FRAUENSHUH HOSPITALITY, LLC has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan FRAUENSHUH HOSPITALITY GROUP OF MN LLC DBA FOURTEEN FOODS
401k plan membership statisitcs for FRAUENSHUH HOSPITALITY GROUP OF MN LLC DBA FOURTEEN FOODS
| Measure | Date | Value |
|---|
| 2022: FRAUENSHUH HOSPITALITY GROUP OF MN LLC DBA FOURTEEN FOODS 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-07-01 | 416 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-07-01 | 438 |
| Number of retired or separated participants receiving benefits | 2022-07-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2022-07-01 | 0 |
| Total of all active and inactive participants | 2022-07-01 | 438 |
| Number of employers contributing to the scheme | 2022-07-01 | 0 |
| 2021: FRAUENSHUH HOSPITALITY GROUP OF MN LLC DBA FOURTEEN FOODS 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-07-01 | 403 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-07-01 | 282 |
| Number of retired or separated participants receiving benefits | 2021-07-01 | 6 |
| Number of other retired or separated participants entitled to future benefits | 2021-07-01 | 0 |
| Total of all active and inactive participants | 2021-07-01 | 288 |
| Number of employers contributing to the scheme | 2021-07-01 | 0 |
| 2020: FRAUENSHUH HOSPITALITY GROUP OF MN LLC DBA FOURTEEN FOODS 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-07-01 | 333 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-07-01 | 401 |
| Number of retired or separated participants receiving benefits | 2020-07-01 | 2 |
| Total of all active and inactive participants | 2020-07-01 | 403 |
| 2019: FRAUENSHUH HOSPITALITY GROUP OF MN LLC DBA FOURTEEN FOODS 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-07-01 | 373 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-07-01 | 383 |
| Number of retired or separated participants receiving benefits | 2019-07-01 | 3 |
| Total of all active and inactive participants | 2019-07-01 | 386 |
| 2018: FRAUENSHUH HOSPITALITY GROUP OF MN LLC DBA FOURTEEN FOODS 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-07-01 | 228 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-07-01 | 237 |
| Number of retired or separated participants receiving benefits | 2018-07-01 | 2 |
| Total of all active and inactive participants | 2018-07-01 | 239 |
| 2017: FRAUENSHUH HOSPITALITY GROUP OF MN LLC DBA FOURTEEN FOODS 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-07-01 | 244 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-07-01 | 258 |
| Number of retired or separated participants receiving benefits | 2017-07-01 | 1 |
| Total of all active and inactive participants | 2017-07-01 | 259 |
| 2016: FRAUENSHUH HOSPITALITY GROUP OF MN LLC DBA FOURTEEN FOODS 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-07-01 | 225 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-07-01 | 261 |
| Number of retired or separated participants receiving benefits | 2016-07-01 | 3 |
| Total of all active and inactive participants | 2016-07-01 | 264 |
| 2015: FRAUENSHUH HOSPITALITY GROUP OF MN LLC DBA FOURTEEN FOODS 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-07-01 | 307 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-07-01 | 331 |
| Number of retired or separated participants receiving benefits | 2015-07-01 | 3 |
| Total of all active and inactive participants | 2015-07-01 | 334 |
| 2014: FRAUENSHUH HOSPITALITY GROUP OF MN LLC DBA FOURTEEN FOODS 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-07-01 | 0 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-07-01 | 289 |
| Total of all active and inactive participants | 2014-07-01 | 289 |
| Total participants, beginning-of-year | 2014-06-01 | 197 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-06-01 | 0 |
| Total of all active and inactive participants | 2014-06-01 | 0 |
| 2013: FRAUENSHUH HOSPITALITY GROUP OF MN LLC DBA FOURTEEN FOODS 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-06-01 | 187 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-06-01 | 199 |
| Number of retired or separated participants receiving benefits | 2013-06-01 | 4 |
| Total of all active and inactive participants | 2013-06-01 | 203 |
| 2012: FRAUENSHUH HOSPITALITY GROUP OF MN LLC DBA FOURTEEN FOODS 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-06-01 | 310 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-06-01 | 295 |
| Number of retired or separated participants receiving benefits | 2012-06-01 | 15 |
| Total of all active and inactive participants | 2012-06-01 | 310 |
| 2022: FRAUENSHUH HOSPITALITY GROUP OF MN LLC DBA FOURTEEN FOODS 2022 form 5500 responses |
|---|
| 2022-07-01 | Type of plan entity | Single employer plan |
| 2022-07-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2022-07-01 | Plan funding arrangement – Insurance | Yes |
| 2022-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: FRAUENSHUH HOSPITALITY GROUP OF MN LLC DBA FOURTEEN FOODS 2021 form 5500 responses |
|---|
| 2021-07-01 | Type of plan entity | Single employer plan |
