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MINNESOTA VIKINGS FOOTBALL, LLC EMPLOYEE MEDICAL PLAN 401k Plan overview

Plan NameMINNESOTA VIKINGS FOOTBALL, LLC EMPLOYEE MEDICAL PLAN
Plan identification number 501

MINNESOTA VIKINGS FOOTBALL, LLC EMPLOYEE MEDICAL PLAN Benefits

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

401k Sponsoring company profile

MINNESOTA VIKINGS FOOTBALL, LLC has sponsored the creation of one or more 401k plans.

Company Name:MINNESOTA VIKINGS FOOTBALL, LLC
Employer identification number (EIN):202310169
NAIC Classification:711210
NAIC Description: Spectator Sports

Additional information about MINNESOTA VIKINGS FOOTBALL, LLC

Jurisdiction of Incorporation: State of Delaware Division of Corporations
Incorporation Date:
Company Identification Number: 3917457

More information about MINNESOTA VIKINGS FOOTBALL, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MINNESOTA VIKINGS FOOTBALL, LLC EMPLOYEE MEDICAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-06-01LARA JURAS2023-11-14
5012021-06-01LARA JURAS2023-01-03
5012020-06-01LARA JURAS2021-12-28
5012019-06-01LARA JURAS2021-03-12
5012018-06-01
5012017-06-01LARA JURAS
5012016-06-01SARAH BLOMQUIST
5012015-06-01SARAH BLOMQUIST
5012014-06-01LISA LARSON
5012013-06-01STEVE POPPEN
5012012-06-01STEVE POPPEN
5012011-06-01STEVE POPPEN STEVE POPPEN2013-03-14
5012010-06-01STEVEN POPPEN
5012009-06-01STEVE POPPEN STEVE POPPEN2011-03-15

Plan Statistics for MINNESOTA VIKINGS FOOTBALL, LLC EMPLOYEE MEDICAL PLAN

401k plan membership statisitcs for MINNESOTA VIKINGS FOOTBALL, LLC EMPLOYEE MEDICAL PLAN

