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EMPLOYEE HEALTH AND DENTAL 401k Plan overview

Plan NameEMPLOYEE HEALTH AND DENTAL
Plan identification number 506

EMPLOYEE HEALTH AND DENTAL Benefits

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

401k Sponsoring company profile

FARM BUREAU MUTUAL INSURANCE COMPANY OF IDAHO has sponsored the creation of one or more 401k plans.

Company Name:FARM BUREAU MUTUAL INSURANCE COMPANY OF IDAHO
Employer identification number (EIN):820189910
NAIC Classification:524150

Additional information about FARM BUREAU MUTUAL INSURANCE COMPANY OF IDAHO

Jurisdiction of Incorporation: Idaho Secretary Of State
Incorporation Date:
Company Identification Number: C23169

More information about FARM BUREAU MUTUAL INSURANCE COMPANY OF IDAHO

Form 5500 Filing Information

Submission information for form 5500 for 401k plan EMPLOYEE HEALTH AND DENTAL

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5062022-01-01
5062021-01-01
5062020-01-01
5062019-01-01
5062018-01-01
5062017-01-01DAVID ACEVEDO
5062016-01-01DAVID ACEVEDO
5062015-01-01DAVID ACEVEDO
5062014-01-01DAVID ACEVEDO
5062013-01-01DAVID ACEVEDO DAVID ACEVEDO2014-07-30
5062012-01-01DAVID ACEVEDO DAVID ACEVEDO2013-07-17
5062011-01-01DAVID ACEVEDO
5062009-01-01 DAVID ACEVEDO2010-09-30

Plan Statistics for EMPLOYEE HEALTH AND DENTAL

401k plan membership statisitcs for EMPLOYEE HEALTH AND DENTAL

Measure Date Value
2022: EMPLOYEE HEALTH AND DENTAL 2022 401k membership
Total participants, beginning-of-year2022-01-01309
Total number of active participants reported on line 7a of the Form 55002022-01-01286
Number of retired or separated participants receiving benefits2022-01-0128
Total of all active and inactive participants2022-01-01314
Total participants2022-01-01314
2021: EMPLOYEE HEALTH AND DENTAL 2021 401k membership
Total participants, beginning-of-year2021-01-01393
Total number of active participants reported on line 7a of the Form 55002021-01-01281
Number of retired or separated participants receiving benefits2021-01-0128
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-01309
Total participants2021-01-01309
2020: EMPLOYEE HEALTH AND DENTAL 2020 401k membership
Total participants, beginning-of-year2020-01-01406
Total number of active participants reported on line 7a of the Form 55002020-01-01370
Number of retired or separated participants receiving benefits2020-01-0123
Total of all active and inactive participants2020-01-01393
Total participants2020-01-01393
2019: EMPLOYEE HEALTH AND DENTAL 2019 401k membership
Total participants, beginning-of-year2019-01-01436
Total number of active participants reported on line 7a of the Form 55002019-01-01382
Number of retired or separated participants receiving benefits2019-01-0124
Total of all active and inactive participants2019-01-01406
Total participants2019-01-01406
2018: EMPLOYEE HEALTH AND DENTAL 2018 401k membership
Total participants, beginning-of-year2018-01-01419
Total number of active participants reported on line 7a of the Form 55002018-01-01411
Number of retired or separated participants receiving benefits2018-01-0125
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-01436
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-01-010
Total participants2018-01-01436
Number of employers contributing to the scheme2018-01-010
2017: EMPLOYEE HEALTH AND DENTAL 2017 401k membership
Total participants, beginning-of-year2017-01-01375
Total number of active participants reported on line 7a of the Form 55002017-01-01395
Number of retired or separated participants receiving benefits2017-01-0124
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-01419
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-01419
2016: EMPLOYEE HEALTH AND DENTAL 2016 401k membership
Total participants, beginning-of-year2016-01-01350
Total number of active participants reported on line 7a of the Form 55002016-01-01358
Number of retired or separated participants receiving benefits2016-01-0117
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-01375
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-01375
2015: EMPLOYEE HEALTH AND DENTAL 2015 401k membership
Total participants, beginning-of-year2015-01-01328
Total number of active participants reported on line 7a of the Form 55002015-01-01334
Number of retired or separated participants receiving benefits2015-01-0116
Number of other retired or separated participants entitled to future benefits2015-01-010
Total of all active and inactive participants2015-01-01350
Total participants2015-01-01350
2014: EMPLOYEE HEALTH AND DENTAL 2014 401k membership
Total participants, beginning-of-year2014-01-01306
Total number of active participants reported on line 7a of the Form 55002014-01-01308
Number of retired or separated participants receiving benefits2014-01-0112
Number of other retired or separated participants entitled to future benefits2014-01-010
Total of all active and inactive participants2014-01-01320
Total participants2014-01-01320
2013: EMPLOYEE HEALTH AND DENTAL 2013 401k membership
Total participants, beginning-of-year2013-01-01307
Total number of active participants reported on line 7a of the Form 55002013-01-01293
Number of retired or separated participants receiving benefits2013-01-0113
Total of all active and inactive participants2013-01-01306
Total participants2013-01-01306
2012: EMPLOYEE HEALTH AND DENTAL 2012 401k membership
Total participants, beginning-of-year2012-01-01297
Total number of active participants reported on line 7a of the Form 55002012-01-01291
Number of retired or separated participants receiving benefits2012-01-0119
Total of all active and inactive participants2012-01-01310
Total participants2012-01-01310
2011: EMPLOYEE HEALTH AND DENTAL 2011 401k membership
Total participants, beginning-of-year2011-01-01293
Total number of active participants reported on line 7a of the Form 55002011-01-01279
Number of retired or separated participants receiving benefits2011-01-0120
Total of all active and inactive participants2011-01-01299
Total participants2011-01-01299
2009: EMPLOYEE HEALTH AND DENTAL 2009 401k membership
Total participants, beginning-of-year2009-01-01301
Total number of active participants reported on line 7a of the Form 55002009-01-01285
Number of retired or separated participants receiving benefits2009-01-0112
Total of all active and inactive participants2009-01-01297
Total participants2009-01-01297

