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VIKING DRILL & TOOL INC. WELFARE BENEFIT PLAN 401k Plan overview

Plan NameVIKING DRILL & TOOL INC. WELFARE BENEFIT PLAN
Plan identification number 501

VIKING DRILL & TOOL INC. WELFARE BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

VIKING DRILL & TOOL, INC. has sponsored the creation of one or more 401k plans.

Company Name:VIKING DRILL & TOOL, INC.
Employer identification number (EIN):362702410
NAIC Classification:333510

Form 5500 Filing Information

Submission information for form 5500 for 401k plan VIKING DRILL & TOOL INC. WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-09-01
5012021-09-01
5012020-09-01
5012019-09-01
5012018-09-01
5012017-09-01MICHAEL KUHL MICHAEL KUHL2019-02-25
5012016-09-01MICHAEL KUHL MICHAEL KUHL2018-01-29
5012015-09-01MICHAEL KUHL MICHAEL KUHL2017-01-13
5012014-09-01MICHAEL KUHL MICHAEL KUHL2016-02-04
5012013-09-01MICHAEL KUHL MICHAEL KUHL2014-12-23
5012011-09-01MICHAEL KUHL
5012010-09-01MICHAEL KUHL
5012009-09-01MICHAEL KUHL

Plan Statistics for VIKING DRILL & TOOL INC. WELFARE BENEFIT PLAN

401k plan membership statisitcs for VIKING DRILL & TOOL INC. WELFARE BENEFIT PLAN

Measure Date Value
2022: VIKING DRILL & TOOL INC. WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year2022-09-01214
Total number of active participants reported on line 7a of the Form 55002022-09-01211
Number of retired or separated participants receiving benefits2022-09-013
Number of other retired or separated participants entitled to future benefits2022-09-013
Total of all active and inactive participants2022-09-01217
2021: VIKING DRILL & TOOL INC. WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-09-01212
Total number of active participants reported on line 7a of the Form 55002021-09-01222
Number of retired or separated participants receiving benefits2021-09-013
Number of other retired or separated participants entitled to future benefits2021-09-013
Total of all active and inactive participants2021-09-01228
2020: VIKING DRILL & TOOL INC. WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-09-01219
Total number of active participants reported on line 7a of the Form 55002020-09-01214
Number of retired or separated participants receiving benefits2020-09-010
Number of other retired or separated participants entitled to future benefits2020-09-010
Total of all active and inactive participants2020-09-01214
2019: VIKING DRILL & TOOL INC. WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-09-01213
Total number of active participants reported on line 7a of the Form 55002019-09-01215
Number of retired or separated participants receiving benefits2019-09-016
Number of other retired or separated participants entitled to future benefits2019-09-013
Total of all active and inactive participants2019-09-01224
2018: VIKING DRILL & TOOL INC. WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-09-01215
Total number of active participants reported on line 7a of the Form 55002018-09-01216
Number of retired or separated participants receiving benefits2018-09-014
Number of other retired or separated participants entitled to future benefits2018-09-010
Total of all active and inactive participants2018-09-01220
2017: VIKING DRILL & TOOL INC. WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-09-01222
Total number of active participants reported on line 7a of the Form 55002017-09-01233
Number of retired or separated participants receiving benefits2017-09-014
Number of other retired or separated participants entitled to future benefits2017-09-010
Total of all active and inactive participants2017-09-01237
2016: VIKING DRILL & TOOL INC. WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-09-01235
Total number of active participants reported on line 7a of the Form 55002016-09-01222
Number of retired or separated participants receiving benefits2016-09-014
Number of other retired or separated participants entitled to future benefits2016-09-010
Total of all active and inactive participants2016-09-01226
2015: VIKING DRILL & TOOL INC. WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-09-01206
Total number of active participants reported on line 7a of the Form 55002015-09-01235
Number of retired or separated participants receiving benefits2015-09-011
Number of other retired or separated participants entitled to future benefits2015-09-010
Total of all active and inactive participants2015-09-01236
2014: VIKING DRILL & TOOL INC. WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-09-01178
Total number of active participants reported on line 7a of the Form 55002014-09-01206
Number of retired or separated participants receiving benefits2014-09-010
Number of other retired or separated participants entitled to future benefits2014-09-010
Total of all active and inactive participants2014-09-01206
2013: VIKING DRILL & TOOL INC. WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-09-01180
Total number of active participants reported on line 7a of the Form 55002013-09-01176
Number of retired or separated participants receiving benefits2013-09-012
Number of other retired or separated participants entitled to future benefits2013-09-010
Total of all active and inactive participants2013-09-01178
2011: VIKING DRILL & TOOL INC. WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year2011-09-01172
Total number of active participants reported on line 7a of the Form 55002011-09-01182
Number of retired or separated participants receiving benefits2011-09-016
Total of all active and inactive participants2011-09-01188
2010: VIKING DRILL & TOOL INC. WELFARE BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year2010-09-01158
Total number of active participants reported on line 7a of the Form 55002010-09-01180
Number of retired or separated participants receiving benefits2010-09-015
Number of other retired or separated participants entitled to future benefits2010-09-010
Total of all active and inactive participants2010-09-01185
2009: VIKING DRILL & TOOL INC. WELFARE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year2009-09-01158
Total number of active participants reported on line 7a of the Form 55002009-09-01152
Number of retired or separated participants receiving benefits2009-09-016
Number of other retired or separated participants entitled to future benefits2009-09-010
Total of all active and inactive participants2009-09-01158

