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BLATTNER HOLDING COMPANY WELFARE BENEFIT PLAN 401k Plan overview

Plan NameBLATTNER HOLDING COMPANY WELFARE BENEFIT PLAN
Plan identification number 507

BLATTNER HOLDING COMPANY WELFARE BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Death benefits (include travel accident but not life insurance)
  • Other welfare benefit cover

401k Sponsoring company profile

BLATTNER HOLDING COMPANY has sponsored the creation of one or more 401k plans.

Company Name:BLATTNER HOLDING COMPANY
Employer identification number (EIN):205347195
NAIC Classification:237310
NAIC Description:Highway, Street, and Bridge Construction

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BLATTNER HOLDING COMPANY WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5072018-01-01DONNA GOEBEL2019-08-15
5072017-01-01
5072016-10-01DONNA GOEBEL
5072015-10-01DONNA GOEBEL

Plan Statistics for BLATTNER HOLDING COMPANY WELFARE BENEFIT PLAN

401k plan membership statisitcs for BLATTNER HOLDING COMPANY WELFARE BENEFIT PLAN

Measure Date Value
2018: BLATTNER HOLDING COMPANY WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-012,164
Total number of active participants reported on line 7a of the Form 55002018-01-010
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-010
Number of employers contributing to the scheme2018-01-010
2017: BLATTNER HOLDING COMPANY WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-011,632
Total number of active participants reported on line 7a of the Form 55002017-01-012,164
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-012,164
2016: BLATTNER HOLDING COMPANY WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-10-012,167
Total number of active participants reported on line 7a of the Form 55002016-10-012,179
Number of retired or separated participants receiving benefits2016-10-010
Number of other retired or separated participants entitled to future benefits2016-10-010
Total of all active and inactive participants2016-10-012,179
2015: BLATTNER HOLDING COMPANY WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-10-011,493
Total number of active participants reported on line 7a of the Form 55002015-10-012,167
Number of retired or separated participants receiving benefits2015-10-010
Number of other retired or separated participants entitled to future benefits2015-10-010
Total of all active and inactive participants2015-10-012,167

