WEILER, INC. has sponsored the creation of one or more 401k plans.
Additional information about WEILER, INC.
Submission information for form 5500 for 401k plan WEILER, INC. HEALTH & WELFARE PLAN
401k plan membership statisitcs for WEILER, INC. HEALTH & WELFARE PLAN
| Measure | Date | Value |
|---|
| 2021: WEILER, INC. HEALTH & WELFARE PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-09-01 | 744 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-09-01 | 404 |
| Number of retired or separated participants receiving benefits | 2021-09-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-09-01 | 0 |
| Total of all active and inactive participants | 2021-09-01 | 404 |
| 2020: WEILER, INC. HEALTH & WELFARE PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-09-01 | 724 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-09-01 | 744 |
| Number of retired or separated participants receiving benefits | 2020-09-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2020-09-01 | 0 |
| Total of all active and inactive participants | 2020-09-01 | 744 |
| 2019: WEILER, INC. HEALTH & WELFARE PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-09-01 | 685 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-09-01 | 724 |
| Number of retired or separated participants receiving benefits | 2019-09-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-09-01 | 0 |
| Total of all active and inactive participants | 2019-09-01 | 724 |
| 2018: WEILER, INC. HEALTH & WELFARE PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-09-01 | 1,291 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-09-01 | 685 |
| Number of retired or separated participants receiving benefits | 2018-09-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-09-01 | 0 |
| Total of all active and inactive participants | 2018-09-01 | 685 |
| 2017: WEILER, INC. HEALTH & WELFARE PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-09-01 | 1,023 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-09-01 | 1,291 |
| Number of retired or separated participants receiving benefits | 2017-09-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-09-01 | 0 |
| Total of all active and inactive participants | 2017-09-01 | 1,291 |
| 2016: WEILER, INC. HEALTH & WELFARE PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-09-01 | 805 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-09-01 | 1,023 |
| Number of retired or separated participants receiving benefits | 2016-09-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2016-09-01 | 0 |
| Total of all active and inactive participants | 2016-09-01 | 1,023 |
| 2015: WEILER, INC. HEALTH & WELFARE PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-09-01 | 100 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-09-01 | 805 |
| Number of retired or separated participants receiving benefits | 2015-09-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2015-09-01 | 0 |
| Total of all active and inactive participants | 2015-09-01 | 805 |
| 2014: WEILER, INC. HEALTH & WELFARE PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-09-01 | 100 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-09-01 | 100 |
| Number of retired or separated participants receiving benefits | 2014-09-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2014-09-01 | 0 |
| Total of all active and inactive participants | 2014-09-01 | 100 |
| 2013: WEILER, INC. HEALTH & WELFARE PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-09-01 | 54 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-09-01 | 100 |
| Number of retired or separated participants receiving benefits | 2013-09-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2013-09-01 | 0 |
| Total of all active and inactive participants | 2013-09-01 | 100 |
| WELLMARK BLUE CROSS BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 88848 ) |
| Policy contract number | 00022060 |
| Policy instance | 3 |
| Insurance contract or identification number | 00022060 | | Number of Individuals Covered | 404 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-08-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,780,860 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VERATRUS BUSINESS SOLUTIONS (National Association of Insurance Commissioners NAIC id number: 13742 ) |
| Policy contract number | 41462 |
| Policy instance | 10 |
| Insurance contract or identification number | 41462 | | Number of Individuals Covered | 374 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-08-31 | | Total amount of commissions paid to insurance broker | USD $4,739 | | Total amount of fees paid to insurance company | USD $2,895 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $47,411 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,739 | | Amount paid for insurance broker fees | 2895 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000484J |
| Policy instance | 1 |
| Insurance contract or identification number | G000484J | | Number of Individuals Covered | 386 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-08-31 | | Total amount of commissions paid to insurance broker | USD $1,456 | | Total amount of fees paid to insurance company | USD $654 | | Other welfare benefits provided | OTHER (AD&D - VOLUNTARY) | | Welfare Benefit Premiums Paid to Carrier | USD $14,561 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,456 | | Amount paid for insurance broker fees | 654 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000484J |
| Policy instance | 2 |