Measure Date Value
2022: MINNESOTA VIKINGS FOOTBALL, LLC EMPLOYEE MEDICAL PLAN 2022 401k membership
Total participants, beginning-of-year2022-06-01246
Total number of active participants reported on line 7a of the Form 55002022-06-01254
Number of retired or separated participants receiving benefits2022-06-010
Number of other retired or separated participants entitled to future benefits2022-06-010
Total of all active and inactive participants2022-06-01254
Number of employers contributing to the scheme2022-06-010
2021: MINNESOTA VIKINGS FOOTBALL, LLC EMPLOYEE MEDICAL PLAN 2021 401k membership
Total participants, beginning-of-year2021-06-01219
Total number of active participants reported on line 7a of the Form 55002021-06-01246
Number of retired or separated participants receiving benefits2021-06-010
Number of other retired or separated participants entitled to future benefits2021-06-010
Total of all active and inactive participants2021-06-01246
Number of employers contributing to the scheme2021-06-010
2020: MINNESOTA VIKINGS FOOTBALL, LLC EMPLOYEE MEDICAL PLAN 2020 401k membership
Total participants, beginning-of-year2020-06-01212
Total number of active participants reported on line 7a of the Form 55002020-06-01211
Number of retired or separated participants receiving benefits2020-06-015
Number of other retired or separated participants entitled to future benefits2020-06-013
Total of all active and inactive participants2020-06-01219
Number of employers contributing to the scheme2020-06-010
2019: MINNESOTA VIKINGS FOOTBALL, LLC EMPLOYEE MEDICAL PLAN 2019 401k membership
Total participants, beginning-of-year2019-06-01206
Total number of active participants reported on line 7a of the Form 55002019-06-01210
Number of retired or separated participants receiving benefits2019-06-012
Number of other retired or separated participants entitled to future benefits2019-06-010
Total of all active and inactive participants2019-06-01212
Number of employers contributing to the scheme2019-06-010
2018: MINNESOTA VIKINGS FOOTBALL, LLC EMPLOYEE MEDICAL PLAN 2018 401k membership
Total participants, beginning-of-year2018-06-01183
Total number of active participants reported on line 7a of the Form 55002018-06-01202
Number of retired or separated participants receiving benefits2018-06-014
Number of other retired or separated participants entitled to future benefits2018-06-010
Total of all active and inactive participants2018-06-01206
2017: MINNESOTA VIKINGS FOOTBALL, LLC EMPLOYEE MEDICAL PLAN 2017 401k membership
Total participants, beginning-of-year2017-06-01165
Total number of active participants reported on line 7a of the Form 55002017-06-01182
Number of retired or separated participants receiving benefits2017-06-011
Number of other retired or separated participants entitled to future benefits2017-06-010
Total of all active and inactive participants2017-06-01183
2016: MINNESOTA VIKINGS FOOTBALL, LLC EMPLOYEE MEDICAL PLAN 2016 401k membership
Total participants, beginning-of-year2016-06-01143
Total number of active participants reported on line 7a of the Form 55002016-06-01165
Number of retired or separated participants receiving benefits2016-06-010
Number of other retired or separated participants entitled to future benefits2016-06-010
Total of all active and inactive participants2016-06-01165
2015: MINNESOTA VIKINGS FOOTBALL, LLC EMPLOYEE MEDICAL PLAN 2015 401k membership
Total participants, beginning-of-year2015-06-01125
Total number of active participants reported on line 7a of the Form 55002015-06-01142
Number of retired or separated participants receiving benefits2015-06-011
Number of other retired or separated participants entitled to future benefits2015-06-010
Total of all active and inactive participants2015-06-01143
2014: MINNESOTA VIKINGS FOOTBALL, LLC EMPLOYEE MEDICAL PLAN 2014 401k membership
Total participants, beginning-of-year2014-06-01122
Total number of active participants reported on line 7a of the Form 55002014-06-01125
Number of retired or separated participants receiving benefits2014-06-010
Number of other retired or separated participants entitled to future benefits2014-06-010
Total of all active and inactive participants2014-06-01125
2013: MINNESOTA VIKINGS FOOTBALL, LLC EMPLOYEE MEDICAL PLAN 2013 401k membership
Total participants, beginning-of-year2013-06-01116
Total number of active participants reported on line 7a of the Form 55002013-06-01120
Number of retired or separated participants receiving benefits2013-06-012
Number of other retired or separated participants entitled to future benefits2013-06-010
Total of all active and inactive participants2013-06-01122
2012: MINNESOTA VIKINGS FOOTBALL, LLC EMPLOYEE MEDICAL PLAN 2012 401k membership
Total participants, beginning-of-year2012-06-01116
Total number of active participants reported on line 7a of the Form 55002012-06-01116
Number of retired or separated participants receiving benefits2012-06-0111
Number of other retired or separated participants entitled to future benefits2012-06-010
Total of all active and inactive participants2012-06-01127
2011: MINNESOTA VIKINGS FOOTBALL, LLC EMPLOYEE MEDICAL PLAN 2011 401k membership
Total participants, beginning-of-year2011-06-01114
Total number of active participants reported on line 7a of the Form 55002011-06-01116
Number of retired or separated participants receiving benefits2011-06-012
Number of other retired or separated participants entitled to future benefits2011-06-010
Total of all active and inactive participants2011-06-01118
2010: MINNESOTA VIKINGS FOOTBALL, LLC EMPLOYEE MEDICAL PLAN 2010 401k membership
Total participants, beginning-of-year2010-06-01113
Total number of active participants reported on line 7a of the Form 55002010-06-01114
Number of retired or separated participants receiving benefits2010-06-015
Number of other retired or separated participants entitled to future benefits2010-06-010
Total of all active and inactive participants2010-06-01119
2009: MINNESOTA VIKINGS FOOTBALL, LLC EMPLOYEE MEDICAL PLAN 2009 401k membership
Total participants, beginning-of-year2009-06-01108
Total number of active participants reported on line 7a of the Form 55002009-06-01111
Number of retired or separated participants receiving benefits2009-06-012
Number of other retired or separated participants entitled to future benefits2009-06-010
Total of all active and inactive participants2009-06-01113

