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COMMUNITY 1ST CREDIT UNION WELFARE BENEFIT PLAN 401k Plan overview

Plan NameCOMMUNITY 1ST CREDIT UNION WELFARE BENEFIT PLAN
Plan identification number 501

COMMUNITY 1ST CREDIT UNION WELFARE BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Other welfare benefit cover

401k Sponsoring company profile

COMMUNITY 1ST CREDIT UNION has sponsored the creation of one or more 401k plans.

Company Name:COMMUNITY 1ST CREDIT UNION
Employer identification number (EIN):420686459
NAIC Classification:522130
NAIC Description:Credit Unions

Form 5500 Filing Information

Submission information for form 5500 for 401k plan COMMUNITY 1ST CREDIT UNION WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01GREG HANSHAW2023-08-03
5012021-01-01GREG HANSHAW2022-07-27
5012020-01-01GREG HANSHAW2021-07-27
5012019-01-01GREG HANSHAW2020-10-12
5012017-01-01
5012016-02-01
5012015-02-01GREG HANSHAW
5012014-02-01
5012013-02-01
5012012-02-01GREG HANSHAW
5012011-02-01THOMAS PFLANZ

Plan Statistics for COMMUNITY 1ST CREDIT UNION WELFARE BENEFIT PLAN

401k plan membership statisitcs for COMMUNITY 1ST CREDIT UNION WELFARE BENEFIT PLAN

Measure Date Value
2022: COMMUNITY 1ST CREDIT UNION WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01339
Total number of active participants reported on line 7a of the Form 55002022-01-01370
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-01370
2021: COMMUNITY 1ST CREDIT UNION WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01334
Total number of active participants reported on line 7a of the Form 55002021-01-01339
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-01339
2020: COMMUNITY 1ST CREDIT UNION WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01343
Total number of active participants reported on line 7a of the Form 55002020-01-01334
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-01334
2019: COMMUNITY 1ST CREDIT UNION WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01324
Total number of active participants reported on line 7a of the Form 55002019-01-01343
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-01343
2017: COMMUNITY 1ST CREDIT UNION WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01291
Total number of active participants reported on line 7a of the Form 55002017-01-01298
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-01298
2016: COMMUNITY 1ST CREDIT UNION WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-02-01267
Total number of active participants reported on line 7a of the Form 55002016-02-01291
Number of retired or separated participants receiving benefits2016-02-010
Number of other retired or separated participants entitled to future benefits2016-02-010
Total of all active and inactive participants2016-02-01291
2015: COMMUNITY 1ST CREDIT UNION WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-02-01229
Total number of active participants reported on line 7a of the Form 55002015-02-01267
Number of retired or separated participants receiving benefits2015-02-010
Number of other retired or separated participants entitled to future benefits2015-02-010
Total of all active and inactive participants2015-02-01267
2014: COMMUNITY 1ST CREDIT UNION WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-02-01223
Total number of active participants reported on line 7a of the Form 55002014-02-01229
Total of all active and inactive participants2014-02-01229
2013: COMMUNITY 1ST CREDIT UNION WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-02-01280
Total number of active participants reported on line 7a of the Form 55002013-02-01223
Total of all active and inactive participants2013-02-01223
2012: COMMUNITY 1ST CREDIT UNION WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year2012-02-01215
Total number of active participants reported on line 7a of the Form 55002012-02-01280
Total of all active and inactive participants2012-02-01280
2011: COMMUNITY 1ST CREDIT UNION WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year2011-02-01215
Total number of active participants reported on line 7a of the Form 55002011-02-01215
Total of all active and inactive participants2011-02-01215

