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SEPTAGON CONSTRUCTION COMPANY EMPLOYEE BENEFITS PLAN 401k Plan overview

Plan NameSEPTAGON CONSTRUCTION COMPANY EMPLOYEE BENEFITS PLAN
Plan identification number 502

SEPTAGON CONSTRUCTION COMPANY EMPLOYEE BENEFITS PLAN Benefits

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

401k Sponsoring company profile

SEPTAGON CONSTRUCTION COMPANY has sponsored the creation of one or more 401k plans.

Company Name:SEPTAGON CONSTRUCTION COMPANY
Employer identification number (EIN):431234876
NAIC Classification:236200

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SEPTAGON CONSTRUCTION COMPANY EMPLOYEE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022022-02-01KRISTIE SCHEAR2023-08-21
5022021-02-01KRISTIE SCHEAR2022-07-25
5022020-02-01KRISTIE SCHEAR2021-08-10
5022019-02-01KRISTIE SCHEAR2020-08-10
5022018-02-01
5022017-02-01KRISTIE SCHEAR
5022016-02-01KRISTIE SCHEAR
5022015-02-01KRISTIE SCHEAR
5022014-02-01
5022013-02-01
5022012-02-01DAVID J. ALBRECHT
5022011-02-01DAVID J. ALBRECHT
5022009-02-01DAVID J. ALBRECHT

Plan Statistics for SEPTAGON CONSTRUCTION COMPANY EMPLOYEE BENEFITS PLAN

401k plan membership statisitcs for SEPTAGON CONSTRUCTION COMPANY EMPLOYEE BENEFITS PLAN

Measure Date Value
2022: SEPTAGON CONSTRUCTION COMPANY EMPLOYEE BENEFITS PLAN 2022 401k membership
Total participants, beginning-of-year2022-02-01113
Total number of active participants reported on line 7a of the Form 55002022-02-01116
Number of retired or separated participants receiving benefits2022-02-010
Number of other retired or separated participants entitled to future benefits2022-02-010
Total of all active and inactive participants2022-02-01116
Number of employers contributing to the scheme2022-02-010
2021: SEPTAGON CONSTRUCTION COMPANY EMPLOYEE BENEFITS PLAN 2021 401k membership
Total participants, beginning-of-year2021-02-01129
Total number of active participants reported on line 7a of the Form 55002021-02-01113
Number of retired or separated participants receiving benefits2021-02-010
Number of other retired or separated participants entitled to future benefits2021-02-010
Total of all active and inactive participants2021-02-01113
Number of employers contributing to the scheme2021-02-010
2020: SEPTAGON CONSTRUCTION COMPANY EMPLOYEE BENEFITS PLAN 2020 401k membership
Total participants, beginning-of-year2020-02-01131
Total number of active participants reported on line 7a of the Form 55002020-02-01128
Number of retired or separated participants receiving benefits2020-02-011
Number of other retired or separated participants entitled to future benefits2020-02-010
Total of all active and inactive participants2020-02-01129
Number of employers contributing to the scheme2020-02-010
2019: SEPTAGON CONSTRUCTION COMPANY EMPLOYEE BENEFITS PLAN 2019 401k membership
Total participants, beginning-of-year2019-02-01133
Total number of active participants reported on line 7a of the Form 55002019-02-01130
Number of retired or separated participants receiving benefits2019-02-010
Number of other retired or separated participants entitled to future benefits2019-02-010
Total of all active and inactive participants2019-02-01130
Number of employers contributing to the scheme2019-02-010
2018: SEPTAGON CONSTRUCTION COMPANY EMPLOYEE BENEFITS PLAN 2018 401k membership
Total participants, beginning-of-year2018-02-01123
Total number of active participants reported on line 7a of the Form 55002018-02-01132
Number of retired or separated participants receiving benefits2018-02-011
Number of other retired or separated participants entitled to future benefits2018-02-010
Total of all active and inactive participants2018-02-01133
2017: SEPTAGON CONSTRUCTION COMPANY EMPLOYEE BENEFITS PLAN 2017 401k membership
Total participants, beginning-of-year2017-02-01114
Total number of active participants reported on line 7a of the Form 55002017-02-01123
Number of retired or separated participants receiving benefits2017-02-010
Number of other retired or separated participants entitled to future benefits2017-02-010
Total of all active and inactive participants2017-02-01123
2016: SEPTAGON CONSTRUCTION COMPANY EMPLOYEE BENEFITS PLAN 2016 401k membership
Total participants, beginning-of-year2016-02-01123
Total number of active participants reported on line 7a of the Form 55002016-02-01114
Number of retired or separated participants receiving benefits2016-02-010
Number of other retired or separated participants entitled to future benefits2016-02-010
Total of all active and inactive participants2016-02-01114
2015: SEPTAGON CONSTRUCTION COMPANY EMPLOYEE BENEFITS PLAN 2015 401k membership
