CASEY MILLER has sponsored the creation of one or more 401k plans.
| Measure | Date | Value |
|---|
| 2022: MILL HEALTH 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 111 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 110 |
| Total of all active and inactive participants | 2022-01-01 | 110 |
| Total participants | 2022-01-01 | 110 |
| 2021: MILL HEALTH 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 121 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 111 |
| Number of retired or separated participants receiving benefits | 2021-01-01 | 1 |
| Total of all active and inactive participants | 2021-01-01 | 112 |
| Total participants | 2021-01-01 | 112 |
| Number of employers contributing to the scheme | 2021-01-01 | 8 |
| 2020: MILL HEALTH 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 125 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 121 |
| Total of all active and inactive participants | 2020-01-01 | 121 |
| Total participants | 2020-01-01 | 121 |
| Number of employers contributing to the scheme | 2020-01-01 | 8 |
| 2019: MILL HEALTH 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 120 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 125 |
| Total of all active and inactive participants | 2019-01-01 | 125 |
| Total participants | 2019-01-01 | 125 |
| Number of employers contributing to the scheme | 2019-01-01 | 8 |
| 2018: MILL HEALTH 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 117 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 120 |
| Total of all active and inactive participants | 2018-01-01 | 120 |
| Total participants | 2018-01-01 | 120 |
| Number of participants with account balances | 2018-01-01 | 120 |
| Number of employers contributing to the scheme | 2018-01-01 | 9 |
| 2017: MILL HEALTH 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 126 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 117 |
| Total of all active and inactive participants | 2017-01-01 | 117 |
| Total participants | 2017-01-01 | 117 |
| Number of participants with account balances | 2017-01-01 | 117 |
| Number of employers contributing to the scheme | 2017-01-01 | 9 |
| 2016: MILL HEALTH 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 83 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 126 |
| Total of all active and inactive participants | 2016-01-01 | 126 |
| Total participants | 2016-01-01 | 126 |
| Number of employers contributing to the scheme | 2016-01-01 | 9 |
| 2015: MILL HEALTH 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 78 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 83 |
| Total of all active and inactive participants | 2015-01-01 | 83 |
| Total participants | 2015-01-01 | 83 |
| Number of employers contributing to the scheme | 2015-01-01 | 9 |
| 2014: MILL HEALTH 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 71 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 78 |
| Total of all active and inactive participants | 2014-01-01 | 78 |
| Total participants | 2014-01-01 | 78 |
| Number of employers contributing to the scheme | 2014-01-01 | 9 |
| 2013: MILL HEALTH 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 71 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 71 |
| Total of all active and inactive participants | 2013-01-01 | 71 |
| Total participants | 2013-01-01 | 71 |
| Number of employers contributing to the scheme | 2013-01-01 | 9 |
| Measure | Date | Value |
|---|
| 2021 : MILL HEALTH 2021 401k financial data |
|---|
| Total income from all sources | 2021-12-31 | $945,178 |
| Expenses. Total of all expenses incurred | 2021-12-31 | $1,003,092 |
| Benefits paid (including direct rollovers) | 2021-12-31 | $998,472 |
| Total plan assets at end of year | 2021-12-31 | $314,900 |
| Total plan assets at beginning of year | 2021-12-31 | $372,814 |
| Expenses. Other expenses not covered elsewhere | 2021-12-31 | $4,620 |
| Other income received | 2021-12-31 | $63,858 |
| Net income (gross income less expenses) | 2021-12-31 | $-57,914 |
| Net plan assets at end of year (total assets less liabilities) | 2021-12-31 | $314,900 |
| Net plan assets at beginning of year (total assets less liabilities) | 2021-12-31 | $372,814 |
| Total contributions received or receivable from employer(s) | 2021-12-31 | $881,320 |
| 2020 : MILL HEALTH 2020 401k financial data |
|---|
| Total income from all sources | 2020-12-31 | $890,181 |
| Expenses. Total of all expenses incurred | 2020-12-31 | $816,166 |
| Benefits paid (including direct rollovers) | 2020-12-31 | $811,306 |
| Total plan assets at end of year | 2020-12-31 | $372,814 |
