AND WELFARE FUND
401k plan membership statisitcs for TWIN CITIES PRINTING PRESSMEN HEALTH AND WELFARE FUND
| Measure | Date | Value |
|---|
| 2021 : TWIN CITIES PRINTING PRESSMEN HEALTH AND WELFARE FUND 2021 401k financial data |
|---|
| Total plan liabilities at beginning of year | 2021-05-31 | $28,789 |
| Total income from all sources | 2021-05-31 | $76 |
| Expenses. Total of all expenses incurred | 2021-05-31 | $168,087 |
| Benefits paid (including direct rollovers) | 2021-05-31 | $115,751 |
| Total plan assets at end of year | 2021-05-31 | $0 |
| Total plan assets at beginning of year | 2021-05-31 | $196,800 |
| Expenses. Other expenses not covered elsewhere | 2021-05-31 | $19,785 |
| Other income received | 2021-05-31 | $76 |
| Net income (gross income less expenses) | 2021-05-31 | $-168,011 |
| Net plan assets at end of year (total assets less liabilities) | 2021-05-31 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2021-05-31 | $168,011 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2021-05-31 | $32,551 |
| 2020 : TWIN CITIES PRINTING PRESSMEN HEALTH AND WELFARE FUND 2020 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2020-05-31 | $28,789 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2020-05-31 | $13,344 |
| Total income from all sources (including contributions) | 2020-05-31 | $259,993 |
| Total of all expenses incurred | 2020-05-31 | $587,481 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2020-05-31 | $544,911 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2020-05-31 | $259,685 |
| Value of total assets at end of year | 2020-05-31 | $196,800 |
| Value of total assets at beginning of year | 2020-05-31 | $508,843 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2020-05-31 | $42,570 |
| Total interest from all sources | 2020-05-31 | $308 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2020-05-31 | No |
| Administrative expenses professional fees incurred | 2020-05-31 | $33,333 |
| Was this plan covered by a fidelity bond | 2020-05-31 | Yes |
| Value of fidelity bond cover | 2020-05-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2020-05-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2020-05-31 | No |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2020-05-31 | $12,661 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2020-05-31 | $126,260 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2020-05-31 | $13,344 |
| Administrative expenses (other) incurred | 2020-05-31 | $3,306 |
| Liabilities. Value of operating payables at end of year | 2020-05-31 | $28,789 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-05-31 | No |
| Value of net income/loss | 2020-05-31 | $-327,488 |
| Value of net assets at end of year (total assets less liabilities) | 2020-05-31 | $168,011 |
| Value of net assets at beginning of year (total assets less liabilities) | 2020-05-31 | $495,499 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2020-05-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2020-05-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2020-05-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2020-05-31 | $184,139 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2020-05-31 | $380,391 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2020-05-31 | $380,391 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2020-05-31 | $308 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2020-05-31 | $544,911 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2020-05-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2020-05-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2020-05-31 | No |
| Contributions received in cash from employer | 2020-05-31 | $259,685 |
| Employer contributions (assets) at beginning of year | 2020-05-31 | $2,192 |
| Contract administrator fees | 2020-05-31 | $5,931 |
| Did the plan have assets held for investment | 2020-05-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-05-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2020-05-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2020-05-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2020-05-31 | Unqualified |
| Accountancy firm name | 2020-05-31 | LETHERT, SKWIRA, SCHULTZ & CO. LLP |
| Accountancy firm EIN | 2020-05-31 | 410738189 |
| 2019 : TWIN CITIES PRINTING PRESSMEN HEALTH AND WELFARE FUND 2019 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-05-31 | $13,344 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-05-31 | $4,940 |
| Total income from all sources (including contributions) | 2019-05-31 | $1,354,981 |
| Total of all expenses incurred | 2019-05-31 | $1,354,738 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2019-05-31 | $1,330,185 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2019-05-31 | $1,354,569 |
| Value of total assets at end of year | 2019-05-31 | $508,843 |
| Value of total assets at beginning of year | 2019-05-31 | $500,196 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2019-05-31 | $24,553 |
| Total interest from all sources | 2019-05-31 | $412 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2019-05-31 | No |
| Administrative expenses professional fees incurred | 2019-05-31 | $9,706 |
| Was this plan covered by a fidelity bond | 2019-05-31 | Yes |
| Value of fidelity bond cover | 2019-05-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2019-05-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2019-05-31 | No |
| Contributions received from participants | 2019-05-31 | $1,957 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2019-05-31 | $126,260 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2019-05-31 | $107,516 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2019-05-31 | $13,344 |
| Administrative expenses (other) incurred | 2019-05-31 | $5,391 |
| Liabilities. Value of operating payables at beginning of year | 2019-05-31 | $4,940 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-05-31 | No |
| Value of net income/loss | 2019-05-31 | $243 |
| Value of net assets at end of year (total assets less liabilities) | 2019-05-31 | $495,499 |
| Value of net assets at beginning of year (total assets less liabilities) | 2019-05-31 | $495,256 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2019-05-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2019-05-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2019-05-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2019-05-31 | $380,391 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2019-05-31 | $391,584 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2019-05-31 | $391,584 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2019-05-31 | $412 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2019-05-31 | $1,330,185 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2019-05-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2019-05-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2019-05-31 | No |
| Contributions received in cash from employer | 2019-05-31 | $1,352,612 |