Total participants, beginning-of-year2015-02-01125
Total number of active participants reported on line 7a of the Form 55002015-02-01122
Number of retired or separated participants receiving benefits2015-02-011
Number of other retired or separated participants entitled to future benefits2015-02-010
Total of all active and inactive participants2015-02-01123
2014: SEPTAGON CONSTRUCTION COMPANY EMPLOYEE BENEFITS PLAN 2014 401k membership
Total participants, beginning-of-year2014-02-01125
Total number of active participants reported on line 7a of the Form 55002014-02-01116
Total of all active and inactive participants2014-02-01116
2013: SEPTAGON CONSTRUCTION COMPANY EMPLOYEE BENEFITS PLAN 2013 401k membership
Total participants, beginning-of-year2013-02-01129
Total number of active participants reported on line 7a of the Form 55002013-02-01125
Total of all active and inactive participants2013-02-01125
2012: SEPTAGON CONSTRUCTION COMPANY EMPLOYEE BENEFITS PLAN 2012 401k membership
Total participants, beginning-of-year2012-02-01143
Total number of active participants reported on line 7a of the Form 55002012-02-01129
Total of all active and inactive participants2012-02-01129
2011: SEPTAGON CONSTRUCTION COMPANY EMPLOYEE BENEFITS PLAN 2011 401k membership
Total participants, beginning-of-year2011-02-01158
Total number of active participants reported on line 7a of the Form 55002011-02-01143
Total of all active and inactive participants2011-02-01143
2009: SEPTAGON CONSTRUCTION COMPANY EMPLOYEE BENEFITS PLAN 2009 401k membership
Total participants, beginning-of-year2009-02-01193
Total number of active participants reported on line 7a of the Form 55002009-02-01163
Total of all active and inactive participants2009-02-01163

Form 5500 Responses for SEPTAGON CONSTRUCTION COMPANY EMPLOYEE BENEFITS PLAN

2022: SEPTAGON CONSTRUCTION COMPANY EMPLOYEE BENEFITS PLAN 2022 form 5500 responses
2022-02-01Type of plan entitySingle employer plan
2022-02-01Plan funding arrangement – InsuranceYes
2022-02-01Plan benefit arrangement – InsuranceYes
2021: SEPTAGON CONSTRUCTION COMPANY EMPLOYEE BENEFITS PLAN 2021 form 5500 responses
2021-02-01Type of plan entitySingle employer plan
2021-02-01Plan funding arrangement – InsuranceYes
2021-02-01Plan benefit arrangement – InsuranceYes
2020: SEPTAGON CONSTRUCTION COMPANY EMPLOYEE BENEFITS PLAN 2020 form 5500 responses
2020-02-01Type of plan entitySingle employer plan
2020-02-01Plan funding arrangement – InsuranceYes
2020-02-01Plan benefit arrangement – InsuranceYes
2019: SEPTAGON CONSTRUCTION COMPANY EMPLOYEE BENEFITS PLAN 2019 form 5500 responses
2019-02-01Type of plan entitySingle employer plan
2019-02-01Plan funding arrangement – InsuranceYes
2019-02-01Plan benefit arrangement – InsuranceYes
2018: SEPTAGON CONSTRUCTION COMPANY EMPLOYEE BENEFITS PLAN 2018 form 5500 responses
2018-02-01Type of plan entitySingle employer plan
2018-02-01Submission has been amendedNo
2018-02-01This submission is the final filingNo
2018-02-01This return/report is a short plan year return/report (less than 12 months)No
2018-02-01Plan is a collectively bargained planNo
2018-02-01Plan funding arrangement – InsuranceYes
2018-02-01Plan benefit arrangement – InsuranceYes
2017: SEPTAGON CONSTRUCTION COMPANY EMPLOYEE BENEFITS PLAN 2017 form 5500 responses
2017-02-01Type of plan entitySingle employer plan
2017-02-01Submission has been amendedNo
2017-02-01This submission is the final filingNo
2017-02-01This return/report is a short plan year return/report (less than 12 months)No
2017-02-01Plan is a collectively bargained planNo
2017-02-01Plan funding arrangement – InsuranceYes
2017-02-01Plan benefit arrangement – InsuranceYes
2016: SEPTAGON CONSTRUCTION COMPANY EMPLOYEE BENEFITS PLAN 2016 form 5500 responses
2016-02-01Type of plan entitySingle employer plan
2016-02-01Submission has been amendedNo
2016-02-01This submission is the final filingNo
2016-02-01This return/report is a short plan year return/report (less than 12 months)No
2016-02-01Plan is a collectively bargained planNo
2016-02-01Plan funding arrangement – InsuranceYes
2016-02-01Plan benefit arrangement – InsuranceYes
2015: SEPTAGON CONSTRUCTION COMPANY EMPLOYEE BENEFITS PLAN 2015 form 5500 responses
2015-02-01Type of plan entitySingle employer plan
2015-02-01Submission has been amendedNo
2015-02-01This submission is the final filingNo
2015-02-01This return/report is a short plan year return/report (less than 12 months)No
2015-02-01Plan is a collectively bargained planNo
2015-02-01Plan funding arrangement – InsuranceYes
2015-02-01Plan benefit arrangement – InsuranceYes