| 2021-07-01 | Submission has been amended | Yes |
| 2021-07-01 | Plan funding arrangement – Insurance | Yes |
| 2021-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: FRAUENSHUH HOSPITALITY GROUP OF MN LLC DBA FOURTEEN FOODS 2020 form 5500 responses |
|---|
| 2020-07-01 | Type of plan entity | Single employer plan |
| 2020-07-01 | Plan funding arrangement – Insurance | Yes |
| 2020-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: FRAUENSHUH HOSPITALITY GROUP OF MN LLC DBA FOURTEEN FOODS 2019 form 5500 responses |
|---|
| 2019-07-01 | Type of plan entity | Single employer plan |
| 2019-07-01 | Plan funding arrangement – Insurance | Yes |
| 2019-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: FRAUENSHUH HOSPITALITY GROUP OF MN LLC DBA FOURTEEN FOODS 2018 form 5500 responses |
|---|
| 2018-07-01 | Type of plan entity | Single employer plan |
| 2018-07-01 | Plan funding arrangement – Insurance | Yes |
| 2018-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: FRAUENSHUH HOSPITALITY GROUP OF MN LLC DBA FOURTEEN FOODS 2017 form 5500 responses |
|---|
| 2017-07-01 | Type of plan entity | Single employer plan |
| 2017-07-01 | Plan funding arrangement – Insurance | Yes |
| 2017-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: FRAUENSHUH HOSPITALITY GROUP OF MN LLC DBA FOURTEEN FOODS 2016 form 5500 responses |
|---|
| 2016-07-01 | Type of plan entity | Single employer plan |
| 2016-07-01 | Plan funding arrangement – Insurance | Yes |
| 2016-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: FRAUENSHUH HOSPITALITY GROUP OF MN LLC DBA FOURTEEN FOODS 2015 form 5500 responses |
|---|
| 2015-07-01 | Type of plan entity | Single employer plan |
| 2015-07-01 | Plan funding arrangement – Insurance | Yes |
| 2015-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: FRAUENSHUH HOSPITALITY GROUP OF MN LLC DBA FOURTEEN FOODS 2014 form 5500 responses |
|---|
| 2014-07-01 | Type of plan entity | Single employer plan |
| 2014-07-01 | Plan funding arrangement – Insurance | Yes |
| 2014-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-06-01 | Type of plan entity | Single employer plan |
| 2014-06-01 | Submission has been amended | Yes |
| 2014-06-01 | This submission is the final filing | Yes |
| 2014-06-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2014-06-01 | Plan funding arrangement – Insurance | Yes |
| 2014-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: FRAUENSHUH HOSPITALITY GROUP OF MN LLC DBA FOURTEEN FOODS 2013 form 5500 responses |
|---|
| 2013-06-01 | Type of plan entity | Single employer plan |
| 2013-06-01 | Plan funding arrangement – Insurance | Yes |
| 2013-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: FRAUENSHUH HOSPITALITY GROUP OF MN LLC DBA FOURTEEN FOODS 2012 form 5500 responses |
|---|
| 2012-06-01 | Type of plan entity | Single employer plan |
| 2012-06-01 | First time form 5500 has been submitted | Yes |
| 2012-06-01 | Submission has been amended | Yes |
| 2012-06-01 | Plan funding arrangement – Insurance | Yes |
| 2012-06-01 | Plan benefit arrangement – Insurance | Yes |
| DELTA DENTAL OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55034 ) |
| Policy contract number | 118793 |
| Policy instance | 5 |
| Insurance contract or identification number | 118793 | | Number of Individuals Covered | 819 | | Insurance policy start date | 2022-07-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0220950 |
| Policy instance | 4 |
| Insurance contract or identification number | 0220950 | | Number of Individuals Covered | 250 | | Insurance policy start date | 2022-07-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $4,945 | | Total amount of fees paid to insurance company | USD $826 | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT,CRITICAL ILLNESS,ACCIDENT | | Welfare Benefit Premiums Paid to Carrier | USD $105,229 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $4,945 | | Amount paid for insurance broker fees | 826 | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION, SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| AXIS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 37273 ) |
| Policy contract number | 8106694 |
| Policy instance | 3 |
| Insurance contract or identification number | 8106694 | | Number of Individuals Covered | 321 | | Insurance policy start date | 2022-07-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $110,112 | | 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 number | 10112641001 |
| Policy instance | 2 |
| Insurance contract or identification number | 10112641001 | | Number of Individuals Covered | 682 | | Insurance policy start date | 2022-07-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $24,393 | | 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 | 238698 |
| Policy instance | 1 |
| Insurance contract or identification number | 238698 | | Number of Individuals Covered | 343 | | Insurance policy start date | 2022-07-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $7,293 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,112,523 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,293 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 220950 |