| Insurance contract or identification number | G000484J | | Number of Individuals Covered | 204 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-08-31 | | Total amount of commissions paid to insurance broker | USD $4,679 | | Total amount of fees paid to insurance company | USD $324 | | Other welfare benefits provided | OTHER (AD&D) | | Welfare Benefit Premiums Paid to Carrier | USD $31,195 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,679 | | Amount paid for insurance broker fees | 324 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000484J |
| Policy instance | 4 |
| Insurance contract or identification number | G000484J | | Number of Individuals Covered | 213 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-08-31 | | Total amount of commissions paid to insurance broker | USD $7,145 | | Total amount of fees paid to insurance company | USD $1,973 | | Other welfare benefits provided | OTHER (LTD VOLUNTARY) | | Welfare Benefit Premiums Paid to Carrier | USD $47,636 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,145 | | Amount paid for insurance broker fees | 1973 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000484J |
| Policy instance | 5 |
| Insurance contract or identification number | G000484J | | Number of Individuals Covered | 301 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-08-31 | | Total amount of commissions paid to insurance broker | USD $21,535 | | Total amount of fees paid to insurance company | USD $5,634 | | Other welfare benefits provided | OTHER (STD VOLUNTARY) | | Welfare Benefit Premiums Paid to Carrier | USD $143,569 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $21,535 | | Amount paid for insurance broker fees | 5634 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000484J |
| Policy instance | 6 |
| Insurance contract or identification number | G000484J | | Number of Individuals Covered | 149 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-08-31 | | Total amount of commissions paid to insurance broker | USD $6,517 | | Total amount of fees paid to insurance company | USD $456 | | Other welfare benefits provided | OTHER (CRITICAL ILLNESS VOLUNTARY) | | Welfare Benefit Premiums Paid to Carrier | USD $43,446 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,517 | | Amount paid for insurance broker fees | 456 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000484J |
| Policy instance | 7 |
| Insurance contract or identification number | G000484J | | Number of Individuals Covered | 233 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-08-31 | | Total amount of commissions paid to insurance broker | USD $6,737 | | Total amount of fees paid to insurance company | USD $2,558 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | OTHER (AD&D VOLUNTARY) | | Welfare Benefit Premiums Paid to Carrier | USD $57,287 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,737 | | Amount paid for insurance broker fees | 2558 | | Insurance broker organization code? | 3 |
|
| WELLMARK HEALTH PLAN OF IOWA (National Association of Insurance Commissioners NAIC id number: 95531 ) |
| Policy contract number | 00022060 |
| Policy instance | 8 |
| Insurance contract or identification number | 00022060 | | Number of Individuals Covered | 17 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-08-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $123,440 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF IOWA (National Association of Insurance Commissioners NAIC id number: 55786 ) |
| Policy contract number | 41462 |
| Policy instance | 9 |
| Insurance contract or identification number | 41462 | | Number of Individuals Covered | 417 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-08-31 | | Total amount of commissions paid to insurance broker | USD $7,653 | | Total amount of fees paid to insurance company | USD $3,948 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $248,618 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,653 | | Amount paid for insurance broker fees | 3948 | | Insurance broker organization code? | 3 |
|
| WELLMARK BLUE CROSS BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 88848 ) |
| Policy contract number | 00022060 |
| Policy instance | 3 |
| Insurance contract or identification number | 00022060 | | Number of Individuals Covered | 390 | | Insurance policy start date | 2020-09-01 | | Insurance policy end date | 2021-08-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,987,735 | | 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 number | G000484J |
| Policy instance | 2 |
| Insurance contract or identification number | G000484J | | Number of Individuals Covered | 234 | | Insurance policy start date | 2020-09-01 | | Insurance policy end date | 2021-09-01 | | Total amount of commissions paid to insurance broker | USD $6,743 | | Total amount of fees paid to insurance company | USD $2,371 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | OTHER (AD&D) | | Welfare Benefit Premiums Paid to Carrier | USD $57,384 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,743 | | Amount paid for insurance broker fees | 2371 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000484J |
| Policy instance | 1 |
| Insurance contract or identification number | G000484J | | Number of Individuals Covered | 370 | | Insurance policy start date | 2020-09-01 | | Insurance policy end date | 2021-08-31 | | Total amount of commissions paid to insurance broker | USD $1,490 | | Total amount of fees paid to insurance company | USD $640 | | Other welfare benefits provided | OTHER (AD&D - VOLUNTARY) | | Welfare Benefit Premiums Paid to Carrier | USD $14,903 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,490 | | Amount paid for insurance broker fees | 640 | | Insurance broker organization code? | 3 |
|
| WELLMARK HEALTH PLAN OF IOWA (National Association of Insurance Commissioners NAIC id number: 95531 ) |
| Policy contract number | 00022060 |
| Policy instance | 9 |