Form 5500 Responses for VIKING DRILL & TOOL INC. WELFARE BENEFIT PLAN

2022: VIKING DRILL & TOOL INC. WELFARE BENEFIT PLAN 2022 form 5500 responses
2022-09-01Type of plan entitySingle employer plan
2022-09-01Plan funding arrangement – InsuranceYes
2022-09-01Plan funding arrangement – General assets of the sponsorYes
2022-09-01Plan benefit arrangement – InsuranceYes
2022-09-01Plan benefit arrangement – General assets of the sponsorYes
2021: VIKING DRILL & TOOL INC. WELFARE BENEFIT PLAN 2021 form 5500 responses
2021-09-01Type of plan entitySingle employer plan
2021-09-01Plan funding arrangement – InsuranceYes
2021-09-01Plan funding arrangement – General assets of the sponsorYes
2021-09-01Plan benefit arrangement – InsuranceYes
2021-09-01Plan benefit arrangement – General assets of the sponsorYes
2020: VIKING DRILL & TOOL INC. WELFARE BENEFIT PLAN 2020 form 5500 responses
2020-09-01Type of plan entitySingle employer plan
2020-09-01Plan funding arrangement – InsuranceYes
2020-09-01Plan funding arrangement – General assets of the sponsorYes
2020-09-01Plan benefit arrangement – InsuranceYes
2020-09-01Plan benefit arrangement – General assets of the sponsorYes
2019: VIKING DRILL & TOOL INC. WELFARE BENEFIT PLAN 2019 form 5500 responses
2019-09-01Type of plan entitySingle employer plan
2019-09-01Plan funding arrangement – InsuranceYes
2019-09-01Plan funding arrangement – General assets of the sponsorYes
2019-09-01Plan benefit arrangement – InsuranceYes
2019-09-01Plan benefit arrangement – General assets of the sponsorYes
2018: VIKING DRILL & TOOL INC. WELFARE BENEFIT PLAN 2018 form 5500 responses
2018-09-01Type of plan entitySingle employer plan
2018-09-01Plan funding arrangement – InsuranceYes
2018-09-01Plan funding arrangement – General assets of the sponsorYes
2018-09-01Plan benefit arrangement – InsuranceYes
2018-09-01Plan benefit arrangement – General assets of the sponsorYes
2017: VIKING DRILL & TOOL INC. WELFARE BENEFIT PLAN 2017 form 5500 responses
2017-09-01Type of plan entitySingle employer plan
2017-09-01Plan funding arrangement – InsuranceYes
2017-09-01Plan funding arrangement – General assets of the sponsorYes
2017-09-01Plan benefit arrangement – InsuranceYes
2017-09-01Plan benefit arrangement – General assets of the sponsorYes
2016: VIKING DRILL & TOOL INC. WELFARE BENEFIT PLAN 2016 form 5500 responses
2016-09-01Type of plan entitySingle employer plan
2016-09-01Plan funding arrangement – InsuranceYes
2016-09-01Plan funding arrangement – General assets of the sponsorYes
2016-09-01Plan benefit arrangement – InsuranceYes
2016-09-01Plan benefit arrangement – General assets of the sponsorYes
2015: VIKING DRILL & TOOL INC. WELFARE BENEFIT PLAN 2015 form 5500 responses
2015-09-01Type of plan entitySingle employer plan
2015-09-01Plan funding arrangement – InsuranceYes
2015-09-01Plan funding arrangement – General assets of the sponsorYes
2015-09-01Plan benefit arrangement – InsuranceYes
2015-09-01Plan benefit arrangement – General assets of the sponsorYes
2014: VIKING DRILL & TOOL INC. WELFARE BENEFIT PLAN 2014 form 5500 responses
2014-09-01Type of plan entitySingle employer plan
2014-09-01Plan funding arrangement – InsuranceYes
2014-09-01Plan funding arrangement – General assets of the sponsorYes
2014-09-01Plan benefit arrangement – InsuranceYes
2014-09-01Plan benefit arrangement – General assets of the sponsorYes
2013: VIKING DRILL & TOOL INC. WELFARE BENEFIT PLAN 2013 form 5500 responses
2013-09-01Type of plan entitySingle employer plan
2013-09-01Plan funding arrangement – InsuranceYes
2013-09-01Plan funding arrangement – General assets of the sponsorYes
2013-09-01Plan benefit arrangement – InsuranceYes
2013-09-01Plan benefit arrangement – General assets of the sponsorYes
2011: VIKING DRILL & TOOL INC. WELFARE BENEFIT PLAN 2011 form 5500 responses
2011-09-01Type of plan entitySingle employer plan
2011-09-01Plan funding arrangement – InsuranceYes
2011-09-01Plan funding arrangement – General assets of the sponsorYes
2011-09-01Plan benefit arrangement – InsuranceYes
2011-09-01Plan benefit arrangement – General assets of the sponsorYes
2010: VIKING DRILL & TOOL INC. WELFARE BENEFIT PLAN 2010 form 5500 responses
2010-09-01Type of plan entitySingle employer plan
2010-09-01Plan funding arrangement – InsuranceYes
2010-09-01Plan funding arrangement – General assets of the sponsorYes
2010-09-01Plan benefit arrangement – InsuranceYes
2010-09-01Plan benefit arrangement – General assets of the sponsorYes
2009: VIKING DRILL & TOOL INC. WELFARE BENEFIT PLAN 2009 form 5500 responses
2009-09-01Type of plan entitySingle employer plan
2009-09-01This submission is the final filingNo
2009-09-01Plan funding arrangement – InsuranceYes
2009-09-01Plan funding arrangement – General assets of the sponsorYes
2009-09-01Plan benefit arrangement – InsuranceYes
2009-09-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0228613
Policy instance 7
Insurance contract or identification number0228613
Number of Individuals Covered81
Insurance policy start date2022-09-01
Insurance policy end date2023-08-31
Total amount of commissions paid to insurance brokerUSD $3,492
Total amount of fees paid to insurance companyUSD $522
Other welfare benefits providedHOSPITAL
Welfare Benefit Premiums Paid to CarrierUSD $24,756