| Employer contributions (assets) at end of year | 2019-05-31 | $2,192 |
| Employer contributions (assets) at beginning of year | 2019-05-31 | $1,096 |
| Contract administrator fees | 2019-05-31 | $9,456 |
| Did the plan have assets held for investment | 2019-05-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-05-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2019-05-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2019-05-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2019-05-31 | Unqualified |
| Accountancy firm name | 2019-05-31 | LETHERT, SKWIRA, SCHULTZ & CO. LLP |
| Accountancy firm EIN | 2019-05-31 | 410738189 |
| 2018 : TWIN CITIES PRINTING PRESSMEN HEALTH AND WELFARE FUND 2018 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2018-05-31 | $4,940 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2018-05-31 | $0 |
| Total income from all sources (including contributions) | 2018-05-31 | $1,397,768 |
| Total of all expenses incurred | 2018-05-31 | $1,350,924 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2018-05-31 | $1,323,598 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2018-05-31 | $1,397,287 |
| Value of total assets at end of year | 2018-05-31 | $500,196 |
| Value of total assets at beginning of year | 2018-05-31 | $448,412 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2018-05-31 | $27,326 |
| Total interest from all sources | 2018-05-31 | $481 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2018-05-31 | No |
| Administrative expenses professional fees incurred | 2018-05-31 | $12,576 |
| Was this plan covered by a fidelity bond | 2018-05-31 | Yes |
| Value of fidelity bond cover | 2018-05-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2018-05-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2018-05-31 | No |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2018-05-31 | $107,516 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2018-05-31 | $110,618 |
| Administrative expenses (other) incurred | 2018-05-31 | $5,349 |
| Liabilities. Value of operating payables at end of year | 2018-05-31 | $4,940 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-05-31 | No |
| Value of net income/loss | 2018-05-31 | $46,844 |
| Value of net assets at end of year (total assets less liabilities) | 2018-05-31 | $495,256 |
| Value of net assets at beginning of year (total assets less liabilities) | 2018-05-31 | $448,412 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2018-05-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2018-05-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2018-05-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2018-05-31 | $391,584 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2018-05-31 | $337,794 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2018-05-31 | $337,794 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2018-05-31 | $481 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2018-05-31 | $1,323,598 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2018-05-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2018-05-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2018-05-31 | No |
| Contributions received in cash from employer | 2018-05-31 | $1,397,287 |
| Employer contributions (assets) at end of year | 2018-05-31 | $1,096 |
| Contract administrator fees | 2018-05-31 | $9,401 |
| Did the plan have assets held for investment | 2018-05-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-05-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2018-05-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2018-05-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2018-05-31 | Unqualified |
| Accountancy firm name | 2018-05-31 | LETHERT, SKWIRA, SCHULTZ & CO. LLP |
| Accountancy firm EIN | 2018-05-31 | 410738189 |
| 2017 : TWIN CITIES PRINTING PRESSMEN HEALTH AND WELFARE FUND 2017 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2017-05-31 | $0 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2017-05-31 | $1,500 |
| Total income from all sources (including contributions) | 2017-05-31 | $1,384,923 |
| Total of all expenses incurred | 2017-05-31 | $1,306,252 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2017-05-31 | $1,283,173 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2017-05-31 | $1,384,556 |
| Value of total assets at end of year | 2017-05-31 | $448,412 |
| Value of total assets at beginning of year | 2017-05-31 | $371,241 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2017-05-31 | $23,079 |
| Total interest from all sources | 2017-05-31 | $367 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2017-05-31 | No |
| Administrative expenses professional fees incurred | 2017-05-31 | $9,981 |
| Was this plan covered by a fidelity bond | 2017-05-31 | Yes |
| Value of fidelity bond cover | 2017-05-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2017-05-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2017-05-31 | No |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2017-05-31 | $110,618 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2017-05-31 | $4,330 |
| Administrative expenses (other) incurred | 2017-05-31 | $5,049 |
| Liabilities. Value of operating payables at beginning of year | 2017-05-31 | $1,500 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2017-05-31 | No |
| Value of net income/loss | 2017-05-31 | $78,671 |
| Value of net assets at end of year (total assets less liabilities) | 2017-05-31 | $448,412 |
| Value of net assets at beginning of year (total assets less liabilities) | 2017-05-31 | $369,741 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2017-05-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2017-05-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2017-05-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2017-05-31 | $337,794 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2017-05-31 | $366,911 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2017-05-31 | $366,911 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2017-05-31 | $367 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2017-05-31 | $1,283,173 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2017-05-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2017-05-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2017-05-31 | No |
| Contributions received in cash from employer | 2017-05-31 | $1,384,556 |
| Contract administrator fees | 2017-05-31 | $8,049 |
| Did the plan have assets held for investment | 2017-05-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2017-05-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2017-05-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2017-05-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2017-05-31 | Unqualified |
| Accountancy firm name | 2017-05-31 | LETHERT, SKWIRA, SCHULTZ & CO. LLP |
| Accountancy firm EIN | 2017-05-31 | 410738189 |