| Total plan assets at beginning of year | 2020-12-31 | $298,799 |
| Expenses. Other expenses not covered elsewhere | 2020-12-31 | $4,860 |
| Other income received | 2020-12-31 | $413 |
| Net income (gross income less expenses) | 2020-12-31 | $74,015 |
| Net plan assets at end of year (total assets less liabilities) | 2020-12-31 | $372,814 |
| Net plan assets at beginning of year (total assets less liabilities) | 2020-12-31 | $298,799 |
| Total contributions received or receivable from employer(s) | 2020-12-31 | $889,768 |
| 2019 : MILL HEALTH 2019 401k financial data |
|---|
| Total income from all sources | 2019-12-31 | $859,426 |
| Expenses. Total of all expenses incurred | 2019-12-31 | $830,910 |
| Benefits paid (including direct rollovers) | 2019-12-31 | $826,567 |
| Total plan assets at end of year | 2019-12-31 | $298,799 |
| Total plan assets at beginning of year | 2019-12-31 | $270,283 |
| Expenses. Other expenses not covered elsewhere | 2019-12-31 | $4,343 |
| Other income received | 2019-12-31 | $826 |
| Net income (gross income less expenses) | 2019-12-31 | $28,516 |
| Net plan assets at end of year (total assets less liabilities) | 2019-12-31 | $298,799 |
| Net plan assets at beginning of year (total assets less liabilities) | 2019-12-31 | $270,283 |
| Total contributions received or receivable from employer(s) | 2019-12-31 | $858,600 |
| 2018 : MILL HEALTH 2018 401k financial data |
|---|
| Total income from all sources | 2018-12-31 | $826,514 |
| Expenses. Total of all expenses incurred | 2018-12-31 | $784,233 |
| Benefits paid (including direct rollovers) | 2018-12-31 | $777,716 |
| Total plan assets at end of year | 2018-12-31 | $270,283 |
| Total plan assets at beginning of year | 2018-12-31 | $228,002 |
| Expenses. Other expenses not covered elsewhere | 2018-12-31 | $6,517 |
| Other income received | 2018-12-31 | $539 |
| Net income (gross income less expenses) | 2018-12-31 | $42,281 |
| Net plan assets at end of year (total assets less liabilities) | 2018-12-31 | $270,283 |
| Net plan assets at beginning of year (total assets less liabilities) | 2018-12-31 | $228,002 |
| Total contributions received or receivable from employer(s) | 2018-12-31 | $825,975 |
| 2017 : MILL HEALTH 2017 401k financial data |
|---|
| Total plan liabilities at end of year | 2017-12-31 | $0 |
| Total plan liabilities at beginning of year | 2017-12-31 | $0 |
| Total income from all sources | 2017-12-31 | $883,046 |
| Expenses. Total of all expenses incurred | 2017-12-31 | $655,978 |
| Benefits paid (including direct rollovers) | 2017-12-31 | $653,147 |
| Total plan assets at end of year | 2017-12-31 | $228,002 |
| Total plan assets at beginning of year | 2017-12-31 | $934 |
| Expenses. Other expenses not covered elsewhere | 2017-12-31 | $2,831 |
| Other income received | 2017-12-31 | $351 |
| Net income (gross income less expenses) | 2017-12-31 | $227,068 |
| Net plan assets at end of year (total assets less liabilities) | 2017-12-31 | $228,002 |
| Net plan assets at beginning of year (total assets less liabilities) | 2017-12-31 | $934 |
| Total contributions received or receivable from employer(s) | 2017-12-31 | $882,695 |
| 2016 : MILL HEALTH 2016 401k financial data |
|---|
| Total income from all sources | 2016-12-31 | $703,998 |
| Expenses. Total of all expenses incurred | 2016-12-31 | $842,948 |
| Benefits paid (including direct rollovers) | 2016-12-31 | $835,464 |
| Total plan assets at end of year | 2016-12-31 | $934 |
| Total plan assets at beginning of year | 2016-12-31 | $139,884 |
| Expenses. Other expenses not covered elsewhere | 2016-12-31 | $3,884 |
| Other income received | 2016-12-31 | $53 |
| Net income (gross income less expenses) | 2016-12-31 | $-138,950 |
| Net plan assets at end of year (total assets less liabilities) | 2016-12-31 | $934 |
| Net plan assets at beginning of year (total assets less liabilities) | 2016-12-31 | $139,884 |
| Total contributions received or receivable from employer(s) | 2016-12-31 | $703,945 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2016-12-31 | $3,600 |
| 2015 : MILL HEALTH 2015 401k financial data |
|---|
| Total income from all sources | 2015-12-31 | $621,028 |
| Expenses. Total of all expenses incurred | 2015-12-31 | $712,473 |
| Benefits paid (including direct rollovers) | 2015-12-31 | $702,242 |
| Total plan assets at end of year | 2015-12-31 | $139,884 |
| Total plan assets at beginning of year | 2015-12-31 | $231,329 |
| Expenses. Other expenses not covered elsewhere | 2015-12-31 | $6,151 |