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,164
Amount paid for insurance broker fees224
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
HEALTHPARTNERS INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 44547 )
Policy contract number3431
Policy instance 1
Insurance contract or identification number3431
Number of Individuals Covered432
Insurance policy start date2022-09-01
Insurance policy end date2023-08-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $88,912
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,547,082
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees88795
Additional information about fees paid to insurance brokerBROKER SERVICE FEE
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGVTL0BK7J
Policy instance 2
Insurance contract or identification numberGVTL0BK7J
Number of Individuals Covered121
Insurance policy start date2022-09-01
Insurance policy end date2023-09-01
Total amount of commissions paid to insurance brokerUSD $5,330
Total amount of fees paid to insurance companyUSD $2,812
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $35,535
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,330
Insurance broker organization code?3
Amount paid for insurance broker fees2812
Additional information about fees paid to insurance brokerOTHER COMPENSATION
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0216814
Policy instance 3
Insurance contract or identification number0216814
Number of Individuals Covered135
Insurance policy start date2022-09-01
Insurance policy end date2023-08-31
Total amount of commissions paid to insurance brokerUSD $2,568
Total amount of fees paid to insurance companyUSD $276
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedGROUP ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $23,183
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,605
Amount paid for insurance broker fees106
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0216813
Policy instance 4
Insurance contract or identification number0216813
Number of Individuals Covered96
Insurance policy start date2022-09-01
Insurance policy end date2023-08-31
Total amount of commissions paid to insurance brokerUSD $3,823
Total amount of fees paid to insurance companyUSD $369
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedCRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $34,311
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,389
Amount paid for insurance broker fees159
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0BK7J
Policy instance 5
Insurance contract or identification numberGLUG0BK7J
Number of Individuals Covered247
Insurance policy start date2022-09-01
Insurance policy end date2023-09-01
Total amount of commissions paid to insurance brokerUSD $7,340
Total amount of fees paid to insurance companyUSD $3,374
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $48,936
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,340
Insurance broker organization code?3
Amount paid for insurance broker fees3374
Additional information about fees paid to insurance brokerOTHER COMPENSATION
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUSIBBK7J
Policy instance 6
Insurance contract or identification numberGUSIBBK7J
Number of Individuals Covered246
Insurance policy start date2022-09-01
Insurance policy end date2023-09-01
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $6,841
Temporary Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees6299
Additional information about fees paid to insurance brokerADMINISTRATION
Insurance broker organization code?5
HEALTHPARTNERS INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 44547 )
Policy contract number3431
Policy instance 1
Insurance contract or identification number3431
Number of Individuals Covered459
Insurance policy start date2021-09-01
Insurance policy end date2022-08-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $84,490
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,385,333
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees84366
Additional information about fees paid to insurance brokerBROKER SERVICE FEE
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGVTL0BK7J
Policy instance 2
Insurance contract or identification numberGVTL0BK7J
Number of Individuals Covered124
Insurance policy start date2021-09-01
Insurance policy end date2022-09-01
Total amount of commissions paid to insurance brokerUSD $5,287
Total amount of fees paid to insurance companyUSD $2,814
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $35,245
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,287
Insurance broker organization code?3
Amount paid for insurance broker fees2814
Additional information about fees paid to insurance brokerOTHER COMPENSATION
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0216814
Policy instance 3
Insurance contract or identification number0216814
Number of Individuals Covered138
Insurance policy start date2021-09-01
Insurance policy end date2022-08-31
Total amount of commissions paid to insurance brokerUSD $2,359
Total amount of fees paid to insurance companyUSD $273
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedGROUP ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $24,792