Form 5500 Responses for COMMUNITY 1ST CREDIT UNION WELFARE BENEFIT PLAN

2022: COMMUNITY 1ST CREDIT UNION WELFARE 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 – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: COMMUNITY 1ST CREDIT UNION WELFARE 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 – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: COMMUNITY 1ST CREDIT UNION WELFARE 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 – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: COMMUNITY 1ST CREDIT UNION WELFARE 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 – General assets of the sponsorYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: COMMUNITY 1ST CREDIT UNION WELFARE 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 – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: COMMUNITY 1ST CREDIT UNION WELFARE BENEFIT PLAN 2016 form 5500 responses
2016-02-01Type of plan entitySingle employer plan
2016-02-01This return/report is a short plan year return/report (less than 12 months)Yes
2016-02-01Plan funding arrangement – InsuranceYes
2016-02-01Plan funding arrangement – General assets of the sponsorYes
2016-02-01Plan benefit arrangement – InsuranceYes
2016-02-01Plan benefit arrangement – General assets of the sponsorYes
2015: COMMUNITY 1ST CREDIT UNION WELFARE BENEFIT PLAN 2015 form 5500 responses
2015-02-01Type of plan entitySingle employer plan
2015-02-01Plan funding arrangement – InsuranceYes
2015-02-01Plan funding arrangement – General assets of the sponsorYes
2015-02-01Plan benefit arrangement – InsuranceYes
2015-02-01Plan benefit arrangement – General assets of the sponsorYes
2014: COMMUNITY 1ST CREDIT UNION WELFARE BENEFIT PLAN 2014 form 5500 responses
2014-02-01Type of plan entitySingle employer plan
2014-02-01Plan funding arrangement – InsuranceYes
2014-02-01Plan funding arrangement – General assets of the sponsorYes
2014-02-01Plan benefit arrangement – InsuranceYes
2014-02-01Plan benefit arrangement – General assets of the sponsorYes
2013: COMMUNITY 1ST CREDIT UNION WELFARE BENEFIT PLAN 2013 form 5500 responses
2013-02-01Type of plan entitySingle employer plan
2013-02-01Plan funding arrangement – InsuranceYes
2013-02-01Plan funding arrangement – General assets of the sponsorYes
2013-02-01Plan benefit arrangement – InsuranceYes
2013-02-01Plan benefit arrangement – General assets of the sponsorYes
2012: COMMUNITY 1ST CREDIT UNION WELFARE BENEFIT PLAN 2012 form 5500 responses
2012-02-01Type of plan entitySingle employer plan
2012-02-01Plan funding arrangement – InsuranceYes
2012-02-01Plan funding arrangement – General assets of the sponsorYes
2012-02-01Plan benefit arrangement – InsuranceYes
2012-02-01Plan benefit arrangement – General assets of the sponsorYes
2011: COMMUNITY 1ST CREDIT UNION WELFARE BENEFIT PLAN 2011 form 5500 responses
2011-02-01Type of plan entitySingle employer plan
2011-02-01First time form 5500 has been submittedYes
2011-02-01Plan funding arrangement – InsuranceYes
2011-02-01Plan funding arrangement – General assets of the sponsorYes
2011-02-01Plan benefit arrangement – InsuranceYes
2011-02-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