2014: SEPTAGON CONSTRUCTION COMPANY EMPLOYEE BENEFITS PLAN 2014 form 5500 responses
2014-02-01Type of plan entitySingle employer plan
2014-02-01Plan funding arrangement – InsuranceYes
2014-02-01Plan benefit arrangement – InsuranceYes
2013: SEPTAGON CONSTRUCTION COMPANY EMPLOYEE BENEFITS PLAN 2013 form 5500 responses
2013-02-01Type of plan entitySingle employer plan
2013-02-01Plan funding arrangement – InsuranceYes
2013-02-01Plan benefit arrangement – InsuranceYes
2012: SEPTAGON CONSTRUCTION COMPANY EMPLOYEE BENEFITS PLAN 2012 form 5500 responses
2012-02-01Type of plan entitySingle employer plan
2012-02-01Plan funding arrangement – InsuranceYes
2012-02-01Plan benefit arrangement – InsuranceYes
2011: SEPTAGON CONSTRUCTION COMPANY EMPLOYEE BENEFITS PLAN 2011 form 5500 responses
2011-02-01Type of plan entitySingle employer plan
2011-02-01Plan funding arrangement – InsuranceYes
2011-02-01Plan benefit arrangement – InsuranceYes
2009: SEPTAGON CONSTRUCTION COMPANY EMPLOYEE BENEFITS PLAN 2009 form 5500 responses
2009-02-01Type of plan entitySingle employer plan
2009-02-01This submission is the final filingNo
2009-02-01Plan funding arrangement – InsuranceYes
2009-02-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 )
Policy contract number30089395
Policy instance 4
Insurance contract or identification number30089395
Number of Individuals Covered112
Insurance policy start date2022-02-01
Insurance policy end date2023-01-31
Total amount of commissions paid to insurance brokerUSD $992
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $15,219
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $992
Amount paid for insurance broker fees0
Insurance broker organization code?3
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number19174
Policy instance 3
Insurance contract or identification number19174
Number of Individuals Covered116
Insurance policy start date2022-02-01
Insurance policy end date2023-01-31
Total amount of commissions paid to insurance brokerUSD $4,625
Total amount of fees paid to insurance companyUSD $780
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $44,384
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,625
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMMISSIONS
DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 )
Policy contract number18932000
Policy instance 2
Insurance contract or identification number18932000
Number of Individuals Covered228
Insurance policy start date2022-02-01
Insurance policy end date2023-01-31
Total amount of commissions paid to insurance brokerUSD $3,431
Total amount of fees paid to insurance companyUSD $398
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $76,227
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $3,431
Amount paid for insurance broker fees398
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
BLUE CROSS AND BLUE SHIELD OF KANSAS CITY (National Association of Insurance Commissioners NAIC id number: 47171 )
Policy contract number15449000
Policy instance 1
Insurance contract or identification number15449000
Number of Individuals Covered221
Insurance policy start date2022-02-01
Insurance policy end date2023-01-31
Total amount of commissions paid to insurance brokerUSD $19,632
Total amount of fees paid to insurance companyUSD $8,349
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $19,632
Amount paid for insurance broker fees8349
Additional information about fees paid to insurance brokerPROVISION OF ADMINISTRATIVE SERVICES TO BCBSKC
Insurance broker organization code?3
BLUE CROSS AND BLUE SHIELD OF KANSAS CITY (National Association of Insurance Commissioners NAIC id number: 47171 )
Policy contract number15449000
Policy instance 1
Insurance contract or identification number15449000
Number of Individuals Covered222
Insurance policy start date2021-02-01
Insurance policy end date2022-01-31
Total amount of commissions paid to insurance brokerUSD $19,632
Total amount of fees paid to insurance companyUSD $8,579
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $19,632
Amount paid for insurance broker fees8579
Additional information about fees paid to insurance brokerPROVISION OF ADMINISTRATIVE SERVICES TO BCBSKC
Insurance broker organization code?3
DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 )
Policy contract number18932000
Policy instance 2
Insurance contract or identification number18932000
Number of Individuals Covered225
Insurance policy start date2021-02-01
Insurance policy end date2022-01-31
Total amount of commissions paid to insurance brokerUSD $2,439
Total amount of fees paid to insurance companyUSD $211