| 2016 : TWIN CITIES PRINTING PRESSMEN HEALTH AND WELFARE FUND 2016 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-05-31 | $1,500 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-05-31 | $0 |
| Total income from all sources (including contributions) | 2016-05-31 | $1,392,937 |
| Total of all expenses incurred | 2016-05-31 | $1,312,451 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2016-05-31 | $1,295,081 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2016-05-31 | $1,392,685 |
| Value of total assets at end of year | 2016-05-31 | $371,241 |
| Value of total assets at beginning of year | 2016-05-31 | $289,255 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2016-05-31 | $17,370 |
| Total interest from all sources | 2016-05-31 | $252 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2016-05-31 | No |
| Administrative expenses professional fees incurred | 2016-05-31 | $6,500 |
| Was this plan covered by a fidelity bond | 2016-05-31 | Yes |
| Value of fidelity bond cover | 2016-05-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2016-05-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2016-05-31 | No |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2016-05-31 | $4,330 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2016-05-31 | $4,818 |
| Administrative expenses (other) incurred | 2016-05-31 | $4,870 |
| Liabilities. Value of operating payables at end of year | 2016-05-31 | $1,500 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-05-31 | No |
| Value of net income/loss | 2016-05-31 | $80,486 |
| Value of net assets at end of year (total assets less liabilities) | 2016-05-31 | $369,741 |
| Value of net assets at beginning of year (total assets less liabilities) | 2016-05-31 | $289,255 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2016-05-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2016-05-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2016-05-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2016-05-31 | $366,911 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2016-05-31 | $284,437 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2016-05-31 | $284,437 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2016-05-31 | $252 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2016-05-31 | $1,295,081 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2016-05-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2016-05-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2016-05-31 | No |
| Contributions received in cash from employer | 2016-05-31 | $1,392,685 |
| Contract administrator fees | 2016-05-31 | $6,000 |
| Did the plan have assets held for investment | 2016-05-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-05-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2016-05-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2016-05-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2016-05-31 | Unqualified |
| Accountancy firm name | 2016-05-31 | LETHERT, SKWIRA, SCHULTZ & CO. LLP |
| Accountancy firm EIN | 2016-05-31 | 410738189 |
| 2015 : TWIN CITIES PRINTING PRESSMEN HEALTH AND WELFARE FUND 2015 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-05-31 | $0 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-05-31 | $92 |
| Total income from all sources (including contributions) | 2015-05-31 | $1,385,093 |
| Total of all expenses incurred | 2015-05-31 | $1,289,206 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2015-05-31 | $1,271,574 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2015-05-31 | $1,384,853 |
| Value of total assets at end of year | 2015-05-31 | $289,255 |
| Value of total assets at beginning of year | 2015-05-31 | $193,460 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2015-05-31 | $17,632 |
| Total interest from all sources | 2015-05-31 | $240 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2015-05-31 | No |
| Administrative expenses professional fees incurred | 2015-05-31 | $7,010 |
| Was this plan covered by a fidelity bond | 2015-05-31 | Yes |
| Value of fidelity bond cover | 2015-05-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2015-05-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2015-05-31 | No |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2015-05-31 | $4,818 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2015-05-31 | $20,069 |
| Administrative expenses (other) incurred | 2015-05-31 | $4,622 |
| Liabilities. Value of operating payables at beginning of year | 2015-05-31 | $92 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-05-31 | No |
| Value of net income/loss | 2015-05-31 | $95,887 |
| Value of net assets at end of year (total assets less liabilities) | 2015-05-31 | $289,255 |
| Value of net assets at beginning of year (total assets less liabilities) | 2015-05-31 | $193,368 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2015-05-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2015-05-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2015-05-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2015-05-31 | $284,437 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2015-05-31 | $165,978 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2015-05-31 | $165,978 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2015-05-31 | $240 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2015-05-31 | $1,271,574 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2015-05-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2015-05-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2015-05-31 | No |
| Contributions received in cash from employer | 2015-05-31 | $1,384,853 |
| Employer contributions (assets) at beginning of year | 2015-05-31 | $7,413 |
| Contract administrator fees | 2015-05-31 | $6,000 |
| Did the plan have assets held for investment | 2015-05-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-05-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2015-05-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2015-05-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2015-05-31 | Unqualified |
| Accountancy firm name | 2015-05-31 | LETHERT, SKWIRA, SCHULTZ & CO. LLP |
| Accountancy firm EIN | 2015-05-31 | 410738189 |
| 2014 : TWIN CITIES PRINTING PRESSMEN HEALTH AND WELFARE FUND 2014 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-05-31 | $92 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-05-31 | $87 |
| Total income from all sources (including contributions) | 2014-05-31 | $1,385,440 |
| Total of all expenses incurred | 2014-05-31 | $1,350,524 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2014-05-31 | $1,333,182 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2014-05-31 | $1,385,199 |
| Value of total assets at end of year | 2014-05-31 | $193,460 |
| Value of total assets at beginning of year | 2014-05-31 | $158,539 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2014-05-31 | $17,342 |
| Total interest from all sources | 2014-05-31 | $241 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2014-05-31 | No |