| Policy instance | 5 |
| Insurance contract or identification number | 220950 | | Number of Individuals Covered | 697 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Total amount of commissions paid to insurance broker | USD $6,069 | | Total amount of fees paid to insurance company | USD $882 | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT,CRITICAL ILLNESS,ACCIDENT | | Welfare Benefit Premiums Paid to Carrier | USD $183,681 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,069 | | Amount paid for insurance broker fees | 882 | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION, NON-MONETARY COMPENSATION, SUPPLEMENTAL COMPENSATION | | 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 | 238698 |
| Policy instance | 1 |
| Insurance contract or identification number | 238698 | | Number of Individuals Covered | 365 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Total amount of commissions paid to insurance broker | USD $7,293 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,353,348 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,293 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 220950 |
| Policy instance | 2 |
| Insurance contract or identification number | 220950 | | Number of Individuals Covered | 697 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $57 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $118,275 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $0 | | Amount paid for insurance broker fees | 57 | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 10112641001 |
| Policy instance | 3 |
| Insurance contract or identification number | 10112641001 | | Number of Individuals Covered | 707 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $49,187 | | 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 | 118793 |
| Policy instance | 4 |
| Insurance contract or identification number | 118793 | | Number of Individuals Covered | 806 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Welfare Benefit Premiums Paid to Carrier | USD $0 | | 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 number | 10112641001 |
| Policy instance | 2 |
| Insurance contract or identification number | 10112641001 | | Number of Individuals Covered | 707 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $49,187 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AXIS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 37273 ) |
| Policy contract number | 8106694 |
| Policy instance | 3 |
| Insurance contract or identification number | 8106694 | | Number of Individuals Covered | 257 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $258,440 | | 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 | 238698 |
| Policy instance | 1 |
| Insurance contract or identification number | 238698 | | Number of Individuals Covered | 345 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | Total amount of commissions paid to insurance broker | USD $2,506 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,610,219 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,506 | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0220950 |
| Policy instance | 2 |
| Insurance contract or identification number | 0220950 | | Number of Individuals Covered | 638 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $31 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $108,390 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 31 | | Additional information about fees paid to insurance broker | MARKETING ALLOWANCE | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55034 ) |
| Policy contract number | 118793 |
| Policy instance | 3 |
| Insurance contract or identification number | 118793 | | Number of Individuals Covered | 429 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $66,706 | | 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 number | 10112641001 |
| Policy instance | 4 |
| Insurance contract or identification number | 10112641001 | | Number of Individuals Covered | 676 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $47,066 | | 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 number | 10112641001 |
| Policy instance | 4 |
| Insurance contract or identification number | 10112641001 | | Number of Individuals Covered | 589 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $25,662 | | 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 | 118793 |
| Policy instance | 3 |
| Insurance contract or identification number | 118793 | | Number of Individuals Covered | 391 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $84,281 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0220950 |
| Policy instance | 2 |
| Insurance contract or identification number | 0220950 | | Number of Individuals Covered | 423 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $41 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $89,403 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 41 | | Additional information about fees paid to insurance broker | MARKETING ALLOWANCE | | 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 | 238698 |