Form 5500 Responses for MINNESOTA VIKINGS FOOTBALL, LLC EMPLOYEE MEDICAL PLAN

2022: MINNESOTA VIKINGS FOOTBALL, LLC EMPLOYEE MEDICAL PLAN 2022 form 5500 responses
2022-06-01Type of plan entitySingle employer plan
2022-06-01Plan funding arrangement – InsuranceYes
2022-06-01Plan benefit arrangement – InsuranceYes
2021: MINNESOTA VIKINGS FOOTBALL, LLC EMPLOYEE MEDICAL PLAN 2021 form 5500 responses
2021-06-01Type of plan entitySingle employer plan
2021-06-01Plan funding arrangement – InsuranceYes
2021-06-01Plan benefit arrangement – InsuranceYes
2020: MINNESOTA VIKINGS FOOTBALL, LLC EMPLOYEE MEDICAL PLAN 2020 form 5500 responses
2020-06-01Type of plan entitySingle employer plan
2020-06-01Plan funding arrangement – InsuranceYes
2020-06-01Plan benefit arrangement – InsuranceYes
2019: MINNESOTA VIKINGS FOOTBALL, LLC EMPLOYEE MEDICAL PLAN 2019 form 5500 responses
2019-06-01Type of plan entitySingle employer plan
2019-06-01Plan funding arrangement – InsuranceYes
2019-06-01Plan benefit arrangement – InsuranceYes
2018: MINNESOTA VIKINGS FOOTBALL, LLC EMPLOYEE MEDICAL PLAN 2018 form 5500 responses
2018-06-01Type of plan entitySingle employer plan
2018-06-01Submission has been amendedNo
2018-06-01This submission is the final filingNo
2018-06-01This return/report is a short plan year return/report (less than 12 months)No
2018-06-01Plan is a collectively bargained planNo
2018-06-01Plan funding arrangement – InsuranceYes
2018-06-01Plan benefit arrangement – InsuranceYes
2017: MINNESOTA VIKINGS FOOTBALL, LLC EMPLOYEE MEDICAL PLAN 2017 form 5500 responses
2017-06-01Type of plan entitySingle employer plan
2017-06-01Submission has been amendedNo
2017-06-01This submission is the final filingNo
2017-06-01This return/report is a short plan year return/report (less than 12 months)No
2017-06-01Plan is a collectively bargained planNo
2017-06-01Plan funding arrangement – InsuranceYes
2017-06-01Plan benefit arrangement – InsuranceYes
2016: MINNESOTA VIKINGS FOOTBALL, LLC EMPLOYEE MEDICAL PLAN 2016 form 5500 responses
2016-06-01Type of plan entitySingle employer plan
2016-06-01Submission has been amendedNo
2016-06-01This submission is the final filingNo
2016-06-01This return/report is a short plan year return/report (less than 12 months)No
2016-06-01Plan is a collectively bargained planNo
2016-06-01Plan funding arrangement – InsuranceYes
2016-06-01Plan benefit arrangement – InsuranceYes
2015: MINNESOTA VIKINGS FOOTBALL, LLC EMPLOYEE MEDICAL PLAN 2015 form 5500 responses
2015-06-01Type of plan entitySingle employer plan
2015-06-01Submission has been amendedNo
2015-06-01This submission is the final filingNo
2015-06-01This return/report is a short plan year return/report (less than 12 months)No
2015-06-01Plan is a collectively bargained planNo
2015-06-01Plan funding arrangement – InsuranceYes