| Administrative expenses professional fees incurred | 2014-05-31 | $6,880 |
| Was this plan covered by a fidelity bond | 2014-05-31 | Yes |
| Value of fidelity bond cover | 2014-05-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2014-05-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2014-05-31 | No |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2014-05-31 | $20,069 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2014-05-31 | $12,663 |
| Administrative expenses (other) incurred | 2014-05-31 | $4,462 |
| Liabilities. Value of operating payables at end of year | 2014-05-31 | $92 |
| Liabilities. Value of operating payables at beginning of year | 2014-05-31 | $87 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-05-31 | No |
| Value of net income/loss | 2014-05-31 | $34,916 |
| Value of net assets at end of year (total assets less liabilities) | 2014-05-31 | $193,368 |
| Value of net assets at beginning of year (total assets less liabilities) | 2014-05-31 | $158,452 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2014-05-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2014-05-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2014-05-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2014-05-31 | $165,978 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2014-05-31 | $142,754 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2014-05-31 | $142,754 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2014-05-31 | $241 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2014-05-31 | $1,333,182 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2014-05-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2014-05-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2014-05-31 | No |
| Contributions received in cash from employer | 2014-05-31 | $1,385,199 |
| Employer contributions (assets) at end of year | 2014-05-31 | $7,413 |
| Employer contributions (assets) at beginning of year | 2014-05-31 | $3,122 |
| Contract administrator fees | 2014-05-31 | $6,000 |
| Did the plan have assets held for investment | 2014-05-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-05-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2014-05-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2014-05-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2014-05-31 | Unqualified |
| Accountancy firm name | 2014-05-31 | LETHERT, SKWIRA, SCHULTZ & CO. LLP |
| Accountancy firm EIN | 2014-05-31 | 410738189 |
| 2013 : TWIN CITIES PRINTING PRESSMEN HEALTH AND WELFARE FUND 2013 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-05-31 | $87 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-05-31 | $0 |
| Total income from all sources (including contributions) | 2013-05-31 | $1,320,178 |
| Total of all expenses incurred | 2013-05-31 | $1,285,084 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2013-05-31 | $1,267,806 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2013-05-31 | $1,320,007 |
| Value of total assets at end of year | 2013-05-31 | $158,539 |
| Value of total assets at beginning of year | 2013-05-31 | $123,358 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2013-05-31 | $17,278 |
| Total interest from all sources | 2013-05-31 | $171 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2013-05-31 | No |
| Administrative expenses professional fees incurred | 2013-05-31 | $6,498 |
| Was this plan covered by a fidelity bond | 2013-05-31 | Yes |
| Value of fidelity bond cover | 2013-05-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2013-05-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2013-05-31 | No |
| Contributions received from participants | 2013-05-31 | $4,854 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2013-05-31 | $12,663 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2013-05-31 | $2,872 |
| Administrative expenses (other) incurred | 2013-05-31 | $4,431 |
| Liabilities. Value of operating payables at end of year | 2013-05-31 | $87 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-05-31 | No |
| Value of net income/loss | 2013-05-31 | $35,094 |
| Value of net assets at end of year (total assets less liabilities) | 2013-05-31 | $158,452 |
| Value of net assets at beginning of year (total assets less liabilities) | 2013-05-31 | $123,358 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2013-05-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2013-05-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2013-05-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2013-05-31 | $142,754 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2013-05-31 | $116,671 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2013-05-31 | $116,671 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2013-05-31 | $171 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2013-05-31 | $1,267,806 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2013-05-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2013-05-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2013-05-31 | No |
| Contributions received in cash from employer | 2013-05-31 | $1,315,153 |
| Employer contributions (assets) at end of year | 2013-05-31 | $3,122 |
| Employer contributions (assets) at beginning of year | 2013-05-31 | $3,815 |
| Contract administrator fees | 2013-05-31 | $6,349 |
| Did the plan have assets held for investment | 2013-05-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-05-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2013-05-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2013-05-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2013-05-31 | Unqualified |
| Accountancy firm name | 2013-05-31 | LETHERT, SKWIRA, SCHULTZ & CO. LLP |
| Accountancy firm EIN | 2013-05-31 | 410738189 |
| 2012 : TWIN CITIES PRINTING PRESSMEN HEALTH AND WELFARE FUND 2012 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-05-31 | $0 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-05-31 | $0 |
| Total income from all sources (including contributions) | 2012-05-31 | $1,243,866 |
| Total of all expenses incurred | 2012-05-31 | $1,228,375 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2012-05-31 | $1,213,046 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2012-05-31 | $1,243,814 |
| Value of total assets at end of year | 2012-05-31 | $123,358 |
| Value of total assets at beginning of year | 2012-05-31 | $107,867 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2012-05-31 | $15,329 |
| Total interest from all sources | 2012-05-31 | $52 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2012-05-31 | No |
| Administrative expenses professional fees incurred | 2012-05-31 | $6,748 |
| Was this plan covered by a fidelity bond | 2012-05-31 | Yes |
| Value of fidelity bond cover | 2012-05-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2012-05-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2012-05-31 | No |