DELTA DENTAL OF IOWA (National Association of Insurance Commissioners NAIC id number: 55786 )
Policy contract number40863
Policy instance 7
Insurance contract or identification number40863
Number of Individuals Covered172
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $6,566
Total amount of fees paid to insurance companyUSD $210
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $132,528
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,566
Amount paid for insurance broker fees210
Additional information about fees paid to insurance brokerSALES AND PERSISTENCY BONUS
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberG 164576
Policy instance 1
Insurance contract or identification numberG 164576
Number of Individuals Covered222
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $3,959
Total amount of fees paid to insurance companyUSD $726
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $55,186
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,959
Amount paid for insurance broker fees726
Additional information about fees paid to insurance brokerADMINISTRATIVE FEES
Insurance broker organization code?3
WELLMARK BLUE CROSS BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 88848 )
Policy contract number00020934
Policy instance 2
Insurance contract or identification number00020934
Number of Individuals Covered161
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,910,942
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number60790846
Policy instance 3
Insurance contract or identification number60790846
Number of Individuals Covered370
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $5,557
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $26,612
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,911
Insurance broker organization code?5
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL 155269
Policy instance 4
Insurance contract or identification numberGL 155269
Number of Individuals Covered233
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $2,935
Total amount of fees paid to insurance companyUSD $595
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $47,114
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,935
Amount paid for insurance broker fees595
Additional information about fees paid to insurance brokerADMINISTRATIVE FEES
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberLTD 127059
Policy instance 5
Insurance contract or identification numberLTD 127059
Number of Individuals Covered222
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $2,554
Total amount of fees paid to insurance companyUSD $224
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $17,150
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,554
Amount paid for insurance broker fees224
Additional information about fees paid to insurance brokerADMINISTRATIVE FEES
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberVG 185337
Policy instance 6
Insurance contract or identification numberVG 185337
Number of Individuals Covered37
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $1,381
Total amount of fees paid to insurance companyUSD $162
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $9,204
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,381
Amount paid for insurance broker fees162
Additional information about fees paid to insurance brokerADMINISTRATIVE FEES
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberG 164576
Policy instance 1
Insurance contract or identification numberG 164576
Number of Individuals Covered196
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $3,621
Total amount of fees paid to insurance companyUSD $625
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $48,423
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,621
Amount paid for insurance broker fees625
Additional information about fees paid to insurance brokerADMINISTRATIVE FEES
Insurance broker organization code?3
WELLMARK BLUE CROSS BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 88848 )
Policy contract number00020934
Policy instance 2
Insurance contract or identification number00020934
Number of Individuals Covered145
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,710,972
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number60790846
Policy instance 3
Insurance contract or identification number60790846
Number of Individuals Covered339
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $4,889
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $25,444
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,561
Insurance broker organization code?5
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL 155269
Policy instance 4
Insurance contract or identification numberGL 155269
Number of Individuals Covered205
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $2,661
Total amount of fees paid to insurance companyUSD $500
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $39,663
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,661
Amount paid for insurance broker fees500
Additional information about fees paid to insurance brokerADMINISTRATIVE FEES
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberLTD 127059
Policy instance 5
Insurance contract or identification numberLTD 127059
Number of Individuals Covered196
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $2,238
Total amount of fees paid to insurance companyUSD $191
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $14,923
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,238
Amount paid for insurance broker fees191
Additional information about fees paid to insurance brokerADMINISTRATIVE FEES
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberVG 185337
Policy instance 6
Insurance contract or identification numberVG 185337
Number of Individuals Covered42
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $1,619
Total amount of fees paid to insurance companyUSD $155
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $10,795
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,619
Amount paid for insurance broker fees155
Additional information about fees paid to insurance brokerADMINISTRATIVE FEES
Insurance broker organization code?3
DELTA DENTAL OF IOWA (National Association of Insurance Commissioners NAIC id number: 55786 )
Policy contract number40863
Policy instance 7
Insurance contract or identification number40863
Number of Individuals Covered155
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $5,798
Total amount of fees paid to insurance companyUSD $1,631
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $126,672
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,798
Amount paid for insurance broker fees1631
Additional information about fees paid to insurance brokerSALES AND PERSISTENCY BONUS
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberG 164576
Policy instance 1
Insurance contract or identification numberG 164576
Number of Individuals Covered197
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $3,284
Total amount of fees paid to insurance companyUSD $1,248
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $41,674
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,284
Amount paid for insurance broker fees1248
Additional information about fees paid to insurance brokerADMINISTRATIVE FEES