Financial Data on BLATTNER HOLDING COMPANY WELFARE BENEFIT PLAN

Measure Date Value
2018 : BLATTNER HOLDING COMPANY WELFARE BENEFIT PLAN 2018 401k financial data
Total transfer of assets from this plan2018-12-31$-5,253,254
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$3,005,167
Total income from all sources (including contributions)2018-12-31$11,457,611
Total of all expenses incurred2018-12-31$14,064,202
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-12-31$13,893,617
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-12-31$11,457,611
Value of total assets at end of year2018-12-31$0
Value of total assets at beginning of year2018-12-31$358,504
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-12-31$170,585
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-12-31Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan2018-12-31$0
Administrative expenses professional fees incurred2018-12-31$170,585
Was this plan covered by a fidelity bond2018-12-31Yes
Value of fidelity bond cover2018-12-31$1,000,000
If this is an individual account plan, was there a blackout period2018-12-31No
Were there any nonexempt tranactions with any party-in-interest2018-12-31No
Contributions received from participants2018-12-31$1,258,328
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2018-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at end of year2018-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2018-12-31$354,943
Liabilities. Value of operating payables at end of year2018-12-31$0
Liabilities. Value of operating payables at beginning of year2018-12-31$188,198
Total non interest bearing cash at end of year2018-12-31$0
Total non interest bearing cash at beginning of year2018-12-31$3,561
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Value of net income/loss2018-12-31$-2,606,591
Value of net assets at end of year (total assets less liabilities)2018-12-31$0
Value of net assets at beginning of year (total assets less liabilities)2018-12-31$-2,646,663
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2018-12-31No
Were any leases to which the plan was party in default or uncollectible2018-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2018-12-31$1,578,371
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-12-31No
Was there a failure to transmit to the plan any participant contributions2018-12-31No
Has the plan failed to provide any benefit when due under the plan2018-12-31No
Contributions received in cash from employer2018-12-31$10,199,283
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-12-31$12,315,246
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32018-12-31No
Liabilities. Value of benefit claims payable at end of year2018-12-31$0
Liabilities. Value of benefit claims payable at beginning of year2018-12-31$2,816,969
Did the plan have assets held for investment2018-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-12-31No
Opinion of an independent qualified public accountant for this plan2018-12-31Unqualified
Accountancy firm name2018-12-31CLIFTONLARSONALLEN LLP
Accountancy firm EIN2018-12-31410746749
2017 : BLATTNER HOLDING COMPANY WELFARE BENEFIT PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets2017-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$3,005,167
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$4,720,601
Total income from all sources (including contributions)2017-12-31$2,409,836
Total loss/gain on sale of assets2017-12-31$0
Total of all expenses incurred2017-12-31$7,622,356
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-12-31$7,194,367
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-12-31$2,409,836
Value of total assets at end of year2017-12-31$358,504
Value of total assets at beginning of year2017-12-31$7,286,458
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-12-31$427,989
Total interest from all sources2017-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2017-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-12-31No
Administrative expenses professional fees incurred2017-12-31$119,184
Was this plan covered by a fidelity bond2017-12-31Yes
Value of fidelity bond cover2017-12-31$1,000,000
If this is an individual account plan, was there a blackout period2017-12-31No
Were there any nonexempt tranactions with any party-in-interest2017-12-31No
Contributions received from participants2017-12-31$207,203
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2017-12-31$110,857
Value of other receiveables (less allowance for doubtful accounts) at end of year2017-12-31$354,943
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2017-12-31$1,057,258
Administrative expenses (other) incurred2017-12-31$3,517
Liabilities. Value of operating payables at end of year2017-12-31$188,198
Total non interest bearing cash at end of year2017-12-31$3,561
Total non interest bearing cash at beginning of year2017-12-31$6,229,200
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Value of net income/loss2017-12-31$-5,212,520
Value of net assets at end of year (total assets less liabilities)2017-12-31$-2,646,663
Value of net assets at beginning of year (total assets less liabilities)2017-12-31$2,565,857
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2017-12-31No
Were any leases to which the plan was party in default or uncollectible2017-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2017-12-31$1,354,548
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-12-31No
Was there a failure to transmit to the plan any participant contributions2017-12-31No
Has the plan failed to provide any benefit when due under the plan2017-12-31No
Contributions received in cash from employer2017-12-31$2,202,633
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-12-31$5,728,962
Contract administrator fees2017-12-31$305,288
Liabilities. Value of benefit claims payable at end of year2017-12-31$2,816,969
Liabilities. Value of benefit claims payable at beginning of year2017-12-31$4,720,601
Did the plan have assets held for investment2017-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-12-31No
Opinion of an independent qualified public accountant for this plan2017-12-31Unqualified
Accountancy firm name2017-12-31CLIFTON LARSON ALLEN LLP
Accountancy firm EIN2017-12-31410746749
2016 : BLATTNER HOLDING COMPANY WELFARE BENEFIT PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets2016-12-31$0
Total transfer of assets to this plan2016-12-31$-189,710
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$4,720,601
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$4,107,755
Total income from all sources (including contributions)2016-12-31$398,352
Total loss/gain on sale of assets2016-12-31$0
Total of all expenses incurred2016-12-31$2,161,193
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-12-31$1,951,517
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-12-31$398,352
Value of total assets at end of year2016-12-31$7,286,458
Value of total assets at beginning of year2016-12-31$8,626,163
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-12-31$209,676
Total interest from all sources2016-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2016-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-12-31No
Administrative expenses professional fees incurred2016-12-31$209,676
Was this plan covered by a fidelity bond2016-12-31Yes
Value of fidelity bond cover2016-12-31$1,000,000
If this is an individual account plan, was there a blackout period2016-12-31No
Were there any nonexempt tranactions with any party-in-interest2016-12-31No
Contributions received from participants2016-12-31$47,190
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2016-12-31$86,739
Value of other receiveables (less allowance for doubtful accounts) at end of year2016-12-31$1,057,258
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2016-12-31$964,987
Total non interest bearing cash at end of year2016-12-31$6,229,200
Total non interest bearing cash at beginning of year2016-12-31$7,661,176
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Value of net income/loss2016-12-31$-1,762,841
Value of net assets at end of year (total assets less liabilities)2016-12-31$2,565,857
Value of net assets at beginning of year (total assets less liabilities)2016-12-31$4,518,408
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2016-12-31No
Were any leases to which the plan was party in default or uncollectible2016-12-31No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-12-31No
Was there a failure to transmit to the plan any participant contributions2016-12-31No
Has the plan failed to provide any benefit when due under the plan2016-12-31No
Contributions received in cash from employer2016-12-31$351,162
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-12-31$1,864,778
Liabilities. Value of benefit claims payable at end of year2016-12-31$4,720,601
Liabilities. Value of benefit claims payable at beginning of year2016-12-31$4,107,755
Did the plan have assets held for investment2016-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-12-31No
Opinion of an independent qualified public accountant for this plan2016-12-31Unqualified
Accountancy firm name2016-12-31CLIFTON LARSON ALLEN LLP
Accountancy firm EIN2016-12-31410746749
Total unrealized appreciation/depreciation of assets2016-09-30$0
Total transfer of assets to this plan2016-09-30$2,574,072
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-09-30$4,107,755
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-09-30$0
Total income from all sources (including contributions)2016-09-30$12,114,241
Total loss/gain on sale of assets2016-09-30$0
Total of all expenses incurred2016-09-30$10,169,905
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-09-30$9,431,276
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-09-30$12,114,241
Value of total assets at end of year2016-09-30$8,626,163
Value of total assets at beginning of year2016-09-30$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-09-30$738,629
Total interest from all sources2016-09-30$0
Total dividends received (eg from common stock, registered investment company shares)2016-09-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-09-30No
Administrative expenses professional fees incurred2016-09-30$738,629
Was this plan covered by a fidelity bond2016-09-30Yes
Value of fidelity bond cover2016-09-30$1,000,000
If this is an individual account plan, was there a blackout period2016-09-30No
Were there any nonexempt tranactions with any party-in-interest2016-09-30No
Contributions received from participants2016-09-30$1,151,863
Income. Received or receivable in cash from other sources (including rollovers)2016-09-30$120,529
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2016-09-30$1,030,936
Value of other receiveables (less allowance for doubtful accounts) at end of year2016-09-30$964,987
Total non interest bearing cash at end of year2016-09-30$7,661,176
Total non interest bearing cash at beginning of year2016-09-30$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-09-30No
Value of net income/loss2016-09-30$1,944,336
Value of net assets at end of year (total assets less liabilities)2016-09-30$4,518,408
Value of net assets at beginning of year (total assets less liabilities)2016-09-30$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-09-30No
Were any loans by the plan or fixed income obligations due to the plan in default2016-09-30No
Were any leases to which the plan was party in default or uncollectible2016-09-30No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-09-30No
Was there a failure to transmit to the plan any participant contributions2016-09-30No
Has the plan failed to provide any benefit when due under the plan2016-09-30No
Contributions received in cash from employer2016-09-30$10,841,849
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-09-30$8,400,340
Liabilities. Value of benefit claims payable at end of year2016-09-30$4,107,755
Did the plan have assets held for investment2016-09-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-09-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-09-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-09-30No
Opinion of an independent qualified public accountant for this plan2016-09-30Unqualified
Accountancy firm name2016-09-30CLIFTONLARSONALLEN LLP
Accountancy firm EIN2016-09-30410746749