| Contributions received from participants | 2012-05-31 | $20,358 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2012-05-31 | $2,872 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2012-05-31 | $4,873 |
| Administrative expenses (other) incurred | 2012-05-31 | $4,566 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-05-31 | No |
| Value of net income/loss | 2012-05-31 | $15,491 |
| Value of net assets at end of year (total assets less liabilities) | 2012-05-31 | $123,358 |
| Value of net assets at beginning of year (total assets less liabilities) | 2012-05-31 | $107,867 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2012-05-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2012-05-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2012-05-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2012-05-31 | $116,671 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2012-05-31 | $99,179 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2012-05-31 | $99,179 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2012-05-31 | $52 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2012-05-31 | $1,213,046 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2012-05-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2012-05-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2012-05-31 | No |
| Contributions received in cash from employer | 2012-05-31 | $1,223,456 |
| Employer contributions (assets) at end of year | 2012-05-31 | $3,815 |
| Employer contributions (assets) at beginning of year | 2012-05-31 | $3,815 |
| Contract administrator fees | 2012-05-31 | $4,015 |
| Did the plan have assets held for investment | 2012-05-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-05-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2012-05-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2012-05-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2012-05-31 | Unqualified |
| Accountancy firm name | 2012-05-31 | LETHERT, SKWIRA, SCHULTZ & CO. LLP |
| Accountancy firm EIN | 2012-05-31 | 410738189 |
| 2011 : TWIN CITIES PRINTING PRESSMEN HEALTH AND WELFARE FUND 2011 401k financial data |
|---|
| Total income from all sources (including contributions) | 2011-05-31 | $1,274,027 |
| Total of all expenses incurred | 2011-05-31 | $1,256,570 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2011-05-31 | $1,240,975 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2011-05-31 | $1,267,131 |
| Value of total assets at end of year | 2011-05-31 | $107,867 |
| Value of total assets at beginning of year | 2011-05-31 | $90,410 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2011-05-31 | $15,595 |
| Total interest from all sources | 2011-05-31 | $11 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2011-05-31 | No |
| Administrative expenses professional fees incurred | 2011-05-31 | $6,000 |
| Was this plan covered by a fidelity bond | 2011-05-31 | Yes |
| Value of fidelity bond cover | 2011-05-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2011-05-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2011-05-31 | No |
| Contributions received from participants | 2011-05-31 | $8,789 |
| Assets. Other investments not covered elsewhere at end of year | 2011-05-31 | $8,688 |
| Assets. Other investments not covered elsewhere at beginning of year | 2011-05-31 | $19,895 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2011-05-31 | $4,691 |
| Other income not declared elsewhere | 2011-05-31 | $6,885 |
| Administrative expenses (other) incurred | 2011-05-31 | $5,151 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-05-31 | No |
| Value of net income/loss | 2011-05-31 | $17,457 |
| Value of net assets at end of year (total assets less liabilities) | 2011-05-31 | $107,867 |
| Value of net assets at beginning of year (total assets less liabilities) | 2011-05-31 | $90,410 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2011-05-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2011-05-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2011-05-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2011-05-31 | $99,179 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2011-05-31 | $70,515 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2011-05-31 | $70,515 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2011-05-31 | $11 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2011-05-31 | $1,236,284 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2011-05-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2011-05-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2011-05-31 | No |
| Contributions received in cash from employer | 2011-05-31 | $1,258,342 |
| Contract administrator fees | 2011-05-31 | $4,444 |
| Did the plan have assets held for investment | 2011-05-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-05-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2011-05-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2011-05-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2011-05-31 | Unqualified |
| Accountancy firm name | 2011-05-31 | LETHERT, SKWIRA, SCHULTZ & CO. LLP |
| Accountancy firm EIN | 2011-05-31 | 410738189 |
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 885432G |
| Policy instance | 5 |
| Insurance contract or identification number | 885432G | | Number of Individuals Covered | 99 | | Insurance policy start date | 2019-06-01 | | Insurance policy end date | 2020-05-31 | | Total amount of commissions paid to insurance broker | USD $2,405 | | Total amount of fees paid to insurance company | USD $416 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $16,034 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,405 | | Amount paid for insurance broker fees | 416 | | Additional information about fees paid to insurance broker | BROKER FEES AND COMMISSIONS | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUG 43A2 |
| Policy instance | 4 |
| Insurance contract or identification number | GUG 43A2 | | Number of Individuals Covered | 102 | | Insurance policy start date | 2019-03-01 | | Insurance policy end date | 2019-10-01 | | Total amount of fees paid to insurance company | USD $968 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $22,041 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 968 | | Additional information about fees paid to insurance broker | BROKER FEES | | Insurance broker organization code? | 3 |
|
| BCBSM, INC. DBA BLUE CROSS AND BLUE SHIELD OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55026 ) |
| Policy contract number | CN482 |
| Policy instance | 3 |
| Insurance contract or identification number | CN482 | | Number of Individuals Covered | 209 | | Insurance policy start date | 2019-06-01 | | Insurance policy end date | 2020-05-31 | | Total amount of commissions paid to insurance broker | USD $14,264 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $445,135 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $14,264 | | Additional information about fees paid to insurance broker | BROKER FEES | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG 43A2 |