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,430
Amount paid for insurance broker fees114
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0216813
Policy instance 4
Insurance contract or identification number0216813
Number of Individuals Covered101
Insurance policy start date2021-09-01
Insurance policy end date2022-08-31
Total amount of commissions paid to insurance brokerUSD $3,124
Total amount of fees paid to insurance companyUSD $350
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedCRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $35,975
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,887
Amount paid for insurance broker fees171
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0BK7J
Policy instance 5
Insurance contract or identification numberGLUG0BK7J
Number of Individuals Covered248
Insurance policy start date2021-09-01
Insurance policy end date2022-09-01
Total amount of commissions paid to insurance brokerUSD $5,883
Total amount of fees paid to insurance companyUSD $2,973
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $39,223
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,883
Insurance broker organization code?3
Amount paid for insurance broker fees2973
Additional information about fees paid to insurance brokerOTHER COMPENSATION
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUSIBBK7J
Policy instance 6
Insurance contract or identification numberGUSIBBK7J
Number of Individuals Covered248
Insurance policy start date2021-09-01
Insurance policy end date2022-09-01
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $6,780
Temporary Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees6239
Additional information about fees paid to insurance brokerADMINISTRATION
Insurance broker organization code?5
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0228613
Policy instance 7
Insurance contract or identification number0228613
Number of Individuals Covered79
Insurance policy start date2021-09-01
Insurance policy end date2022-08-31
Total amount of commissions paid to insurance brokerUSD $3,641
Total amount of fees paid to insurance companyUSD $1,080
Other welfare benefits providedHOSPITAL
Welfare Benefit Premiums Paid to CarrierUSD $24,444
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,126
Amount paid for insurance broker fees436
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0228613
Policy instance 8
Insurance contract or identification number0228613
Number of Individuals Covered85
Insurance policy start date2020-09-01
Insurance policy end date2021-08-31
Total amount of commissions paid to insurance brokerUSD $15,557
Total amount of fees paid to insurance companyUSD $116
Other welfare benefits providedHOSPITAL
Welfare Benefit Premiums Paid to CarrierUSD $21,971
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,340
Amount paid for insurance broker fees116
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0BK7J
Policy instance 6
Insurance contract or identification numberGLUG0BK7J
Number of Individuals Covered241
Insurance policy start date2020-09-01
Insurance policy end date2021-09-01
Total amount of commissions paid to insurance brokerUSD $5,361
Total amount of fees paid to insurance companyUSD $2,864
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $35,744
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,595
Insurance broker organization code?3
Amount paid for insurance broker fees2864
Additional information about fees paid to insurance brokerOTHER COMPENSATION
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0216813
Policy instance 5
Insurance contract or identification number0216813
Number of Individuals Covered114
Insurance policy start date2020-09-01
Insurance policy end date2021-08-31
Total amount of commissions paid to insurance brokerUSD $9,087
Total amount of fees paid to insurance companyUSD $75
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedCRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $36,802
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,556
Insurance broker organization code?3
Amount paid for insurance broker fees44
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0216814
Policy instance 4
Insurance contract or identification number0216814
Number of Individuals Covered146
Insurance policy start date2020-09-01
Insurance policy end date2021-08-31
Total amount of commissions paid to insurance brokerUSD $6,451
Total amount of fees paid to insurance companyUSD $62
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedGROUP ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $26,132
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,945
Insurance broker organization code?3
Amount paid for insurance broker fees40
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGVTL0BK7J
Policy instance 3
Insurance contract or identification numberGVTL0BK7J
Number of Individuals Covered110
Insurance policy start date2020-09-01
Insurance policy end date2021-09-01
Total amount of commissions paid to insurance brokerUSD $5,295
Total amount of fees paid to insurance companyUSD $2,812
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $35,294
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,492
Insurance broker organization code?3
Amount paid for insurance broker fees2812