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $79,621
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $2,439
Amount paid for insurance broker fees211
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number19174
Policy instance 3
Insurance contract or identification number19174
Number of Individuals Covered113
Insurance policy start date2021-02-01
Insurance policy end date2022-01-31
Total amount of commissions paid to insurance brokerUSD $4,314
Total amount of fees paid to insurance companyUSD $24
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $38,886
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,314
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerTHIRD PARTY ADMINISTRATION FEES
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 )
Policy contract number30089395
Policy instance 4
Insurance contract or identification number30089395
Number of Individuals Covered119
Insurance policy start date2021-02-01
Insurance policy end date2022-01-31
Total amount of commissions paid to insurance brokerUSD $963
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $16,843
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $963
Amount paid for insurance broker fees0
Insurance broker organization code?3
BLUE CROSS AND BLUE SHIELD OF KANSAS CITY (National Association of Insurance Commissioners NAIC id number: 47171 )
Policy contract number15449000
Policy instance 1
Insurance contract or identification number15449000
Number of Individuals Covered261
Insurance policy start date2020-02-01
Insurance policy end date2021-01-31
Total amount of commissions paid to insurance brokerUSD $17,996
Total amount of fees paid to insurance companyUSD $8,257
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $17,996
Amount paid for insurance broker fees8257
Additional information about fees paid to insurance brokerADMINISTRATIVE SERVICES
Insurance broker organization code?3
DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 )
Policy contract number18932000
Policy instance 2
Insurance contract or identification number18932000
Number of Individuals Covered266
Insurance policy start date2020-02-01
Insurance policy end date2021-01-31
Total amount of commissions paid to insurance brokerUSD $2,499
Total amount of fees paid to insurance companyUSD $203
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $80,726
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $2,499
Amount paid for insurance broker fees203
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number19174
Policy instance 3
Insurance contract or identification number19174
Number of Individuals Covered128
Insurance policy start date2020-02-01
Insurance policy end date2021-01-31
Total amount of commissions paid to insurance brokerUSD $4,721
Total amount of fees paid to insurance companyUSD $25
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $43,207
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,721
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerTHIRD PARTY ADMINISTRATION FEES
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 )
Policy contract number30089395
Policy instance 4
Insurance contract or identification number30089395
Number of Individuals Covered134
Insurance policy start date2020-02-01
Insurance policy end date2021-01-31
Total amount of commissions paid to insurance brokerUSD $794
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $18,741
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $794
Amount paid for insurance broker fees0
Insurance broker organization code?3
BLUE CROSS AND BLUE SHIELD OF KANSAS CITY (National Association of Insurance Commissioners NAIC id number: 47171 )
Policy contract number15449000
Policy instance 1
Insurance contract or identification number15449000
Number of Individuals Covered248
Insurance policy start date2019-02-01
Insurance policy end date2020-01-31
Total amount of commissions paid to insurance brokerUSD $19,632
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,632
Amount paid for insurance broker fees0
Insurance broker organization code?3
DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 )
Policy contract number18932000
Policy instance 2
Insurance contract or identification number18932000
Number of Individuals Covered242
Insurance policy start date2019-02-01
Insurance policy end date2020-01-31
Total amount of commissions paid to insurance brokerUSD $2,394
Total amount of fees paid to insurance companyUSD $89
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $81,216
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,394
Amount paid for insurance broker fees89
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number19174