| Other income received | 2015-12-31 | $508 |
| Net income (gross income less expenses) | 2015-12-31 | $-91,445 |
| Net plan assets at end of year (total assets less liabilities) | 2015-12-31 | $139,884 |
| Net plan assets at beginning of year (total assets less liabilities) | 2015-12-31 | $231,329 |
| Total contributions received or receivable from employer(s) | 2015-12-31 | $620,520 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2015-12-31 | $4,080 |
| 2014 : MILL HEALTH 2014 401k financial data |
|---|
| Total income from all sources | 2014-12-31 | $618,531 |
| Expenses. Total of all expenses incurred | 2014-12-31 | $680,195 |
| Benefits paid (including direct rollovers) | 2014-12-31 | $670,845 |
| Total plan assets at end of year | 2014-12-31 | $231,329 |
| Total plan assets at beginning of year | 2014-12-31 | $292,993 |
| Expenses. Other expenses not covered elsewhere | 2014-12-31 | $9,021 |
| Other income received | 2014-12-31 | $536 |
| Net income (gross income less expenses) | 2014-12-31 | $-61,664 |
| Net plan assets at end of year (total assets less liabilities) | 2014-12-31 | $231,329 |
| Net plan assets at beginning of year (total assets less liabilities) | 2014-12-31 | $292,993 |
| Total contributions received or receivable from employer(s) | 2014-12-31 | $617,995 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2014-12-31 | $329 |
| 2013 : MILL HEALTH 2013 401k financial data |
|---|
| Total income from all sources | 2013-12-31 | $580,933 |
| Expenses. Total of all expenses incurred | 2013-12-31 | $397,853 |
| Benefits paid (including direct rollovers) | 2013-12-31 | $396,254 |
| Total plan assets at end of year | 2013-12-31 | $292,993 |
| Total plan assets at beginning of year | 2013-12-31 | $109,913 |
| Other income received | 2013-12-31 | $6,458 |
| Net income (gross income less expenses) | 2013-12-31 | $183,080 |
| Net plan assets at end of year (total assets less liabilities) | 2013-12-31 | $292,993 |
| Net plan assets at beginning of year (total assets less liabilities) | 2013-12-31 | $109,913 |
| Total contributions received or receivable from employer(s) | 2013-12-31 | $574,475 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2013-12-31 | $1,599 |
| 2022: MILL HEALTH 2022 form 5500 responses |
|---|
| 2022-01-01 | Type of plan entity | Mulitple employer plan |
| 2022-01-01 | Submission has been amended | No |
| 2022-01-01 | This submission is the final filing | No |
| 2022-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2022-01-01 | Plan is a collectively bargained plan | No |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021: MILL HEALTH 2021 form 5500 responses |
|---|
| 2021-01-01 | Type of plan entity | Mulitple employer plan |
| 2021-01-01 | Submission has been amended | No |
| 2021-01-01 | This submission is the final filing | No |
| 2021-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2021-01-01 | Plan is a collectively bargained plan | No |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: MILL HEALTH 2020 form 5500 responses |
|---|
| 2020-01-01 | Type of plan entity | Mulitple employer plan |
| 2020-01-01 | Submission has been amended | No |
| 2020-01-01 | This submission is the final filing | No |
| 2020-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2020-01-01 | Plan is a collectively bargained plan | No |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: MILL HEALTH 2019 form 5500 responses |
|---|
| 2019-01-01 | Type of plan entity | Mulitple employer plan |
| 2019-01-01 | Submission has been amended | No |
| 2019-01-01 | This submission is the final filing | No |
| 2019-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2019-01-01 | Plan is a collectively bargained plan | No |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: MILL HEALTH 2018 form 5500 responses |
|---|
| 2018-01-01 | Type of plan entity | Mulitple employer plan |
| 2018-01-01 | Submission has been amended | No |
| 2018-01-01 | This submission is the final filing | No |
| 2018-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2018-01-01 | Plan is a collectively bargained plan | No |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: MILL HEALTH 2017 form 5500 responses |
|---|
| 2017-01-01 | Type of plan entity | Mulitple employer plan |
| 2017-01-01 | Submission has been amended | No |
| 2017-01-01 | This submission is the final filing | No |
| 2017-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-01-01 | Plan is a collectively bargained plan | No |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: MILL HEALTH 2016 form 5500 responses |