Additional information about fees paid to insurance brokerOTHER COMPENSATION
HEALTHPARTNERS INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 44547 )
Policy contract number3431
Policy instance 2
Insurance contract or identification number3431
Number of Individuals Covered444
Insurance policy start date2020-09-01
Insurance policy end date2021-08-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $47,061
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,642,139
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees46941
Additional information about fees paid to insurance brokerBROKER SERVICE FEE
Insurance broker organization code?3
DELTA DENTAL PLAN OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number335680
Policy instance 1
Insurance contract or identification number335680
Number of Individuals Covered486
Insurance policy start date2020-09-01
Insurance policy end date2021-08-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUSIBBK7J
Policy instance 7
Insurance contract or identification numberGUSIBBK7J
Number of Individuals Covered241
Insurance policy start date2020-09-01
Insurance policy end date2021-09-01
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $6,129
Temporary Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees5593
Additional information about fees paid to insurance brokerADMINISTRATION
Insurance broker organization code?5
DELTA DENTAL PLAN OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number335680
Policy instance 1
Insurance contract or identification number335680
Number of Individuals Covered480
Insurance policy start date2019-09-01
Insurance policy end date2020-08-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
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 number3431
Policy instance 2
Insurance contract or identification number3431
Number of Individuals Covered456
Insurance policy start date2019-09-01
Insurance policy end date2020-08-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $89,240
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,631,172
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees89117
Additional information about fees paid to insurance brokerBROKER SERVICE FEE
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGVTL0BK7J
Policy instance 3
Insurance contract or identification numberGVTL0BK7J
Number of Individuals Covered115
Insurance policy start date2019-06-01
Insurance policy end date2020-06-01
Total amount of commissions paid to insurance brokerUSD $4,962
Total amount of fees paid to insurance companyUSD $891
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $33,079
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,962
Insurance broker organization code?3
Amount paid for insurance broker fees480
Additional information about fees paid to insurance brokerOTHER COMPENSATION
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0216814
Policy instance 4
Insurance contract or identification number0216814
Number of Individuals Covered246
Insurance policy start date2019-09-01
Insurance policy end date2020-08-31
Total amount of commissions paid to insurance brokerUSD $14,004
Total amount of fees paid to insurance companyUSD $148
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedGROUP ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $22,892
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,402
Insurance broker organization code?3
Amount paid for insurance broker fees148
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0216813
Policy instance 5
Insurance contract or identification number0216813
Number of Individuals Covered150
Insurance policy start date2019-09-01
Insurance policy end date2020-08-31
Total amount of commissions paid to insurance brokerUSD $21,595
Total amount of fees paid to insurance companyUSD $186
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedCRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $32,010
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,957
Insurance broker organization code?5
Amount paid for insurance broker fees186
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0BK7J
Policy instance 6
Insurance contract or identification numberGLUG0BK7J
Number of Individuals Covered241
Insurance policy start date2019-06-01
Insurance policy end date2020-06-01
Total amount of commissions paid to insurance brokerUSD $5,343
Total amount of fees paid to insurance companyUSD $1,352
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $35,622
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,343
Insurance broker organization code?3
Amount paid for insurance broker fees728
Additional information about fees paid to insurance brokerOTHER COMPENSATION
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUSIBBK7J
Policy instance 7
Insurance contract or identification numberGUSIBBK7J
Number of Individuals Covered241
Insurance policy start date2019-06-01
Insurance policy end date2020-06-01
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $6,943
Temporary Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees6690
Additional information about fees paid to insurance brokerADMINISTRATION
Insurance broker organization code?5
DELTA DENTAL PLAN OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number226447
Policy instance 1