Policy instance 3
Insurance contract or identification number19174
Number of Individuals Covered130
Insurance policy start date2019-02-01
Insurance policy end date2020-01-31
Total amount of commissions paid to insurance brokerUSD $4,539
Total amount of fees paid to insurance companyUSD $48
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $41,145
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,539
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerTHIRD PARTY ADMINISTRATION FEES
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 )
Policy contract number30089395
Policy instance 4
Insurance contract or identification number30089395
Number of Individuals Covered135
Insurance policy start date2019-02-01
Insurance policy end date2020-01-31
Total amount of commissions paid to insurance brokerUSD $1,051
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $18,298
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,051
Amount paid for insurance broker fees0
Insurance broker organization code?3
BLUE CROSS AND BLUE SHIELD OF KANSAS CITY (National Association of Insurance Commissioners NAIC id number: 47171 )
Policy contract number15449000
Policy instance 1
Insurance contract or identification number15449000
Number of Individuals Covered259
Insurance policy start date2018-02-01
Insurance policy end date2019-01-31
Total amount of commissions paid to insurance brokerUSD $19,632
Total amount of fees paid to insurance companyUSD $11,280
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,632
Amount paid for insurance broker fees11280
Additional information about fees paid to insurance brokerADMINISTRATIVE SERVICES TO BCBSKC
Insurance broker organization code?3
DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 )
Policy contract number18932000
Policy instance 2
Insurance contract or identification number18932000
Number of Individuals Covered250
Insurance policy start date2018-02-01
Insurance policy end date2019-01-31
Total amount of commissions paid to insurance brokerUSD $1,960
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 BenefitYes
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 $71,347
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,960
Insurance broker organization code?3
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number19174
Policy instance 3
Insurance contract or identification number19174
Number of Individuals Covered157
Insurance policy start date2018-02-01
Insurance policy end date2019-01-31
Total amount of commissions paid to insurance brokerUSD $4,404
Total amount of fees paid to insurance companyUSD $46
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 BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D
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 $38,188
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,404
Insurance broker organization code?3
Amount paid for insurance broker fees46
Additional information about fees paid to insurance brokerTHIRD PARTY ADMINISTRATION FEES
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number19174
Policy instance 3
Insurance contract or identification number19174
Number of Individuals Covered122
Insurance policy start date2017-02-01
Insurance policy end date2018-01-31
Total amount of commissions paid to insurance brokerUSD $4,279
Total amount of fees paid to insurance companyUSD $41
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 BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D
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 $35,700
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,279
Insurance broker organization code?3
Amount paid for insurance broker fees41
Additional information about fees paid to insurance brokerTHIRD PARTY ADMINISTRATION FEES
Insurance broker nameAXA ASSISTANCE, USA
DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 )
Policy contract number18932000
Policy instance 2
Insurance contract or identification number18932000
Number of Individuals Covered253
Insurance policy start date2017-02-01
Insurance policy end date2018-01-31
Total amount of commissions paid to insurance brokerUSD $2,021
Total amount of fees paid to insurance companyUSD $704
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 BenefitYes
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 $68,242
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,021
Amount paid for insurance broker fees704
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
Insurance broker nameTRUSS, LLC
BLUE CROSS AND BLUE SHIELD OF KANSAS CITY (National Association of Insurance Commissioners NAIC id number: 47171 )