| Insurance contract or identification number | 00022060 | | Number of Individuals Covered | 15 | | Insurance policy start date | 2020-09-01 | | Insurance policy end date | 2021-08-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $72,136 | | 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 number | G000484J |
| Policy instance | 4 |
| Insurance contract or identification number | G000484J | | Number of Individuals Covered | 221 | | Insurance policy start date | 2020-09-01 | | Insurance policy end date | 2021-09-01 | | Total amount of commissions paid to insurance broker | USD $6,191 | | Total amount of fees paid to insurance company | USD $1,574 | | Other welfare benefits provided | OTHER (LTD VOLUNTARY) | | Welfare Benefit Premiums Paid to Carrier | USD $41,276 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,191 | | Amount paid for insurance broker fees | 1574 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000484J |
| Policy instance | 5 |
| Insurance contract or identification number | G000484J | | Number of Individuals Covered | 280 | | Insurance policy start date | 2020-09-01 | | Insurance policy end date | 2021-09-01 | | Total amount of commissions paid to insurance broker | USD $17,045 | | Total amount of fees paid to insurance company | USD $4,258 | | Other welfare benefits provided | OTHER (STD VOLUNTARY) | | Welfare Benefit Premiums Paid to Carrier | USD $113,634 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $17,045 | | Amount paid for insurance broker fees | 4258 | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0217276 |
| Policy instance | 6 |
| Insurance contract or identification number | 0217276 | | Number of Individuals Covered | 279 | | Insurance policy start date | 2020-09-01 | | Insurance policy end date | 2021-08-31 | | Total amount of commissions paid to insurance broker | USD $10,185 | | Total amount of fees paid to insurance company | USD $577 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $51,908 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,185 | | Amount paid for insurance broker fees | 577 | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 5994680 |
| Policy instance | 7 |
| Insurance contract or identification number | 5994680 | | Number of Individuals Covered | 744 | | Insurance policy start date | 2020-09-01 | | Insurance policy end date | 2021-08-31 | | Total amount of commissions paid to insurance broker | USD $10,291 | | Total amount of fees paid to insurance company | USD $42 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $277,816 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,291 | | Amount paid for insurance broker fees | 42 | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0217275 |
| Policy instance | 8 |
| Insurance contract or identification number | 0217275 | | Number of Individuals Covered | 493 | | Insurance policy start date | 2020-09-01 | | Insurance policy end date | 2021-08-31 | | Total amount of commissions paid to insurance broker | USD $5,362 | | Total amount of fees paid to insurance company | USD $154 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $22,714 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,362 | | Amount paid for insurance broker fees | 154 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000484J |
| Policy instance | 2 |
| Insurance contract or identification number | G000484J | | Number of Individuals Covered | 407 | | Insurance policy start date | 2019-09-01 | | Insurance policy end date | 2020-09-01 | | Total amount of commissions paid to insurance broker | USD $1,588 | | Total amount of fees paid to insurance company | USD $586 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | OTHER (AD&D) | | Welfare Benefit Premiums Paid to Carrier | USD $15,875 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| WELLMARK HEALTH PLAN OF IOWA (National Association of Insurance Commissioners NAIC id number: 95531 ) |
| Policy contract number | 00022060 |
| Policy instance | 9 |
| Insurance contract or identification number | 00022060 | | Number of Individuals Covered | 7 | | Insurance policy start date | 2019-09-01 | | Insurance policy end date | 2020-08-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $44,816 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0217275 |
| Policy instance | 8 |
| Insurance contract or identification number | 0217275 | | Number of Individuals Covered | 496 | | Insurance policy start date | 2019-09-01 | | Insurance policy end date | 2020-08-31 | | Total amount of commissions paid to insurance broker | USD $5,306 | | Total amount of fees paid to insurance company | USD $109 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $30,317 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 5994680 |
| Policy instance | 7 |
| Insurance contract or identification number | 5994680 | | Number of Individuals Covered | 724 | | Insurance policy start date | 2019-09-01 | | Insurance policy end date | 2020-08-31 | | Total amount of commissions paid to insurance broker | USD $10,562 | | Total amount of fees paid to insurance company | USD $28 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $278,468 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0217276 |
| Policy instance | 6 |
| Insurance contract or identification number | 0217276 | | Number of Individuals Covered | 247 | | Insurance policy start date | 2019-09-01 | | Insurance policy end date | 2020-08-31 | | Total amount of commissions paid to insurance broker | USD $8,982 | | Total amount of fees paid to insurance company | USD $650 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $48,653 | | 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 number | G000484J |
| Policy instance | 5 |