Form 5500 Responses for BLATTNER HOLDING COMPANY WELFARE BENEFIT PLAN

2018: BLATTNER HOLDING COMPANY WELFARE BENEFIT PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01This submission is the final filingYes
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement - TrustYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: BLATTNER HOLDING COMPANY WELFARE BENEFIT PLAN 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 – TrustYes
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement - TrustYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: BLATTNER HOLDING COMPANY WELFARE BENEFIT PLAN 2016 form 5500 responses
2016-10-01Type of plan entitySingle employer plan
2016-10-01Submission has been amendedNo
2016-10-01This submission is the final filingNo
2016-10-01This return/report is a short plan year return/report (less than 12 months)Yes
2016-10-01Plan is a collectively bargained planNo
2016-10-01Plan funding arrangement – InsuranceYes
2016-10-01Plan funding arrangement – TrustYes
2016-10-01Plan funding arrangement – General assets of the sponsorYes
2016-10-01Plan benefit arrangement – InsuranceYes
2016-10-01Plan benefit arrangement - TrustYes
2016-10-01Plan benefit arrangement – General assets of the sponsorYes
2015: BLATTNER HOLDING COMPANY WELFARE BENEFIT PLAN 2015 form 5500 responses
2015-10-01Type of plan entitySingle employer plan
2015-10-01First time form 5500 has been submittedYes
2015-10-01Submission has been amendedNo
2015-10-01This submission is the final filingNo
2015-10-01This return/report is a short plan year return/report (less than 12 months)No
2015-10-01Plan is a collectively bargained planNo
2015-10-01Plan funding arrangement – TrustYes
2015-10-01Plan funding arrangement – General assets of the sponsorYes
2015-10-01Plan benefit arrangement - TrustYes
2015-10-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

MIDWEST EAP SOLUTIONS (National Association of Insurance Commissioners NAIC id number: 62130 )
Policy contract numberDH BLATTNER
Policy instance 1
Insurance contract or identification numberDH BLATTNER
Number of Individuals Covered0
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 $0
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 BenefitNo
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
Other welfare benefits providedEMPLOYEE ASSISTANCE PROGRAM
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 $-10,224
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number174737
Policy instance 2
Insurance contract or identification number174737
Number of Individuals Covered2367
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $3,366
Total amount of fees paid to insurance companyUSD $516
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
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 $25,262
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,366
Amount paid for insurance broker fees64
Additional information about fees paid to insurance brokerNON-MONETARY COMPENSATION
Insurance broker organization code?3
Insurance broker nameGALLAGHER BENEFIT SERVICES, INC.
BCBSM, INC. DBA BLUE CROSS AND BLUE SHIELD OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55026 )
Policy contract number200811
Policy instance 3
Insurance contract or identification number200811
Number of Individuals Covered4915
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 $0
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 BenefitNo
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 $767,227
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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