2015-06-01Plan benefit arrangement – InsuranceYes
2014: MINNESOTA VIKINGS FOOTBALL, LLC EMPLOYEE MEDICAL PLAN 2014 form 5500 responses
2014-06-01Type of plan entitySingle employer plan
2014-06-01Submission has been amendedNo
2014-06-01This submission is the final filingNo
2014-06-01This return/report is a short plan year return/report (less than 12 months)No
2014-06-01Plan is a collectively bargained planNo
2014-06-01Plan funding arrangement – InsuranceYes
2014-06-01Plan benefit arrangement – InsuranceYes
2013: MINNESOTA VIKINGS FOOTBALL, LLC EMPLOYEE MEDICAL PLAN 2013 form 5500 responses
2013-06-01Type of plan entitySingle employer plan
2013-06-01Submission has been amendedNo
2013-06-01This submission is the final filingNo
2013-06-01This return/report is a short plan year return/report (less than 12 months)No
2013-06-01Plan is a collectively bargained planNo
2013-06-01Plan funding arrangement – InsuranceYes
2013-06-01Plan benefit arrangement – InsuranceYes
2012: MINNESOTA VIKINGS FOOTBALL, LLC EMPLOYEE MEDICAL PLAN 2012 form 5500 responses
2012-06-01Type of plan entitySingle employer plan
2012-06-01Submission has been amendedNo
2012-06-01This submission is the final filingNo
2012-06-01This return/report is a short plan year return/report (less than 12 months)No
2012-06-01Plan is a collectively bargained planNo
2012-06-01Plan funding arrangement – InsuranceYes
2012-06-01Plan benefit arrangement – InsuranceYes
2011: MINNESOTA VIKINGS FOOTBALL, LLC EMPLOYEE MEDICAL PLAN 2011 form 5500 responses
2011-06-01Type of plan entitySingle employer plan
2011-06-01Submission has been amendedNo
2011-06-01This submission is the final filingNo
2011-06-01This return/report is a short plan year return/report (less than 12 months)No
2011-06-01Plan is a collectively bargained planNo
2011-06-01Plan funding arrangement – InsuranceYes
2011-06-01Plan benefit arrangement – InsuranceYes
2010: MINNESOTA VIKINGS FOOTBALL, LLC EMPLOYEE MEDICAL PLAN 2010 form 5500 responses
2010-06-01Type of plan entitySingle employer plan
2010-06-01Submission has been amendedNo
2010-06-01This submission is the final filingNo
2010-06-01This return/report is a short plan year return/report (less than 12 months)No
2010-06-01Plan is a collectively bargained planNo
2010-06-01Plan funding arrangement – InsuranceYes
2010-06-01Plan benefit arrangement – InsuranceYes
2009: MINNESOTA VIKINGS FOOTBALL, LLC EMPLOYEE MEDICAL PLAN 2009 form 5500 responses
2009-06-01Type of plan entitySingle employer plan
2009-06-01Submission has been amendedNo
2009-06-01This submission is the final filingNo
2009-06-01This return/report is a short plan year return/report (less than 12 months)No
2009-06-01Plan is a collectively bargained planNo
2009-06-01Plan funding arrangement – InsuranceYes
2009-06-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