Form 5500 Responses for EMPLOYEE HEALTH AND DENTAL

2022: EMPLOYEE HEALTH AND DENTAL 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
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: EMPLOYEE HEALTH AND DENTAL 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
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: EMPLOYEE HEALTH AND DENTAL 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
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: EMPLOYEE HEALTH AND DENTAL 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
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
2018: EMPLOYEE HEALTH AND DENTAL 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: EMPLOYEE HEALTH AND DENTAL 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
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: EMPLOYEE HEALTH AND DENTAL 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – General assets of the sponsorYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – General assets of the sponsorYes
2015: EMPLOYEE HEALTH AND DENTAL 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – General assets of the sponsorYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – General assets of the sponsorYes
2014: EMPLOYEE HEALTH AND DENTAL 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – General assets of the sponsorYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – General assets of the sponsorYes
2013: EMPLOYEE HEALTH AND DENTAL 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – General assets of the sponsorYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – General assets of the sponsorYes
2012: EMPLOYEE HEALTH AND DENTAL 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – General assets of the sponsorYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – General assets of the sponsorYes
2011: EMPLOYEE HEALTH AND DENTAL 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – General assets of the sponsorYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – General assets of the sponsorYes
2009: EMPLOYEE HEALTH AND DENTAL 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – General assets of the sponsorYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

BLUE CROSS OF IDAHO HEALTH SERVICE INC. (National Association of Insurance Commissioners NAIC id number: 60095 )
Policy contract number10017433
Policy instance 1
Insurance contract or identification number10017433
Number of Individuals Covered314
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $50,505
Total amount of fees paid to insurance companyUSD $782,909
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $50,505
Amount paid for insurance broker fees9450
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?4
BLUE CROSS OF IDAHO HEALTH SERVICE INC. (National Association of Insurance Commissioners NAIC id number: 60095 )
Policy contract number10017433
Policy instance 1
Insurance contract or identification number10017433
Number of Individuals Covered309
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $56,862
Total amount of fees paid to insurance companyUSD $859,005
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $56,862
Amount paid for insurance broker fees10412
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?4
BLUE CROSS OF IDAHO HEALTH SERVICE INC. (National Association of Insurance Commissioners NAIC id number: 60095 )
Policy contract number10017433
Policy instance 1
Insurance contract or identification number10017433
Number of Individuals Covered393
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $938,647
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $62,361
Amount paid for insurance broker fees12000
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?4
BLUE CROSS OF IDAHO HEALTH SERVICE INC. (National Association of Insurance Commissioners NAIC id number: 60095 )
Policy contract number10017433
Policy instance 1
Insurance contract or identification number10017433
Number of Individuals Covered406
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $1,012,806
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $66,781
Amount paid for insurance broker fees12480
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?4
BLUE CROSS OF IDAHO (National Association of Insurance Commissioners NAIC id number: 60095 )
Policy contract number10017433
Policy instance 1
Insurance contract or identification number10017433
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $901,900
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $61,789
Amount paid for insurance broker fees6688
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?4
Insurance broker nameARTHUR J. GALLAGHER & CO
BLUE CROSS OF IDAHO (National Association of Insurance Commissioners NAIC id number: 60095 )
Policy contract number10017433
Policy instance 1
Insurance contract or identification number10017433
Number of Individuals Covered350
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $691,357
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $52,646
Amount paid for insurance broker fees5584
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?4
Insurance broker nameARTHUR J. GALLAGHER & CO
BLUE CROSS OF IDAHO (National Association of Insurance Commissioners NAIC id number: 60095 )
Policy contract number10017433
Policy instance 1
Insurance contract or identification number10017433
Number of Individuals Covered320
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $605,447
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $44,640
Amount paid for insurance broker fees3571
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?4
Insurance broker nameARTHUR J. GALLAGHER & CO.
BLUE CROSS OF IDAHO (National Association of Insurance Commissioners NAIC id number: 60095 )
Policy contract number1007433
Policy instance 1
Insurance contract or identification number1007433
Number of Individuals Covered306
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $575,848
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $44,268
Amount paid for insurance broker fees3541
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?4
Insurance broker nameWESTERN BENEFITS SOLUTIONS
BLUE CROSS OF IDAHO (National Association of Insurance Commissioners NAIC id number: 60095 )
Policy contract number10017433
Policy instance 1
Insurance contract or identification number10017433
Number of Individuals Covered310
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of fees paid to insurance companyUSD $617,587
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,451
Amount paid for insurance broker fees43140
Additional information about fees paid to insurance brokerBROKER
Insurance broker organization code?4
Insurance broker nameWESTERN BENEFITS SOLUTIONS
BLUE CROSS OF IDAHO (National Association of Insurance Commissioners NAIC id number: 60095 )
Policy contract number10017433
Policy instance 1
Insurance contract or identification number10017433
Number of Individuals Covered299
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of fees paid to insurance companyUSD $574,123
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS OF IDAHO (National Association of Insurance Commissioners NAIC id number: 60095 )
Policy contract number10017433
Policy instance 1
Insurance contract or identification number10017433
Number of Individuals Covered300
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of fees paid to insurance companyUSD $540,253
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $27,650
Amount paid for insurance broker fees2476
Additional information about fees paid to insurance brokerBROKER
Insurance broker organization code?4
Insurance broker nameWESTERN BENEFITS SOLUTIONS

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