Insurance broker organization code?3
WELLMARK BLUE CROSS BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 88848 )
Policy contract number00020934
Policy instance 2
Insurance contract or identification number00020934
Number of Individuals Covered143
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,715,132
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number60790846
Policy instance 3
Insurance contract or identification number60790846
Number of Individuals Covered334
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $4,941
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $21,558
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,588
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL 155269
Policy instance 4
Insurance contract or identification numberGL 155269
Number of Individuals Covered215
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $2,365
Total amount of fees paid to insurance companyUSD $1,142
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $33,351
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,365
Amount paid for insurance broker fees1142
Additional information about fees paid to insurance brokerADMINISTRATIVE FEES
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberLTD 127059
Policy instance 5
Insurance contract or identification numberLTD 127059
Number of Individuals Covered197
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $1,911
Total amount of fees paid to insurance companyUSD $426
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $12,738
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,911
Amount paid for insurance broker fees426
Additional information about fees paid to insurance brokerADMINISTRATIVE FEES
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberVG 185337
Policy instance 6
Insurance contract or identification numberVG 185337
Number of Individuals Covered45
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $1,554
Total amount of fees paid to insurance companyUSD $219
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $10,360
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,554
Amount paid for insurance broker fees219
Additional information about fees paid to insurance brokerADMINISTRATIVE FEES
Insurance broker organization code?3
DELTA DENTAL OF IOWA (National Association of Insurance Commissioners NAIC id number: 55786 )
Policy contract number40863
Policy instance 7
Insurance contract or identification number40863
Number of Individuals Covered144
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $5,867
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $112,422
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,867
Additional information about fees paid to insurance brokerSALES AND PERSISTENCY BONUS
Insurance broker organization code?3
WELLMARK BLUE CROSS BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 88848 )
Policy contract number00020934
Policy instance 2
Insurance contract or identification number00020934
Number of Individuals Covered144
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $131,081
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
WELLMARK BLUE CROSS BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 88848 )
Policy contract number00020934
Policy instance 3
Insurance contract or identification number00020934
Number of Individuals Covered151
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,526,183
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number60790846
Policy instance 4
Insurance contract or identification number60790846
Number of Individuals Covered343
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $4,998
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $23,849
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,618
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL 155269
Policy instance 5
Insurance contract or identification numberGL 155269
Number of Individuals Covered215
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $2,712
Total amount of fees paid to insurance companyUSD $269
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $38,063
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,712
Amount paid for insurance broker fees269
Additional information about fees paid to insurance brokerADMINISTRATIVE FEES
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberLTD 127059
Policy instance 6
Insurance contract or identification numberLTD 127059
Number of Individuals Covered195
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $2,129
Total amount of fees paid to insurance companyUSD $138
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $14,191
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,129
Amount paid for insurance broker fees138
Additional information about fees paid to insurance brokerADMINISTRATIVE FEES
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberVG 185337
Policy instance 7
Insurance contract or identification numberVG 185337
Number of Individuals Covered46
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $1,094
Total amount of fees paid to insurance companyUSD $98
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $7,294
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,094
Amount paid for insurance broker fees98
Additional information about fees paid to insurance brokerADMINISTRATIVE FEES
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberG 164576
Policy instance 1
Insurance contract or identification numberG 164576
Number of Individuals Covered195
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $3,562
Total amount of fees paid to insurance companyUSD $196
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $41,597
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,562
Amount paid for insurance broker fees196
Additional information about fees paid to insurance brokerADMINISTRATIVE FEES
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number60790846
Policy instance 6
Insurance contract or identification number60790846
Number of Individuals Covered298
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $3,977
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $17,177
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,083
Insurance broker organization code?3
Insurance broker nameHOLMES, MURPHY & ASSOCIATES
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberG 164576
Policy instance 1
Insurance contract or identification numberG 164576
Number of Individuals Covered123
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $1,702
Total amount of fees paid to insurance companyUSD $642
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $15,844
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,702
Amount paid for insurance broker fees642
Additional information about fees paid to insurance brokerADMINISTRATIVE FEES
Insurance broker organization code?3
Insurance broker nameHOLMES MURPHY & ASSOCIATES
WELLMARK BLUE CROSS BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 88848 )
Policy contract number00020934
Policy instance 2
Insurance contract or identification number00020934
Number of Individuals Covered142
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $5,235
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $123,465
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,235
Insurance broker organization code?3
Insurance broker nameHOLMES, MURPHY & ASSOCIATES