Policy contract number15449000
Policy instance 1
Insurance contract or identification number15449000
Number of Individuals Covered250
Insurance policy start date2017-02-01
Insurance policy end date2018-01-31
Total amount of commissions paid to insurance brokerUSD $19,632
Total amount of fees paid to insurance companyUSD $10,121
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,632
Amount paid for insurance broker fees10121
Additional information about fees paid to insurance brokerADMINISTRATIVE SERVICES TO BCBSKC
Insurance broker organization code?3
Insurance broker nameTRUSS, LLC
DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 )
Policy contract number18931000
Policy instance 2
Insurance contract or identification number18931000
Number of Individuals Covered24
Insurance policy start date2015-02-01
Insurance policy end date2016-01-31
Total amount of commissions paid to insurance brokerUSD $1,935
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
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 $64,931
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,935
Insurance broker organization code?3
Insurance broker nameTRUSS, LLC
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number19174
Policy instance 3
Insurance contract or identification number19174
Number of Individuals Covered122
Insurance policy start date2015-02-01
Insurance policy end date2016-01-31
Total amount of commissions paid to insurance brokerUSD $4,000
Total amount of fees paid to insurance companyUSD $43
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D
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 $32,117
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,000
Insurance broker organization code?3
Amount paid for insurance broker fees43
Additional information about fees paid to insurance brokerTHIRD PARTY ADMINISTRATION FEES
Insurance broker nameAXA ASSISTANCE, USA
BLUE CROSS AND BLUE SHIELD OF KANSAS CITY (National Association of Insurance Commissioners NAIC id number: 47171 )
Policy contract number15449000
Policy instance 1
Insurance contract or identification number15449000
Number of Individuals Covered243
Insurance policy start date2015-02-01
Insurance policy end date2016-01-31
Total amount of commissions paid to insurance brokerUSD $19,632
Total amount of fees paid to insurance companyUSD $16,256
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,632
Amount paid for insurance broker fees16256
Additional information about fees paid to insurance brokerADMINISTRATIVE SERVICES
Insurance broker organization code?3
Insurance broker nameTRUSS, LLC
BLUE CROSS AND BLUE SHIELD OF KANSAS CITY (National Association of Insurance Commissioners NAIC id number: 47171 )
Policy contract number15449000
Policy instance 1
Insurance contract or identification number15449000
Number of Individuals Covered231
Insurance policy start date2014-02-01
Insurance policy end date2015-01-31
Total amount of commissions paid to insurance brokerUSD $19,632
Total amount of fees paid to insurance companyUSD $16,763
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Other welfare benefits providedCOST-PLUS
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,632
Amount paid for insurance broker fees16763
Additional information about fees paid to insurance brokerADMINISTRATIVE SERVICES
Insurance broker organization code?3
Insurance broker nameCRETCHER HEARTLAND LLC
DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 )
Policy contract number1893-1000
Policy instance 2
Insurance contract or identification number1893-1000
Number of Individuals Covered237
Insurance policy start date2014-02-01
Insurance policy end date2015-01-31
Total amount of commissions paid to insurance brokerUSD $2,592
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $64,559
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,592
Insurance broker organization code?3
Insurance broker nameCRETCHER HEARTLAND LLC
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number19174
Policy instance 3
Insurance contract or identification number19174
Number of Individuals Covered116
Insurance policy start date2014-02-01
Insurance policy end date2015-01-31
Total amount of commissions paid to insurance brokerUSD $4,760
Total amount of fees paid to insurance companyUSD $45
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D, VOLUNTARY LIFE AND AD&D
Welfare Benefit Premiums Paid to CarrierUSD $66,954
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,760
Insurance broker organization code?3
Amount paid for insurance broker fees45
Additional information about fees paid to insurance brokerTPA