| Policy instance | 2 |
| Insurance contract or identification number | GLUG 43A2 | | Number of Individuals Covered | 101 | | Insurance policy start date | 2019-03-01 | | Insurance policy end date | 2019-10-01 | | Total amount of commissions paid to insurance broker | USD $438 | | Total amount of fees paid to insurance company | USD $128 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,923 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $438 | | Amount paid for insurance broker fees | 128 | | Additional information about fees paid to insurance broker | BROKER FEE | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55034 ) |
| Policy contract number | 0379 |
| Policy instance | 1 |
| Insurance contract or identification number | 0379 | | Insurance policy start date | 2019-06-01 | | Insurance policy end date | 2020-05-31 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55034 ) |
| Policy contract number | 0379 |
| Policy instance | 1 |
| Insurance contract or identification number | 0379 | | Number of Individuals Covered | 205 | | Insurance policy start date | 2018-06-01 | | Insurance policy end date | 2019-05-31 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BCBSM, INC. DBA BLUE CROSS AND BLUE SHIELD OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55026 ) |
| Policy contract number | CN482 |
| Policy instance | 3 |
| Insurance contract or identification number | CN482 | | Number of Individuals Covered | 209 | | Insurance policy start date | 2018-06-01 | | Insurance policy end date | 2019-05-31 | | Total amount of commissions paid to insurance broker | USD $36,680 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,174,043 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $36,680 | | Additional information about fees paid to insurance broker | BROKER FEES | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUG 43A2 |
| Policy instance | 4 |
| Insurance contract or identification number | GUG 43A2 | | Number of Individuals Covered | 102 | | Insurance policy start date | 2018-03-01 | | Insurance policy end date | 2019-03-01 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $39,655 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 885432G |
| Policy instance | 5 |
| Insurance contract or identification number | 885432G | | Number of Individuals Covered | 99 | | Insurance policy start date | 2018-06-01 | | Insurance policy end date | 2019-05-31 | | Total amount of commissions paid to insurance broker | USD $3,967 | | Total amount of fees paid to insurance company | USD $1,400 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $26,445 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,967 | | Amount paid for insurance broker fees | 1400 | | Additional information about fees paid to insurance broker | BROKER FEES AND COMMISSIONS | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG 43A2 |
| Policy instance | 2 |
| Insurance contract or identification number | GLUG 43A2 | | Number of Individuals Covered | 101 | | Insurance policy start date | 2018-03-01 | | Insurance policy end date | 2019-03-01 | | Total amount of commissions paid to insurance broker | USD $789 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,259 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $789 | | Additional information about fees paid to insurance broker | BROKER FEE | | Insurance broker organization code? | 3 |
|
| BCBSM, INC. DBA BLUE CROSS AND BLUE SHIELD OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55026 ) |
| Policy contract number | CN482 |
| Policy instance | 3 |
| Insurance contract or identification number | CN482 | | Number of Individuals Covered | 225 | | Insurance policy start date | 2017-06-01 | | Insurance policy end date | 2018-05-31 | | Total amount of commissions paid to insurance broker | USD $37,278 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,194,921 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG 43A2 |
| Policy instance | 2 |
| Insurance contract or identification number | GLUG 43A2 | | Number of Individuals Covered | 102 | | Insurance policy start date | 2017-03-01 | | Insurance policy end date | 2018-03-01 | | Total amount of commissions paid to insurance broker | USD $777 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,178 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55034 ) |
| Policy contract number | 0379 |
| Policy instance | 1 |
| Insurance contract or identification number | 0379 | | Number of Individuals Covered | 104 | | Insurance policy start date | 2017-06-01 | | Insurance policy end date | 2018-05-31 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUG 43A2 |
| Policy instance | 4 |
| Insurance contract or identification number | GUG 43A2 | | Number of Individuals Covered | 102 | | Insurance policy start date | 2017-03-01 | | Insurance policy end date | 2018-03-01 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $38,704 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HMO MINNESOTA DBA BLUE PLUS (National Association of Insurance Commissioners NAIC id number: 95649 ) |
| Policy contract number | CN482 |
| Policy instance | 5 |
| Insurance contract or identification number | CN482 | | Number of Individuals Covered | 60 | | Insurance policy start date | 2015-06-01 | | Insurance policy end date | 2016-05-31 | | Total amount of commissions paid to insurance broker | USD $9,215 | | Total amount of fees paid to insurance company | USD $510 | | Welfare Benefit Premiums Paid to Carrier | USD $307,123 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,215 | | Amount paid for insurance broker fees | 510 | | Additional information about fees paid to insurance broker | BROKER FEES | | Insurance broker organization code? | 3 | | Insurance broker name | WELLS FARGO INSURANCE SERVICES - MN |
|
| DELTA DENTAL OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55034 ) |
| Policy contract number | 0379 |
| Policy instance | 1 |
| Insurance contract or identification number | 0379 | | Number of Individuals Covered | 100 | | Insurance policy start date | 2015-06-01 | | Insurance policy end date | 2016-05-31 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG 43A2 |
| Policy instance | 2 |
| Insurance contract or identification number | GLUG 43A2 | | Number of Individuals Covered | 98 | | Insurance policy start date | 2015-03-01 | | Insurance policy end date | 2016-03-01 | | Total amount of commissions paid to insurance broker | USD $766 | | Total amount of fees paid to insurance company | USD $116 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,107 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $766 | | Amount paid for insurance broker fees | 116 | | Additional information about fees paid to insurance broker | BROKER FEE | | Insurance broker organization code? | 3 | | Insurance broker name | WELLS FARGO INS SERVICES |
|
| BCBSM, INC. DBA BLUE CROSS AND BLUE SHIELD OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55026 ) |