WELLMARK BLUE CROSS BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 88848 )
Policy contract number00020934
Policy instance 3
Insurance contract or identification number00020934
Number of Individuals Covered141
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $50,170
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,300,208
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $50,170
Insurance broker organization code?3
Insurance broker nameHOLMES, MURPHY & ASSOCIATES
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL 155269
Policy instance 4
Insurance contract or identification numberGL 155269
Number of Individuals Covered174
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $1,820
Total amount of fees paid to insurance companyUSD $794
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $21,521
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,820
Amount paid for insurance broker fees794
Additional information about fees paid to insurance brokerADMINISTRATIVE FEES
Insurance broker organization code?3
Insurance broker nameHOLMES MUPRHY & ASSOCIATES INC
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberLTD 127059
Policy instance 5
Insurance contract or identification numberLTD 127059
Number of Individuals Covered123
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $1,668
Total amount of fees paid to insurance companyUSD $450
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $11,119
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,668
Amount paid for insurance broker fees450
Additional information about fees paid to insurance brokerADMINISTRATIVE FEES
Insurance broker organization code?3
Insurance broker nameHOLMES MURPHY & ASSOCIATES
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number60790846
Policy instance 1
Insurance contract or identification number60790846
Number of Individuals Covered267
Insurance policy start date2015-02-01
Insurance policy end date2016-01-31
Total amount of commissions paid to insurance brokerUSD $3,427
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $16,322
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,632
Insurance broker organization code?3
Insurance broker nameGROUP BENEFITS
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number145548
Policy instance 2
Insurance contract or identification number145548
Number of Individuals Covered37
Insurance policy start date2015-04-01
Insurance policy end date2016-02-01
Total amount of commissions paid to insurance brokerUSD $1,025
Total amount of fees paid to insurance companyUSD $137
Other welfare benefits providedLIFESTYLE LIFE
Welfare Benefit Premiums Paid to CarrierUSD $5,475
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,025
Amount paid for insurance broker fees137
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
Insurance broker nameHOLMES, MURPHY & ASSOCIATES, INC.
WELLMARK BLUE CROSS BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 88848 )
Policy contract number00020934
Policy instance 4
Insurance contract or identification number00020934
Number of Individuals Covered125
Insurance policy start date2015-02-01
Insurance policy end date2016-01-31
Total amount of commissions paid to insurance brokerUSD $56,278
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,043,777
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $56,278
Insurance broker organization code?3
Insurance broker nameHOLMES, MURPHY & ASSOCIATES
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number205879
Policy instance 5
Insurance contract or identification number205879
Number of Individuals Covered153
Insurance policy start date2015-02-01
Insurance policy end date2016-01-31
Total amount of commissions paid to insurance brokerUSD $5,921
Total amount of fees paid to insurance companyUSD $567
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedADD
Welfare Benefit Premiums Paid to CarrierUSD $58,092
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,828
Amount paid for insurance broker fees567
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
Insurance broker nameGROUP BENEFITS LTD
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number205879
Policy instance 6
Insurance contract or identification number205879
Number of Individuals Covered152
Insurance policy start date2015-02-01
Insurance policy end date2016-01-31
Total amount of commissions paid to insurance brokerUSD $6,353
Total amount of fees paid to insurance companyUSD $1,217
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedADD
Welfare Benefit Premiums Paid to CarrierUSD $55,577
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,353
Amount paid for insurance broker fees1217
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
Insurance broker nameHOLMES, MURPHY, & ASSOCIATES, INC.
WELLMARK BLUE CROSS BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 88848 )
Policy contract number00020934
Policy instance 3
Insurance contract or identification number00020934
Number of Individuals Covered120
Insurance policy start date2015-02-01
Insurance policy end date2016-01-31
Total amount of commissions paid to insurance brokerUSD $5,126
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $107,281
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,126
Insurance broker organization code?3
Insurance broker nameHOLMES, MURPHY & ASSOCIATES
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number60790-846
Policy instance 1
Insurance contract or identification number60790-846
Number of Individuals Covered229
Insurance policy start date2014-02-01
Insurance policy end date2015-01-31
Total amount of commissions paid to insurance brokerUSD $2,941
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
Welfare Benefit Premiums Paid to CarrierUSD $14,003
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,541
Insurance broker organization code?3
Insurance broker nameGROUP BENEFITS
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number205879
Policy instance 2
Insurance contract or identification number205879
Number of Individuals Covered155
Insurance policy start date2013-04-01
Insurance policy end date2014-03-31
Total amount of commissions paid to insurance brokerUSD $6,623
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
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedADD
Welfare Benefit Premiums Paid to CarrierUSD $57,373
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,623
Insurance broker organization code?3
Insurance broker nameGROUP BENEFITS LTD
WELLMARK BLUE CROSS BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 88848 )
Policy contract number00020934
Policy instance 3
Insurance contract or identification number00020934
Number of Individuals Covered120
Insurance policy start date2014-02-01
Insurance policy end date2015-01-31
Total amount of commissions paid to insurance brokerUSD $4,779
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
Welfare Benefit Premiums Paid to CarrierUSD $99,678
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,129
Insurance broker organization code?3
Insurance broker nameHOLMES, MURPHY & ASSOCIATES
WELLMARK BLUE CROSS BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 88848 )
Policy contract number00020934
Policy instance 4
Insurance contract or identification number00020934
Number of Individuals Covered118