Insurance contract or identification number226447
Number of Individuals Covered491
Insurance policy start date2018-09-01
Insurance policy end date2019-08-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
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 number0216813
Policy instance 7
Insurance contract or identification number0216813
Number of Individuals Covered90
Insurance policy start date2018-09-01
Insurance policy end date2019-08-31
Total amount of commissions paid to insurance brokerUSD $19,302
Total amount of fees paid to insurance companyUSD $1,185
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedCRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $35,457
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,581
Amount paid for insurance broker fees638
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0216814
Policy instance 6
Insurance contract or identification number0216814
Number of Individuals Covered120
Insurance policy start date2018-09-01
Insurance policy end date2019-08-31
Total amount of commissions paid to insurance brokerUSD $14,892
Total amount of fees paid to insurance companyUSD $287
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedGROUP ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $24,868
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,935
Amount paid for insurance broker fees152
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract number
Policy instance 5
Number of Individuals Covered236
Insurance policy start date2018-09-01
Insurance policy end date2019-08-31
Total amount of commissions paid to insurance brokerUSD $1,340
Total amount of fees paid to insurance companyUSD $1,676
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $8,931
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees1676
Additional information about fees paid to insurance brokerADMINISTRATION
Insurance broker organization code?5
Commission paid to Insurance BrokerUSD $1,340
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number101385001
Policy instance 4
Insurance contract or identification number101385001
Number of Individuals Covered158
Insurance policy start date2018-09-01
Insurance policy end date2019-08-31
Total amount of commissions paid to insurance brokerUSD $5,439
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $32,501
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,900
Insurance broker organization code?3
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number101385001
Policy instance 3
Insurance contract or identification number101385001
Number of Individuals Covered128
Insurance policy start date2018-09-01
Insurance policy end date2019-08-31
Total amount of commissions paid to insurance brokerUSD $3,831
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $19,345
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,902
Insurance broker organization code?3
HEALTHPARTNERS INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 44547 )
Policy contract number3431
Policy instance 2
Insurance contract or identification number3431
Number of Individuals Covered448
Insurance policy start date2018-09-01
Insurance policy end date2019-08-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $53,757
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,705,798
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees53636
Additional information about fees paid to insurance brokerBROKER SERVICE FEE
Insurance broker organization code?3
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number101771701
Policy instance 5
Insurance contract or identification number101771701
Number of Individuals Covered228
Insurance policy start date2017-09-01
Insurance policy end date2018-08-31
Total amount of commissions paid to insurance brokerUSD $3,477
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $21,733
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number101771701
Policy instance 4
Insurance contract or identification number101771701
Number of Individuals Covered110
Insurance policy start date2017-09-01
Insurance policy end date2018-08-31
Total amount of commissions paid to insurance brokerUSD $3,855
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $20,293
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 number3431
Policy instance 3
Insurance contract or identification number3431
Number of Individuals Covered442
Insurance policy start date2017-09-01
Insurance policy end date2018-08-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $50,752
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,311,311
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL PLAN OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number226447
Policy instance 2
Insurance contract or identification number226447
Number of Individuals Covered458
Insurance policy start date2017-09-01
Insurance policy end date2018-08-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number101385001
Policy instance 1
Insurance contract or identification number101385001
Number of Individuals Covered233
Insurance policy start date2017-09-01
Insurance policy end date2018-08-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $6,540
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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