| Policy contract number | CN482 |
| Policy instance | 3 |
| Insurance contract or identification number | CN482 | | Number of Individuals Covered | 186 | | Insurance policy start date | 2015-06-01 | | Insurance policy end date | 2016-05-31 | | Total amount of commissions paid to insurance broker | USD $26,257 | | Total amount of fees paid to insurance company | USD $2,038 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $876,467 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $26,257 | | Amount paid for insurance broker fees | 2038 | | Additional information about fees paid to insurance broker | BROKER FEES | | Insurance broker organization code? | 3 | | Insurance broker name | WELLS FARGO INSURANCE SERVICES - MN |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUG 43A2 |
| Policy instance | 4 |
| Insurance contract or identification number | GUG 43A2 | | Number of Individuals Covered | 98 | | Insurance policy start date | 2015-03-01 | | Insurance policy end date | 2016-03-01 | | Total amount of fees paid to insurance company | USD $877 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $38,507 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 877 | | Additional information about fees paid to insurance broker | BROKER FEE | | Insurance broker organization code? | 3 | | Insurance broker name | WELLS FARGO INS SERVICES |
|
| HMO MINNESOTA DBA BLUE PLUS (National Association of Insurance Commissioners NAIC id number: 95649 ) |
| Policy contract number | CN482 |
| Policy instance | 5 |
| Insurance contract or identification number | CN482 | | Number of Individuals Covered | 66 | | Insurance policy start date | 2014-06-01 | | Insurance policy end date | 2015-05-31 | | Total amount of commissions paid to insurance broker | USD $11,129 | | Welfare Benefit Premiums Paid to Carrier | USD $267,952 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,129 | | Additional information about fees paid to insurance broker | BROKER FEES | | Insurance broker organization code? | 3 | | Insurance broker name | WELLS FARGO INSURANCE SERVICES - MN |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUG 43A2 |
| Policy instance | 4 |
| Insurance contract or identification number | GUG 43A2 | | Number of Individuals Covered | 99 | | Insurance policy start date | 2014-03-01 | | Insurance policy end date | 2015-03-01 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $39,032 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BCBSM, INC. DBA BLUE CROSS AND BLUE SHIELD OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55026 ) |
| Policy contract number | CN482 |
| Policy instance | 3 |
| Insurance contract or identification number | CN482 | | Number of Individuals Covered | 184 | | Insurance policy start date | 2014-06-01 | | Insurance policy end date | 2015-05-31 | | Total amount of commissions paid to insurance broker | USD $28,937 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $686,971 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $28,937 | | Additional information about fees paid to insurance broker | BROKER FEES | | Insurance broker organization code? | 3 | | Insurance broker name | WELLS FARGO INSURANCE SERVICES - MN |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG 43A2 |
| Policy instance | 2 |
| Insurance contract or identification number | GLUG 43A2 | | Number of Individuals Covered | 99 | | Insurance policy start date | 2014-03-01 | | Insurance policy end date | 2015-03-01 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,177 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Additional information about fees paid to insurance broker | BROKER FEE | | Insurance broker organization code? | 3 | | Insurance broker name | WELLS FARGO INS SERVICES |
|
| DELTA DENTAL OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55034 ) |
| Policy contract number | 0379 |
| Policy instance | 1 |
| Insurance contract or identification number | 0379 | | Number of Individuals Covered | 97 | | Insurance policy start date | 2014-06-01 | | Insurance policy end date | 2015-05-31 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG 43A2 |
| Policy instance | 2 |
| Insurance contract or identification number | GLUG 43A2 | | Number of Individuals Covered | 99 | | Insurance policy start date | 2013-03-01 | | Insurance policy end date | 2014-03-01 | | Total amount of commissions paid to insurance broker | USD $758 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,055 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $758 | | Additional information about fees paid to insurance broker | BROKER FEE | | Insurance broker organization code? | 3 | | Insurance broker name | WELLS FARGO INS SERVICES |
|
| HMO MINNESOTA DBA BLUE PLUS (National Association of Insurance Commissioners NAIC id number: 95649 ) |
| Policy contract number | CN482 |
| Policy instance | 5 |
| Insurance contract or identification number | CN482 | | Number of Individuals Covered | 77 | | Insurance policy start date | 2013-06-01 | | Insurance policy end date | 2014-05-31 | | Total amount of commissions paid to insurance broker | USD $13,261 | | Welfare Benefit Premiums Paid to Carrier | USD $471,170 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,261 | | Additional information about fees paid to insurance broker | BROKER FEES | | Insurance broker organization code? | 3 | | Insurance broker name | WELLS FARGO INSURANCE SERVICES - MN |
|
| DELTA DENTAL OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55034 ) |
| Policy contract number | 0379 |
| Policy instance | 1 |
| Insurance contract or identification number | 0379 | | Number of Individuals Covered | 99 | | Insurance policy start date | 2013-06-01 | | Insurance policy end date | 2014-05-31 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUG 43A2 |
| Policy instance | 4 |
| Insurance contract or identification number | GUG 43A2 | | Number of Individuals Covered | 99 | | Insurance policy start date | 2013-03-01 | | Insurance policy end date | 2014-03-01 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $38,114 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BCBSM, INC. DBA BLUE CROSS AND BLUE SHIELD OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55026 ) |
| Policy contract number | CN482 |
| Policy instance | 3 |
| Insurance contract or identification number | CN482 | | Number of Individuals Covered | 180 | | Insurance policy start date | 2013-06-01 | | Insurance policy end date | 2014-05-31 | | Total amount of commissions paid to insurance broker | USD $21,544 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $742,120 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $21,544 | | Additional information about fees paid to insurance broker | BROKER FEES | | Insurance broker organization code? | 3 | | Insurance broker name | WELLS FARGO INSURANCE SERVICES - MN |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG 43A2 |
| Policy instance | 2 |