| Insurance contract or identification number | G000484J | | Number of Individuals Covered | 238 | | Insurance policy start date | 2019-09-01 | | Insurance policy end date | 2020-09-01 | | Total amount of commissions paid to insurance broker | USD $15,610 | | Total amount of fees paid to insurance company | USD $3,868 | | Other welfare benefits provided | OTHER (STD VOLUNTARY) | | Welfare Benefit Premiums Paid to Carrier | USD $104,066 | | 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 number | G000484J |
| Policy instance | 4 |
| Insurance contract or identification number | G000484J | | Number of Individuals Covered | 184 | | Insurance policy start date | 2019-09-01 | | Insurance policy end date | 2020-09-01 | | Total amount of commissions paid to insurance broker | USD $5,734 | | Total amount of fees paid to insurance company | USD $1,475 | | Other welfare benefits provided | OTHER (LTD VOLUNTARY) | | Welfare Benefit Premiums Paid to Carrier | USD $38,227 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| WELLMARK BLUE CROSS BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 88848 ) |
| Policy contract number | 00022060 |
| Policy instance | 3 |
| Insurance contract or identification number | 00022060 | | Number of Individuals Covered | 358 | | Insurance policy start date | 2019-09-01 | | Insurance policy end date | 2020-08-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,743,953 | | 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 number | G000484J |
| Policy instance | 1 |
| Insurance contract or identification number | G000484J | | Number of Individuals Covered | 254 | | Insurance policy start date | 2019-09-01 | | Insurance policy end date | 2020-09-01 | | Total amount of commissions paid to insurance broker | USD $6,771 | | Total amount of fees paid to insurance company | USD $2,150 | | Other welfare benefits provided | OTHER (AD&D - VOLUNTARY) | | Welfare Benefit Premiums Paid to Carrier | USD $57,855 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | KM05994680 |
| Policy instance | 1 |
| Insurance contract or identification number | KM05994680 | | Number of Individuals Covered | 685 | | Insurance policy start date | 2018-09-01 | | Insurance policy end date | 2019-08-31 | | Total amount of commissions paid to insurance broker | USD $11,981 | | Total amount of fees paid to insurance company | USD $47 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $297,649 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,981 | | Amount paid for insurance broker fees | 47 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000484J |
| Policy instance | 2 |
| Insurance contract or identification number | G000484J | | Number of Individuals Covered | 264 | | Insurance policy start date | 2018-09-01 | | Insurance policy end date | 2019-09-01 | | Total amount of commissions paid to insurance broker | USD $6,505 | | Total amount of fees paid to insurance company | USD $2,034 | | Other welfare benefits provided | OTHER (AD&D - VOLUNTARY) | | Welfare Benefit Premiums Paid to Carrier | USD $53,411 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,505 | | Amount paid for insurance broker fees | 2034 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000484J |
| Policy instance | 3 |
| Insurance contract or identification number | G000484J | | Number of Individuals Covered | 424 | | Insurance policy start date | 2018-09-01 | | Insurance policy end date | 2019-09-01 | | Total amount of commissions paid to insurance broker | USD $1,459 | | Total amount of fees paid to insurance company | USD $561 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | OTHER (AD&D) | | Welfare Benefit Premiums Paid to Carrier | USD $14,588 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,459 | | Amount paid for insurance broker fees | 561 | | Insurance broker organization code? | 3 |
|
| WELLMARK BLUE CROSS BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 88848 ) |
| Policy contract number | 00022060 |
| Policy instance | 4 |
| Insurance contract or identification number | 00022060 | | Number of Individuals Covered | 402 | | Insurance policy start date | 2018-09-01 | | Insurance policy end date | 2019-08-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,658,389 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000484J |
| Policy instance | 5 |
| Insurance contract or identification number | G000484J | | Number of Individuals Covered | 217 | | Insurance policy start date | 2018-09-01 | | Insurance policy end date | 2019-09-01 | | Total amount of commissions paid to insurance broker | USD $5,830 | | Total amount of fees paid to insurance company | USD $497 | | Other welfare benefits provided | OTHER (LTD VOLUNTARY) | | Welfare Benefit Premiums Paid to Carrier | USD $38,867 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,830 | | Amount paid for insurance broker fees | 497 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000484J |
| Policy instance | 6 |
| Insurance contract or identification number | G000484J | | Number of Individuals Covered | 244 | | Insurance policy start date | 2018-09-01 | | Insurance policy end date | 2019-09-01 | | Total amount of commissions paid to insurance broker | USD $14,716 | | Total amount of fees paid to insurance company | USD $1,189 | | Other welfare benefits provided | OTHER (STD VOLUNTARY) | | Welfare Benefit Premiums Paid to Carrier | USD $98,108 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $14,716 | | Amount paid for insurance broker fees | 1189 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000484J |
| Policy instance | 2 |