Insurance broker nameAXA ASSISTANCE, USA
BLUE CROSS AND BLUE SHIELD OF KANSAS CITY (National Association of Insurance Commissioners NAIC id number: 47171 )
Policy contract number15449000
Policy instance 1
Insurance contract or identification number15449000
Number of Individuals Covered257
Insurance policy start date2013-02-01
Insurance policy end date2014-01-31
Total amount of commissions paid to insurance brokerUSD $19,632
Total amount of fees paid to insurance companyUSD $16,493
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Other welfare benefits providedCOST-PLUS
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,632
Amount paid for insurance broker fees16493
Additional information about fees paid to insurance brokerADMINISTRATIVE SERVICES
Insurance broker organization code?3
Insurance broker nameCRETCHER HEARTLAND LLC
DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 )
Policy contract number1893-1000
Policy instance 2
Insurance contract or identification number1893-1000
Number of Individuals Covered264
Insurance policy start date2013-02-01
Insurance policy end date2014-01-31
Total amount of commissions paid to insurance brokerUSD $1,931
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $64,664
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,931
Insurance broker organization code?3
Insurance broker nameCRETCHER HEARTLAND LLC
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number19174
Policy instance 3
Insurance contract or identification number19174
Number of Individuals Covered125
Insurance policy start date2013-02-01
Insurance policy end date2014-01-31
Total amount of commissions paid to insurance brokerUSD $4,390
Total amount of fees paid to insurance companyUSD $43
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D, VOLUNTARY LIFE AND AD&D
Welfare Benefit Premiums Paid to CarrierUSD $67,858
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,390
Insurance broker organization code?3
Amount paid for insurance broker fees43
Additional information about fees paid to insurance brokerTPA ADMIN FEES
Insurance broker nameAXA ASSISTANCE, USA
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number19174
Policy instance 3
Insurance contract or identification number19174
Number of Individuals Covered122
Insurance policy start date2012-02-01
Insurance policy end date2013-01-31
Total amount of commissions paid to insurance brokerUSD $4,873
Total amount of fees paid to insurance companyUSD $43
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D, VOLUNTARY LIFE AND AD&D
Welfare Benefit Premiums Paid to CarrierUSD $66,660
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,873
Insurance broker organization code?3
Amount paid for insurance broker fees43
Insurance broker nameAXA ASSISTANCE USA
DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 )
Policy contract number1893-1000
Policy instance 2
Insurance contract or identification number1893-1000
Number of Individuals Covered270
Insurance policy start date2012-02-01
Insurance policy end date2013-01-31
Total amount of commissions paid to insurance brokerUSD $1,927
Total amount of fees paid to insurance companyUSD $381
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Were dividends or retroactive rate refunds paid in cash?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,927
Amount paid for insurance broker fees381
Additional information about fees paid to insurance brokerDELTA REWARDS
Insurance broker organization code?3
Insurance broker nameCRETCHER HEARTLAND LLC
BLUE CROSS AND BLUE SHIELD OF KANSAS CITY (National Association of Insurance Commissioners NAIC id number: 47171 )
Policy contract number15449000
Policy instance 1
Insurance contract or identification number15449000
Number of Individuals Covered264
Insurance policy start date2012-02-01
Insurance policy end date2013-01-31
Total amount of commissions paid to insurance brokerUSD $19,632
Total amount of fees paid to insurance companyUSD $19,283
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Other welfare benefits providedCOST-PLUS
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,632
Amount paid for insurance broker fees19283
Additional information about fees paid to insurance brokerADMINISTRATIVE SERVICES TO BCBSKC
Insurance broker organization code?3
Insurance broker nameCRETCHER HEARTLAND LLC
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number113546
Policy instance 4
Insurance contract or identification number113546
Number of Individuals Covered23
Insurance policy start date2011-02-01
Insurance policy end date2012-01-31
Total amount of commissions paid to insurance brokerUSD $1,674