| Insurance contract or identification number | GLUG 43A2 | | Number of Individuals Covered | 96 | | Insurance policy start date | 2012-03-01 | | Insurance policy end date | 2013-03-01 | | Total amount of commissions paid to insurance broker | USD $743 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,956 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $743 | | Additional information about fees paid to insurance broker | BROKER FEE | | Insurance broker organization code? | 3 | | Insurance broker name | WELLS FARGO INS SERVICES |
|
| HMO MINNESOTA DBA BLUE PLUS (National Association of Insurance Commissioners NAIC id number: 95649 ) |
| Policy contract number | CN482 |
| Policy instance | 5 |
| Insurance contract or identification number | CN482 | | Number of Individuals Covered | 114 | | Insurance policy start date | 2012-04-01 | | Insurance policy end date | 2013-03-31 | | Total amount of commissions paid to insurance broker | USD $12,490 | | Welfare Benefit Premiums Paid to Carrier | USD $488,933 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $12,490 | | Additional information about fees paid to insurance broker | BROKER FEES | | Insurance broker organization code? | 3 | | Insurance broker name | WELLS FARGO INSURANCE SERVICES - MN |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUG 43A2 |
| Policy instance | 4 |
| Insurance contract or identification number | GUG 43A2 | | Number of Individuals Covered | 96 | | Insurance policy start date | 2012-03-01 | | Insurance policy end date | 2013-03-01 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $37,162 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BCBSM, INC. DBA BLUE CROSS AND BLUE SHIELD OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55026 ) |
| Policy contract number | CN482 |
| Policy instance | 3 |
| Insurance contract or identification number | CN482 | | Number of Individuals Covered | 146 | | Insurance policy start date | 2012-04-01 | | Insurance policy end date | 2013-03-31 | | Total amount of commissions paid to insurance broker | USD $16,714 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $655,286 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $16,714 | | Additional information about fees paid to insurance broker | BROKER FEES | | Insurance broker organization code? | 3 | | Insurance broker name | WELLS FARGO INSURANCE SERVICES - MN |
|
| DELTA DENTAL OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55034 ) |
| Policy contract number | 0379 |
| Policy instance | 1 |
| Insurance contract or identification number | 0379 | | Number of Individuals Covered | 97 | | Insurance policy start date | 2012-06-01 | | Insurance policy end date | 2013-05-31 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUG 43A2 |
| Policy instance | 4 |
| Insurance contract or identification number | GUG 43A2 | | Number of Individuals Covered | 95 | | Insurance policy start date | 2011-03-01 | | Insurance policy end date | 2012-03-01 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $37,458 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55034 ) |
| Policy contract number | 0379 |
| Policy instance | 1 |
| Insurance contract or identification number | 0379 | | Number of Individuals Covered | 94 | | Insurance policy start date | 2011-06-01 | | Insurance policy end date | 2012-05-31 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG 43A2 |
| Policy instance | 2 |
| Insurance contract or identification number | GLUG 43A2 | | Number of Individuals Covered | 96 | | Insurance policy start date | 2011-03-01 | | Insurance policy end date | 2012-03-01 | | Total amount of commissions paid to insurance broker | USD $758 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,053 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HMO MINNESOTA DBA BLUE PLUS (National Association of Insurance Commissioners NAIC id number: 95649 ) |
| Policy contract number | CN482 |
| Policy instance | 5 |
| Insurance contract or identification number | CN482 | | Number of Individuals Covered | 115 | | Insurance policy start date | 2011-04-01 | | Insurance policy end date | 2012-03-31 | | Total amount of commissions paid to insurance broker | USD $10,965 | | Welfare Benefit Premiums Paid to Carrier | USD $485,088 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BCBSM, INC. DBA BLUE CROSS AND BLUE SHIELD OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55026 ) |
| Policy contract number | CN482 |
| Policy instance | 3 |
| Insurance contract or identification number | CN482 | | Number of Individuals Covered | 142 | | Insurance policy start date | 2011-04-01 | | Insurance policy end date | 2012-03-31 | | Total amount of commissions paid to insurance broker | USD $13,929 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $603,790 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BCBSM, INC. DBA BLUE CROSS AND BLUE SHIELD OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55026 ) |
| Policy contract number | CN482 |
| Policy instance | 3 |
| Insurance contract or identification number | CN482 | | Number of Individuals Covered | 129 | | Insurance policy start date | 2010-04-01 | | Insurance policy end date | 2011-03-31 | | Total amount of commissions paid to insurance broker | USD $17,425 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $613,029 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55034 ) |
| Policy contract number | 0379 |
| Policy instance | 1 |
| Insurance contract or identification number | 0379 | | Number of Individuals Covered | 96 | | Insurance policy start date | 2010-06-01 | | Insurance policy end date | 2011-05-31 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG 43A2 |
| Policy instance | 4 |
| Insurance contract or identification number | GLUG 43A2 | | Number of Individuals Covered | 99 | | Insurance policy start date | 2010-03-01 | | Insurance policy end date | 2011-03-01 | | Total amount of fees paid to insurance company | USD $1,002 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $39,393 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG 43A2 |
| Policy instance | 2 |
| Insurance contract or identification number | GLUG 43A2 | | Number of Individuals Covered | 100 | | Insurance policy start date | 2010-03-01 | | Insurance policy end date | 2011-03-01 | | Total amount of commissions paid to insurance broker | USD $928 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,303 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HMO MINNESOTA DBA BLUE PLUS (National Association of Insurance Commissioners NAIC id number: 95649 ) |
| Policy contract number | CN482 |
| Policy instance | 5 |
| Insurance contract or identification number | CN482 | | Number of Individuals Covered | 124 | | Insurance policy start date | 2010-04-01 | | Insurance policy end date | 2011-03-31 | | Total amount of commissions paid to insurance broker | USD $15,333 | | Welfare Benefit Premiums Paid to Carrier | USD $498,465 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