| Insurance contract or identification number | G000484J | | Number of Individuals Covered | 206 | | Insurance policy start date | 2017-09-01 | | Insurance policy end date | 2018-09-01 | | Total amount of commissions paid to insurance broker | USD $5,520 | | Total amount of fees paid to insurance company | USD $2,189 | | Other welfare benefits provided | OTHER (LIFE - VOLUNTARY) | | Welfare Benefit Premiums Paid to Carrier | USD $41,339 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,520 | | Amount paid for insurance broker fees | 2189 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000484J |
| Policy instance | 3 |
| Insurance contract or identification number | G000484J | | Number of Individuals Covered | 329 | | Insurance policy start date | 2017-09-01 | | Insurance policy end date | 2018-09-01 | | Total amount of commissions paid to insurance broker | USD $1,159 | | Total amount of fees paid to insurance company | USD $654 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | OTHER (AD&D) | | Welfare Benefit Premiums Paid to Carrier | USD $11,588 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,159 | | Amount paid for insurance broker fees | 654 | | Insurance broker organization code? | 3 |
|
| WELLMARK BLUE CROSS BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 88848 ) |
| Policy contract number | 00022060 |
| Policy instance | 4 |
| Insurance contract or identification number | 00022060 | | Number of Individuals Covered | 382 | | Insurance policy start date | 2017-09-01 | | Insurance policy end date | 2018-08-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,294,167 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | KM05994680 |
| Policy instance | 1 |
| Insurance contract or identification number | KM05994680 | | Number of Individuals Covered | 1291 | | Insurance policy start date | 2017-09-01 | | Insurance policy end date | 2018-08-31 | | Total amount of commissions paid to insurance broker | USD $9,044 | | Total amount of fees paid to insurance company | USD $45 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $245,296 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,044 | | Amount paid for insurance broker fees | 45 | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | KM05994680 |
| Policy instance | 1 |
| Insurance contract or identification number | KM05994680 | | Number of Individuals Covered | 1023 | | Insurance policy start date | 2016-09-01 | | Insurance policy end date | 2017-08-31 | | Total amount of commissions paid to insurance broker | USD $8,809 | | Total amount of fees paid to insurance company | USD $21 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $231,359 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,809 | | Amount paid for insurance broker fees | 21 | | Insurance broker organization code? | 3 |
|
| WELLMARK BLUE CROSS BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 88848 ) |
| Policy contract number | 00022060 |
| Policy instance | 3 |
| Insurance contract or identification number | 00022060 | | Number of Individuals Covered | 321 | | Insurance policy start date | 2016-09-01 | | Insurance policy end date | 2017-08-31 | | Total amount of commissions paid to insurance broker | USD $63,626 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,900,296 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $63,626 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000484J |
| Policy instance | 2 |
| Insurance contract or identification number | G000484J | | Number of Individuals Covered | 292 | | Insurance policy start date | 2016-09-01 | | Insurance policy end date | 2017-09-01 | | Total amount of commissions paid to insurance broker | USD $1,010 | | Total amount of fees paid to insurance company | USD $272 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | OTHER (AD&D) | | Welfare Benefit Premiums Paid to Carrier | USD $10,100 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,010 | | Amount paid for insurance broker fees | 272 | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | KM05994680 |
| Policy instance | 1 |
| Insurance contract or identification number | KM05994680 | | Number of Individuals Covered | 805 | | Insurance policy start date | 2015-09-01 | | Insurance policy end date | 2016-08-31 | | Total amount of commissions paid to insurance broker | USD $8,520 | | Total amount of fees paid to insurance company | USD $2,066 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $153,402 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,520 | | Amount paid for insurance broker fees | 2066 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000484J |
| Policy instance | 2 |
| Insurance contract or identification number | G000484J | | Number of Individuals Covered | 207 | | Insurance policy start date | 2015-09-01 | | Insurance policy end date | 2016-09-01 | | Total amount of commissions paid to insurance broker | USD $686 | | Total amount of fees paid to insurance company | USD $200 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | OTHER (AD&D) | | Welfare Benefit Premiums Paid to Carrier | USD $6,858 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $686 | | Amount paid for insurance broker fees | 200 | | Insurance broker organization code? | 3 |
|
| WELLMARK BLUE CROSS BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 88848 ) |
| Policy contract number | 00022060 |
| Policy instance | 3 |
| Insurance contract or identification number | 00022060 | | Number of Individuals Covered | 263 | | Insurance policy start date | 2015-09-01 | | Insurance policy end date | 2016-08-31 | | Total amount of commissions paid to insurance broker | USD $64,656 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,515,055 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $64,656 | | Insurance broker organization code? | 3 |
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