| Policy instance | 1 |
| Insurance contract or identification number | 238698 | | Number of Individuals Covered | 330 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $2,506 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,070,383 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,506 | | 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 | 238698 |
| Policy instance | 1 |
| Insurance contract or identification number | 238698 | | Number of Individuals Covered | 312 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2019-06-30 | | Total amount of commissions paid to insurance broker | USD $11,758 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,744,089 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,758 | | Insurance broker organization code? | 3 |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 900092 |
| Policy instance | 2 |
| Insurance contract or identification number | 900092 | | Number of Individuals Covered | 487 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2019-06-30 | | Total amount of commissions paid to insurance broker | USD $1,722 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D, CHILD CI, EE CI, SPOUSE CI | | Welfare Benefit Premiums Paid to Carrier | USD $110,609 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,722 |
|
| DELTA DENTAL OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55034 ) |
| Policy contract number | 118793 |
| Policy instance | 3 |
| Insurance contract or identification number | 118793 | | Number of Individuals Covered | 352 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2019-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $101,826 | | 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 number | 10112651001 |
| Policy instance | 4 |
| Insurance contract or identification number | 10112651001 | | Number of Individuals Covered | 280 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2019-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $18,866 | | 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 | 238698 |
| Policy instance | 1 |
| Insurance contract or identification number | 238698 | | Number of Individuals Covered | 206 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $11,759 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,516,417 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 9000092 |
| Policy instance | 2 |
| Insurance contract or identification number | 9000092 | | Number of Individuals Covered | 539 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $1,812 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D, CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $119,343 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
| Policy contract number | 5484721 |
| Policy instance | 3 |
| Insurance contract or identification number | 5484721 | | Number of Individuals Covered | 266 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $84,418 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| MEDICA (National Association of Insurance Commissioners NAIC id number: 1259 ) |
| Policy contract number | 301069 |
| Policy instance | 1 |
| Insurance contract or identification number | 301069 | | Number of Individuals Covered | 225 | | Insurance policy start date | 2015-07-01 | | Insurance policy end date | 2016-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,232,736 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 501581 |
| Policy instance | 2 |
| Insurance contract or identification number | 501581 | | Number of Individuals Covered | 151 | | Insurance policy start date | 2015-07-01 | | Insurance policy end date | 2016-06-30 | | Total amount of commissions paid to insurance broker | USD $1,688 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $16,978 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $868 | | Insurance broker organization code? | 3 | | Insurance broker name | KEYSTONE INSURANCE AND BENEFITS |
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| AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 ) |
| Policy contract number | G 00614105 |
| Policy instance | 3 |
| Insurance contract or identification number | G 00614105 | | Number of Individuals Covered | 319 | | Insurance policy start date | 2015-07-01 | | Insurance policy end date | 2016-06-30 | | Total amount of commissions paid to insurance broker | USD $8,791 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $45,556 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,791 | | Insurance broker organization code? | 3 | | Insurance broker name | INSURAMAX INC |
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| DELTA DENTAL OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55034 ) |
| Policy contract number | 331942 |
| Policy instance | 4 |