Insurance policy start date2014-02-01
Insurance policy end date2015-01-31
Total amount of commissions paid to insurance brokerUSD $59,861
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
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $890,189
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $42,533
Insurance broker organization code?3
Insurance broker nameHOLMES, MURPHY & ASSOCIATES
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number60790-846
Policy instance 1
Insurance contract or identification number60790-846
Number of Individuals Covered223
Insurance policy start date2013-02-01
Insurance policy end date2014-01-31
Total amount of commissions paid to insurance brokerUSD $3,120
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
Welfare Benefit Premiums Paid to CarrierUSD $14,855
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,634
Insurance broker organization code?3
Insurance broker nameGROUP BENEFITS
WELLMARK BLUE CROSS BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 88848 )
Policy contract number00020934
Policy instance 4
Insurance contract or identification number00020934
Number of Individuals Covered103
Insurance policy start date2013-02-01
Insurance policy end date2014-01-31
Total amount of commissions paid to insurance brokerUSD $56,464
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
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $819,637
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $56,464
Insurance broker organization code?3
Insurance broker nameGROUP BENEFITS LTD
WELLMARK BLUE CROSS BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 88848 )
Policy contract number00020934
Policy instance 3
Insurance contract or identification number00020934
Number of Individuals Covered110
Insurance policy start date2013-02-01
Insurance policy end date2014-01-31
Total amount of commissions paid to insurance brokerUSD $4,277
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
Welfare Benefit Premiums Paid to CarrierUSD $89,267
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,277
Insurance broker organization code?3
Insurance broker nameGROUP BENEFITS LTD
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number205879
Policy instance 2
Insurance contract or identification number205879
Number of Individuals Covered133
Insurance policy start date2013-04-01
Insurance policy end date2013-03-31
Total amount of commissions paid to insurance brokerUSD $6,946
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
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedADD
Welfare Benefit Premiums Paid to CarrierUSD $57,286
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,946
Insurance broker organization code?3
Insurance broker nameGROUP BENEFITS LTD
DEARBORN NATIONAL (National Association of Insurance Commissioners NAIC id number: 85090 )
Policy contract numberM250000052
Policy instance 1
Insurance contract or identification numberM250000052
Number of Individuals Covered280
Insurance policy start date2011-04-01
Insurance policy end date2012-03-31
Total amount of commissions paid to insurance brokerUSD $14,393
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
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedADD, DEPSP
Welfare Benefit Premiums Paid to CarrierUSD $70,695
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,393
Insurance broker organization code?3
Insurance broker nameWELLMARK INC
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number60790-846
Policy instance 2
Insurance contract or identification number60790-846
Number of Individuals Covered218
Insurance policy start date2012-02-01
Insurance policy end date2013-01-31
Total amount of commissions paid to insurance brokerUSD $3,241
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
Welfare Benefit Premiums Paid to CarrierUSD $15,431
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,698
Insurance broker organization code?3
Insurance broker nameGROUP BENEFITS
WELLMARK BLUE CROSS BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 88848 )
Policy contract number00020934
Policy instance 3
Insurance contract or identification number00020934
Number of Individuals Covered94
Insurance policy start date2012-02-01
Insurance policy end date2013-01-31
Total amount of commissions paid to insurance brokerUSD $53,994
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
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $798,631
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $53,994
Insurance broker organization code?3
Insurance broker nameGROUP BENEFITS LTD
WELLMARK BLUE CROSS BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 88848 )
Policy contract number00020934
Policy instance 4
Insurance contract or identification number00020934
Number of Individuals Covered100
Insurance policy start date2012-02-01
Insurance policy end date2013-01-31
Total amount of commissions paid to insurance brokerUSD $3,838
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
Welfare Benefit Premiums Paid to CarrierUSD $79,428
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,838
Insurance broker organization code?3
Insurance broker nameGROUP BENEFITS LTD
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number60790-846
Policy instance 3
Insurance contract or identification number60790-846
Number of Individuals Covered215
Insurance policy start date2011-02-01
Insurance policy end date2012-01-31
Total amount of commissions paid to insurance brokerUSD $3,004
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
Welfare Benefit Premiums Paid to CarrierUSD $14,303
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
WELLMARK BLUE CROSS BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 88848 )
Policy contract number00020934
Policy instance 2
Insurance contract or identification number00020934
Number of Individuals Covered86
Insurance policy start date2011-02-01
Insurance policy end date2012-01-31
Total amount of commissions paid to insurance brokerUSD $3,262
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
Welfare Benefit Premiums Paid to CarrierUSD $67,681
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DEARBORN NATIONAL (National Association of Insurance Commissioners NAIC id number: 85090 )
Policy contract numberM250000052
Policy instance 4
Insurance contract or identification numberM250000052
Number of Individuals Covered101
Insurance policy start date2010-04-01
Insurance policy end date2011-03-31
Total amount of commissions paid to insurance brokerUSD $10,796
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
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedADD, DEPSP
Welfare Benefit Premiums Paid to CarrierUSD $51,856
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
WELLMARK BLUE CROSS BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 88848 )
Policy contract number00020934
Policy instance 1
Insurance contract or identification number00020934
Number of Individuals Covered86
Insurance policy start date2011-02-01
Insurance policy end date2012-01-31
Total amount of commissions paid to insurance brokerUSD $50,339
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
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $790,669
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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