|---|
| 2016-01-01 | Type of plan entity | Mulitple employer plan |
| 2016-01-01 | Submission has been amended | No |
| 2016-01-01 | This submission is the final filing | No |
| 2016-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-01-01 | Plan is a collectively bargained plan | No |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: MILL HEALTH 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Mulitple employer plan |
| 2015-01-01 | Submission has been amended | No |
| 2015-01-01 | This submission is the final filing | No |
| 2015-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-01-01 | Plan is a collectively bargained plan | No |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: MILL HEALTH 2014 form 5500 responses |
|---|
| 2014-01-01 | Type of plan entity | Mulitple employer plan |
| 2014-01-01 | Submission has been amended | No |
| 2014-01-01 | This submission is the final filing | No |
| 2014-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-01-01 | Plan is a collectively bargained plan | No |
| 2014-01-01 | Plan funding arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: MILL HEALTH 2013 form 5500 responses |
|---|
| 2013-01-01 | Type of plan entity | Mulitple employer plan |
| 2013-01-01 | First time form 5500 has been submitted | Yes |
| 2013-01-01 | Submission has been amended | No |
| 2013-01-01 | This submission is the final filing | No |
| 2013-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-01-01 | Plan is a collectively bargained plan | No |
| 2013-01-01 | Plan funding arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 ) |
| Policy contract number | 250925 |
| Policy instance | 1 |
| Insurance contract or identification number | 250925 | | Number of Individuals Covered | 110 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of fees paid to insurance company | USD $51,279 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 |
|
| BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 ) |
| Policy contract number | 250925 |
| Policy instance | 1 |
| Insurance contract or identification number | 250925 | | Number of Individuals Covered | 112 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 |
|
| BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 ) |
| Policy contract number | 250925 |
| Policy instance | 1 |
| Insurance contract or identification number | 250925 | | Number of Individuals Covered | 121 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No |
|
| BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 ) |
| Policy contract number | 250925 |
| Policy instance | 1 |
| Insurance contract or identification number | 250925 | | Number of Individuals Covered | 125 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No |
|
| BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 ) |
| Policy contract number | 19100 |
| Policy instance | 1 |
| Insurance contract or identification number | 19100 | | Number of Individuals Covered | 120 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No |
|
| BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 ) |
| Policy contract number | 19100 |
| Policy instance | 1 |
| Insurance contract or identification number | 19100 | | Number of Individuals Covered | 117 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $198,874 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 ) |
| Policy contract number | 19100 |
| Policy instance | 1 |
| Insurance contract or identification number | 19100 | | Number of Individuals Covered | 126 | | Insurance policy start date | 2016-01-01 | | Insurance policy end date | 2016-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $232,599 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 ) |
| Policy contract number | 19100 |
| Policy instance | 1 |
| Insurance contract or identification number | 19100 | | Number of Individuals Covered | 145 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $210,511 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 ) |
| Policy contract number | 19100 |
| Policy instance | 1 |
| Insurance contract or identification number | 19100 | | Number of Individuals Covered | 142 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $187,185 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 ) |
| Policy contract number | 19110 |
| Policy instance | 1 |
| Insurance contract or identification number | 19110 | | Number of Individuals Covered | 128 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $164,905 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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