| Insurance contract or identification number | 331942 | | Number of Individuals Covered | 214 | | Insurance policy start date | 2015-07-01 | | Insurance policy end date | 2016-06-30 | | Total amount of commissions paid to insurance broker | USD $11,781 | | Total amount of fees paid to insurance company | USD $0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,781 | | Insurance broker organization code? | 3 | | Insurance broker name | INSURAMAX INC |
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| BCBSM, INC. DBA BLUE CROSS AND BLUE SHIELD OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55026 ) |
| Policy contract number | AJ200 |
| Policy instance | 2 |
| Insurance contract or identification number | AJ200 | | Number of Individuals Covered | 243 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-06-30 | | Total amount of commissions paid to insurance broker | USD $15,051 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $610,039 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $15,051 | | Insurance broker name | INSURAMAX, INC. |
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| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00501581 |
| Policy instance | 1 |
| Insurance contract or identification number | 00501581 | | Number of Individuals Covered | 289 | | Insurance policy start date | 2014-03-01 | | Insurance policy end date | 2015-02-28 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $125,891 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| MEDICA (National Association of Insurance Commissioners NAIC id number: 1259 ) |
| Policy contract number | 148676 |
| Policy instance | 1 |
| Insurance contract or identification number | 148676 | | Number of Individuals Covered | 198 | | Insurance policy start date | 2014-06-01 | | Insurance policy end date | 2014-06-30 | | Total amount of commissions paid to insurance broker | USD $17,091 | | Total amount of fees paid to insurance company | USD $1,309 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $103,776 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $17,091 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 1309 | | Additional information about fees paid to insurance broker | BROKER INCENTIVE PROGRAM | | Insurance broker name | MARSH & MCLENNAN AGENCY LLC |
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| MEDICA (National Association of Insurance Commissioners NAIC id number: 1259 ) |
| Policy contract number | 148676 |
| Policy instance | 1 |
| Insurance contract or identification number | 148676 | | Number of Individuals Covered | 203 | | Insurance policy start date | 2013-06-01 | | Insurance policy end date | 2014-05-31 | | Total amount of commissions paid to insurance broker | USD $32,910 | | Total amount of fees paid to insurance company | USD $1,309 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,097,003 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $18,932 | | Amount paid for insurance broker fees | 1309 | | Additional information about fees paid to insurance broker | BROKER INCENTIVE PROGRAM | | Insurance broker organization code? | 3 | | Insurance broker name | INSURAMAX INC |
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| HEALTHPARTNERS INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 44547 ) |
| Policy contract number | 24995 |
| Policy instance | 1 |
| Insurance contract or identification number | 24995 | | Number of Individuals Covered | 59 | | Insurance policy start date | 2012-06-01 | | Insurance policy end date | 2013-05-31 | | Total amount of commissions paid to insurance broker | USD $11,180 | | Total amount of fees paid to insurance company | USD $699 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $375,647 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,180 | | Amount paid for insurance broker fees | 699 | | Additional information about fees paid to insurance broker | PRODUCTION BONUSES/INDIRECT COMP | | Insurance broker organization code? | 3 | | Insurance broker name | MARSH & MCLENNAN AGENCY LLC |
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| HEALTHPARTNERS INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 44547 ) |
| Policy contract number | 24995 |
| Policy instance | 2 |
| Insurance contract or identification number | 24995 | | Number of Individuals Covered | 59 | | Insurance policy start date | 2012-06-01 | | Insurance policy end date | 2013-05-31 | | Total amount of commissions paid to insurance broker | USD $11,180 | | Total amount of fees paid to insurance company | USD $699 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $375,647 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 ) |
| Policy contract number | 00013885 |
| Policy instance | 1 |
| Insurance contract or identification number | 00013885 | | Number of Individuals Covered | 110 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-05-31 | | Total amount of commissions paid to insurance broker | USD $5,528 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $341,158 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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