HEALTHPARTNERS INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 44547 )
Policy contract number15321
Policy instance 1
Insurance contract or identification number15321
Number of Individuals Covered576
Insurance policy start date2022-06-01
Insurance policy end date2023-05-31
Total amount of commissions paid to insurance brokerUSD $68,745
Total amount of fees paid to insurance companyUSD $142
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,957,653
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $68,745
Amount paid for insurance broker fees142
Additional information about fees paid to insurance brokerINDIRECT COMPENSATION
Insurance broker organization code?3
HEALTHPARTNERS INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 44547 )
Policy contract number15321
Policy instance 1
Insurance contract or identification number15321
Number of Individuals Covered549
Insurance policy start date2021-06-01
Insurance policy end date2022-05-31
Total amount of commissions paid to insurance brokerUSD $72,109
Total amount of fees paid to insurance companyUSD $115
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,575,306
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $72,109
Amount paid for insurance broker fees115
Additional information about fees paid to insurance brokerINDIRECT COMPENSATION
Insurance broker organization code?3
HEALTHPARTNERS INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 44547 )
Policy contract number15321
Policy instance 1
Insurance contract or identification number15321
Number of Individuals Covered506
Insurance policy start date2020-06-01
Insurance policy end date2021-05-31
Total amount of commissions paid to insurance brokerUSD $69,826
Total amount of fees paid to insurance companyUSD $124
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,268,587
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $47,828
Insurance broker organization code?3
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerINDIRECT COMPENSATION
HEALTHPARTNERS INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 44547 )
Policy contract number15321
Policy instance 1
Insurance contract or identification number15321
Number of Individuals Covered478
Insurance policy start date2019-06-01
Insurance policy end date2020-05-31
Total amount of commissions paid to insurance brokerUSD $62,023
Total amount of fees paid to insurance companyUSD $100
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,223,867
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $62,023
Amount paid for insurance broker fees100
Additional information about fees paid to insurance brokerINDIRECT COMPENSATION
Insurance broker organization code?3
HEALTHPARTNERS (National Association of Insurance Commissioners NAIC id number: 95766 )
Policy contract number15321
Policy instance 1
Insurance contract or identification number15321
Number of Individuals Covered206
Insurance policy start date2018-06-01
Insurance policy end date2019-05-31
Total amount of fees paid to insurance companyUSD $58,557
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 BenefitNo
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
Welfare Benefit Premiums Paid to CarrierUSD $1,972,309
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees58557
Additional information about fees paid to insurance brokerBROKER SERVICE FEE
Insurance broker organization code?3
HEALTHPARTNERS (National Association of Insurance Commissioners NAIC id number: 95766 )
Policy contract number15321
Policy instance 1
Insurance contract or identification number15321
Number of Individuals Covered183
Insurance policy start date2017-06-01
Insurance policy end date2018-05-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $39,815
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 BenefitNo
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
Welfare Benefit Premiums Paid to CarrierUSD $1,709,300
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HEALTHPARTNERS INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 44547 )
Policy contract number15321
Policy instance 1
Insurance contract or identification number15321
Number of Individuals Covered143
Insurance policy start date2015-06-01
Insurance policy end date2016-05-31
Total amount of commissions paid to insurance brokerUSD $31,640
Total amount of fees paid to insurance companyUSD $8
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 BenefitNo
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
Welfare Benefit Premiums Paid to CarrierUSD $1,132,093
Commission paid to Insurance BrokerUSD $31,640
Amount paid for insurance broker fees8
Additional information about fees paid to insurance brokerPRODUCTION BONUS
Insurance broker organization code?3
Insurance broker nameASSOCIATED FINANCIAL GROUP
HEALTHPARTNERS INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 44547 )
Policy contract number15321
Policy instance 1
Insurance contract or identification number15321
Number of Individuals Covered125
Insurance policy start date2014-06-01
Insurance policy end date2015-05-31
Total amount of commissions paid to insurance brokerUSD $29,605
Total amount of fees paid to insurance companyUSD $0
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 BenefitNo
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
Welfare Benefit Premiums Paid to CarrierUSD $1,056,416
Commission paid to Insurance BrokerUSD $29,605
Additional information about fees paid to insurance brokerPRODUCTION BONUS 4235
Insurance broker organization code?3
Insurance broker nameASSOCIATED FINANCIAL GROUP
HEALTHPARTNERS INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 44547 )
Policy contract number15321
Policy instance 1
Insurance contract or identification number15321
Number of Individuals Covered116
Insurance policy start date2013-06-01
Insurance policy end date2014-05-31
Total amount of commissions paid to insurance brokerUSD $34,374
Total amount of fees paid to insurance companyUSD $3,562
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 BenefitNo
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
Welfare Benefit Premiums Paid to CarrierUSD $1,061,045
Commission paid to Insurance BrokerUSD $34,374
Amount paid for insurance broker fees3562
Additional information about fees paid to insurance brokerPRODUCTION BONUS
Insurance broker organization code?3
Insurance broker nameASSOCIATED FINANCIAL GROUP
HEALTHPARTNERS INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 44547 )
Policy contract number15321
Policy instance 1
Insurance contract or identification number15321
Number of Individuals Covered116
Insurance policy start date2012-06-01
Insurance policy end date2013-05-31
Total amount of commissions paid to insurance brokerUSD $31,116
Total amount of fees paid to insurance companyUSD $0
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 BenefitNo
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
Welfare Benefit Premiums Paid to CarrierUSD $1,015,592
Commission paid to Insurance BrokerUSD $31,116
Insurance broker organization code?3
Insurance broker nameASSOCIATED FINANCIAL GROUP
HEALTHPARTNERS (National Association of Insurance Commissioners NAIC id number: 95766 )
Policy contract number15321
Policy instance 1
Insurance contract or identification number15321
Number of Individuals Covered116
Insurance policy start date2011-06-01
Insurance policy end date2012-05-31
Total amount of commissions paid to insurance brokerUSD $30,748
Total amount of fees paid to insurance companyUSD $904
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 BenefitNo
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
Welfare Benefit Premiums Paid to CarrierUSD $954,664
MEDICA (National Association of Insurance Commissioners NAIC id number: 1259 )
Policy contract number445830
Policy instance 1
Insurance contract or identification number445830
Number of Individuals Covered114
Insurance policy start date2010-06-01
Insurance policy end date2011-05-31
Total amount of commissions paid to insurance brokerUSD $22,468
Total amount of fees paid to insurance companyUSD $888
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 BenefitNo
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
Welfare Benefit Premiums Paid to CarrierUSD $966,348

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