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedLIFESTYLE ADD
Welfare Benefit Premiums Paid to CarrierUSD $10,291
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 )
Policy contract number1893-1000
Policy instance 3
Insurance contract or identification number1893-1000
Number of Individuals Covered293
Insurance policy start date2011-02-01
Insurance policy end date2012-01-31
Total amount of commissions paid to insurance brokerUSD $2,287
Total amount of fees paid to insurance companyUSD $781
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $76,243
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number113547
Policy instance 2
Insurance contract or identification number113547
Number of Individuals Covered142
Insurance policy start date2011-02-01
Insurance policy end date2012-01-31
Total amount of commissions paid to insurance brokerUSD $788
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedADD
Welfare Benefit Premiums Paid to CarrierUSD $7,286
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS AND BLUE SHIELD OF KANSAS CITY (National Association of Insurance Commissioners NAIC id number: 47171 )
Policy contract number15449000
Policy instance 1
Insurance contract or identification number15449000
Number of Individuals Covered295
Insurance policy start date2011-02-01
Insurance policy end date2012-01-31
Total amount of commissions paid to insurance brokerUSD $19,632
Total amount of fees paid to insurance companyUSD $20,756
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Other welfare benefits providedCOST-PLUS
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number113708
Policy instance 5
Insurance contract or identification number113708
Number of Individuals Covered24
Insurance policy start date2011-02-01
Insurance policy end date2012-01-31
Total amount of commissions paid to insurance brokerUSD $1,445
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $8,856
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number113546
Policy instance 4
Insurance contract or identification number113546
Number of Individuals Covered27
Insurance policy start date2010-02-01
Insurance policy end date2011-01-31
Total amount of commissions paid to insurance brokerUSD $1,763
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedLIFESTYLE ADD
Welfare Benefit Premiums Paid to CarrierUSD $11,757
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,763
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameCRETCHER HEARTLAND, INC
DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 )
Policy contract number1893-1000
Policy instance 3
Insurance contract or identification number1893-1000
Number of Individuals Covered321
Insurance policy start date2010-02-01
Insurance policy end date2011-01-31
Total amount of commissions paid to insurance brokerUSD $2,342
Total amount of fees paid to insurance companyUSD $591
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $78,077
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,342
Amount paid for insurance broker fees591
Additional information about fees paid to insurance brokerDELTA REWARDS
Insurance broker organization code?3
Insurance broker nameCRETCHER HEARTLAND, INC
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number113547
Policy instance 2
Insurance contract or identification number113547
Number of Individuals Covered158
Insurance policy start date2010-02-01
Insurance policy end date2011-01-31
Total amount of commissions paid to insurance brokerUSD $827
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedADD
Welfare Benefit Premiums Paid to CarrierUSD $8,268
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $827
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameCRETCHER HEARTLAND, INC
BLUE CROSS AND BLUE SHIELD OF KANSAS CITY (National Association of Insurance Commissioners NAIC id number: 47171 )
Policy contract number15449000
Policy instance 1
Insurance contract or identification number15449000
Number of Individuals Covered318
Insurance policy start date2010-02-01
Insurance policy end date2011-01-31
Total amount of commissions paid to insurance brokerUSD $19,632
Total amount of fees paid to insurance companyUSD $21,203
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Other welfare benefits providedCOST-PLUS
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,632
Amount paid for insurance broker fees21203
Additional information about fees paid to insurance brokerADMINISTRATIVE SERVICES
Insurance broker organization code?3
Insurance broker nameCRETCHER HEARTLAND, INC

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